title: Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya.
abstract: BACKGROUND
  Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15-19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya.
  
  
  METHODS
  Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models.
  
  
  RESULTS
  Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8-2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1-0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6-4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1-0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5-3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5-1.5).
  
  
  CONCLUSIONS
  The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes.
authors.affiliation: Population Council, Ralph Bunche Road, General Accident House, Nairobi, 00500, Kenya. fonyango@popcouncil.org
authors.forename: Francis
authors.initials: F
authors.lastname: Obare
authors.forename: Anke
authors.initials: A
authors.lastname: van der Kwaak
authors.forename: Harriet
authors.initials: H
authors.lastname: Birungi
mesh_terms: D000028:Abortion, Induced; D000022:Abortion, Spontaneous / Q000209:etiology; D000293:Adolescent; D003267:Contraception / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections; D006306:Health Surveys; D006801:Humans; D007630:Kenya; D016015:Logistic Models; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D012307:Risk Factors; D050497:Stillbirth; D055815:Young Adult