title: Exploring fertility decisions among pregnant HIV-positive women on antiretroviral therapy at a health centre in Balaka, Malawi: A descriptive qualitative.
abstract: BACKGROUND
  The proportions of women of reproductive age living with the human immunodeficiency virus (HIV) vary between different regions of the world, with significantly higher proportions in sub-Saharan Africa. Family planning is one of the major issues that couples and families affected with HIV must confront. We aimed to assess the cultural and social factors associated with childbearing and family planning knowledge, decision-making, and practices among HIV-positive pregnant women attending antenatal clinic at a health centre in Balaka, Malawi.
  
  
  METHODS
  This was a qualitative descriptive study carried out at Kalembo Health Centre in Balaka. A purposive sampling technique was used to select pregnant women enroled in the antiretroviral therapy (ART) programme. A sample size of thirty-five women was decided upon after data saturation. Qualitative inquiry was used during data collection. Data were analysed using systematic text condensation, while numbers and percentages were generated using Microsoft Excel.
  
  
  RESULTS
  Out of 35 participants, 20 were aged between 25 and 34 years, and 18 had been married at least three times. All 35 women wished to have their own biological child. Factors, reported by participants, that promote childbearing included: the desire to please their husbands, fear of losing their husbands to others if they did not bear children, the knowledge that ART would help prevent their children from acquiring the virus, the desire to prove to others that they can also bear children, and a lack of family planning leading to unplanned pregnancies.
  
  
  CONCLUSIONS
  The factors that lead to pregnancies among women on ART in Balaka ranged from assured safety of the child from HIV, lack of contraception, to other factors related to their partners. The authors recognize and support the freedom for women to become pregnant and bear children, and, in the context of HIV infection, fertility and reproductive services should include a comprehensive approach towards addressing issues of HIV and AIDS and childbearing among infected women.
authors.affiliation: Department of Environmental Health, The Polytechnic, University of Malawi, Blantyre, Malawi.
authors.forename: T
authors.initials: T
authors.lastname: Biseck
authors.affiliation: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Kumwenda
authors.affiliation: Department of Environmental Health, The Polytechnic, University of Malawi, Blantyre, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Kalulu
authors.affiliation: Department of Environmental Health, The Polytechnic, University of Malawi, Blantyre, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Chidziwisano
authors.affiliation: Department of Environmental Health, The Polytechnic, University of Malawi, Blantyre, Malawi.
authors.forename: L
authors.initials: L
authors.lastname: Kalumbi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003268:Contraception Behavior; D003469:Culture; D003657:Decision Making; D005191:Family Characteristics; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D008295:Malawi; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D036301:Qualitative Research; D012098:Reproduction; D012747:Sexual Partners; D012959:Socioeconomic Factors
chemical_list: D019380:Anti-HIV Agents