title: Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women.
abstract: The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% vs. 37%, p = 0.004). Nearly all women (97%) did not want a child in the next 2 years, but HIV-infected women were more likely to desire no more children (adjusted prevalence ratio [PR]: 1.59; 95% confidence interval [CI]: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR: 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR: 0.83; 95% CI: 0.75, 0.92) are safe during breast-feeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breast-feeding may facilitate postpartum use.
authors.affiliation: a The University of North Carolina Project-Malawi , Lilongwe , Malawi.
authors.forename: Michele S
authors.initials: MS
authors.lastname: O'Shea
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Gretchen S
authors.initials: GS
authors.lastname: Stuart
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kaliti
authors.forename: Mwawi
authors.initials: M
authors.lastname: Mwale
authors.forename: Phylos P
authors.initials: PP
authors.lastname: Bonongwe
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Tang
mesh_terms: D000328:Adult; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations / Q000627:therapeutic use*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D033182:Intention; D010353:Patient Education as Topic; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011795:Surveys and Questionnaires
chemical_list: D003692:Delayed-Action Preparations
keywords: HIV; Malawi; contraception; family planning; postpartum