title: Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe.
abstract: BACKGROUND
  Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe.
  
  
  METHODS
  We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use.
  
  
  RESULTS
  Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy.
  
  
  CONCLUSIONS
  Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.
authors.affiliation: University of California, Berkeley, California, United States of America.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.affiliation: University of California, Berkeley, California, United States of America.
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.affiliation: University of California, Berkeley, California, United States of America.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Ralph
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.affiliation: Children's Investment Fund Foundation, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Hakobyan
authors.affiliation: Centre for Sexual Health and HIV Research, Harare, Zimbabwe.
authors.forename: Constancia
authors.initials: C
authors.lastname: Watadzaushe
authors.affiliation: Centre for Sexual Health and HIV Research, Harare, Zimbabwe.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dirawo
authors.affiliation: Centre for Sexual Health and HIV Research, Harare, Zimbabwe; University College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: University of California, Berkeley, California, United States of America.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
mesh_terms: D000328:Adult; D003267:Contraception; D003273:Contraceptive Devices; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D015030:Zimbabwe