title: Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study.
abstract: BACKGROUND
  Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability.
  
  
  METHODS
  We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires.
  
  
  RESULTS
  The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44%) of pregnancies were unintended. Among women reporting unintended pregnancy, 36% were not using a contraceptive method prior to conception. Among contraception users, 81% used condoms, 13% oral contraceptives and 5% an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48% reported knowing they were HIV-uninfected, and 22% reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one's HIV positive status prior to conception (compared with knowing one's negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8).
  
  
  CONCLUSIONS
  The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gmayondi@bhp.org.bw.
authors.forename: Gloria K
authors.initials: GK
authors.lastname: Mayondi
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. kwirth@hsph.harvard.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wirth
authors.affiliation: EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. chelseaamorroni@gmail.com.|University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. chelseaamorroni@gmail.com.|Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana. chelseaamorroni@gmail.com.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Morroni
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. smoyo@bhp.org.bw.
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gajibola@bhp.org.bw.
authors.forename: Gbolahan
authors.initials: G
authors.lastname: Ajibola
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. mdiseko@bhp.org.bw.
authors.forename: Modiegi
authors.initials: M
authors.lastname: Diseko
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. msakoi@bhp.org.bw.
authors.forename: Maureen
authors.initials: M
authors.lastname: Sakoi
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmagetse@bhp.org.bw.
authors.forename: Jane Dipuo
authors.initials: JD
authors.lastname: Magetse
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. kmoabi@bhp.org.bw.
authors.forename: Kebaiphe
authors.initials: K
authors.lastname: Moabi
authors.affiliation: Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA. jeanleid@gmail.com.
authors.forename: Jean
authors.initials: J
authors.lastname: Leidner
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmakhema@bhp.org.bw.|Harvard School of Public Health, Boston, MA, USA. jmakhema@bhp.org.bw.
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.affiliation: Boston Children's Hospital, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.|Harvard Medical School, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.
authors.forename: Betsy
authors.initials: B
authors.lastname: Kammerer
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. slockman@hsph.harvard.edu.|Harvard School of Public Health, Boston, MA, USA. slockman@hsph.harvard.edu.|Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA. slockman@hsph.harvard.edu.
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
mesh_terms: D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003276:Contraceptives, Oral / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D033182:Intention; D009042:Motivation; D049590:Postpartum Period; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012725:Sexual Behavior; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral