title: Bucking social norms: examining anomalous fertility aspirations in the face of HIV in Lusaka, Zambia.
abstract: In settings of high fertility and high HIV prevalence, individuals are making fertility decisions while simultaneously trying to avoid or manage HIV. We sought to increase our understanding of how individuals dually manage HIV risk while attempting to achieve their fertility goals as part of the project entitled HIV Status and Achieving Fertility Desires conducted in Zambia in 2011. Using multivariate regression to predict fertility patterns based on socio-demographic characteristics for respondents from facility-based and community-based surveys, we employed Anomalous Case Analysis (ACA) whereby in-depth interview respondents were selected from the groups of outliers amongst the survey respondents who reported lower or higher fertility preferences than predicted as well as those who adhered to predicted patterns, and lived in Lusaka (n=45). All of the facility-based respondents were HIV-positive. We utilize the Theory of Conjunctural Action (TCA) to categorize domains of influence on individuals' preferences and behavior. Both community-based and facility-based right-tail respondents (outliers whose fertility intentions indicated that they wanted a/nother child when we predicted that they did not) expressed comparatively less control over their fertility and gave more weight to pressures from others to continue childbearing. Partner communication about fertility desires was greater among left-tail respondents (outliers whose fertility intentions indicated that they did not want a/nother child when we predicted that they did). HIV-positive right-tail respondents were more likely to see anti-retroviral therapies (ARTs) which prevent mother to child transmission of HIV as highly effective, mitigating inhibitions to further childbearing. Drug interactions between ARTs and contraceptives were identified as a limitation to HIV-positive individuals' contraceptive options on both sides of the distribution. Factors that should be taken into account in the future to understand fertility behavior in high HIV-prevalent settings include couples' communication around fertility and perception of the efficacy of ARTs.
authors.affiliation: Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: amoore@guttmacher.org.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Moore
authors.affiliation: Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: skeogh@guttmacher.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Keogh
authors.affiliation: Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: mkavanaugh@guttmacher.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Kavanaugh
authors.affiliation: Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: abankole@guttmacher.org.
authors.forename: Akinrinola
authors.initials: A
authors.lastname: Bankole
authors.affiliation: Institute of Economic & Social Research, University of Zambia, Lusaka, Zambia. Electronic address: pimpsy10101@yahoo.com.
authors.forename: Chishimba
authors.initials: C
authors.lastname: Mulambia
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. Electronic address: namuunda.mutombo@gmail.com.
authors.forename: Namuunda
authors.initials: N
authors.lastname: Mutombo
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003267:Contraception; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission; D006679:HIV Seropositivity; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D043762:Reproductive Behavior / Q000523:psychology*; D066262:Social Norms; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia
chemical_list: D044966:Anti-Retroviral Agents
keywords: Anomalous Case Analysis (ACA); Fertility preferences; HIV/AIDS; In-depth interviews; Lusaka, Zambia; Mixed methods