The correlates and reasons for planned and unplanned Pregnancies among HIV-positive women in western Kenya

Abstract

Introduction: Although studies have documented that women living in sub-Saharan Africa continue to bear children after testing positive for HIV, few studies have examined whether such pregnancies are planned or unplanned. Unplanned pregnancy disrupts optimal conditions for motherhood, and women with unplanned pregnancies and their babies are at higher risk for negative health outcomes during and after pregnancy. Relatively little is known about socio-cultural factors associated with these pregnancies. Objective: To examine the correlates and reasons for unplanned and planned pregnancy among HIV -positive women in western Kenya. Setting: The US AID-Academic Model Providing Access to Healthcare (AMPATH) Partnership HIV clinic in Eldoret. Methods: In this cross-sectional survey, two hundred and eleven women who had become pregnant at least once after being diagnosed with HIV were randomly selected to examine whether they planned their pregnancies or not, and the reasons why they either planned to become pregnant or became pregnant despite not intending to do so. Results: Majority (136, 64%) of the women interviewed reported that their post HIV- diagnosis pregnancies were unplanned. Compared to those with planned pregnancies, women with unplanned pregnancies were likely to be older, have lower incomes, perceive health workers as unsupportive of HIV-infected women (allp<.05), and live in rural areas (p=0.058). Multivariate adjustment revealed that women who experienced unplanned pregnancies were more likely to be unmarried (AOR = 2.1; 95% CI = 1.0 - 4.4), have more children at the time of diagnosis (AOR = 1.5; 95% CI = 1.1 - 2.0), have partners who also did not want children (AOR = 21; 95% CI = 7.6 - 58.2) and perceive their communities as unsupportive of HI V-positive women (AOR = 2.6; 95% CI = 1.1 - 6.6). Over 20% of the women remain at risk for repeat unplanned pregnancy. Most women (83%) with unplanned pregnancies felt that lack of, improper usage or failure of family planning methods contributed to their pregnancies. Conclusion: This study documents a high prevalence of unplanned pregnancies among HIV-infected women, especially those who are unmarried and those who feel communities and health workers do not support childbearing by HIV -infected women. Unplanned pregnancy is also associated with lack of reproductive intentions by male partners and higher parity at time of HIV diagnosis. Majority of the women perceived failure or lack of contraceptive methods as responsible for their unplanned pregnancies.