Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Patterns of family planning use and fertility intentions among women living with HIV in Kenya: Where are the gaps?"
Timothy Abuya and Charity Ndwiga

Background
Increasing access to sexual and reproductive health (SRH) services for women living with HIV is important in enabling them to achieve their desired fertility goals. This paper seeks to describe patterns of family planning (FP) use and fertility desires among women living with HIV in Kenya as part of larger study evaluating the benefits of integrating HIV and FP services, including reduction of unintended pregnancies and changes in reproductive behavior.

Methods
Data is based on an analysis of a subset of women from a larger survey conducted among a cohort of women (N=1959) recruited from family planning units in 12 selected facilities (6 intervention n=955 and 6 control n=1004) to generate evidence eight months after the introduction of a model of integrating family planning and HIV services. 12.8% of this sample were women living with HIV (n=251) and are the focus of this paper.

Results
Findings demonstrate that nearly half (43%) of WLWH did not desire their last pregnancy with no differences between the intervention and comparison group. Of these, 44.4% were using a family planning method when they became pregnant (50% reported using contraceptive pills). Among these, 70% reported non-compliance as the reason behind getting pregnant. Most women (80.1%) preferred not to have any more children and reported three children as their desired family size. In 52% of the responses, women reported this coincided with their partner’s desired family size too. Overall, 40% of the women indicated they used dual protection; using condoms in addition to another method in the last 12 months. However, 61.7% of the intervention group reported using condoms for dual protection to prevent both HIV/STI and pregnancies compared to 22.2% in the comparison group (p<0.001). Although most women living with HIV preferred not to have more children, most relied on short-term methods with the majority receiving condoms (46.8%), injectables (31.6%), contraceptive pills (10.1%).

Conclusions
These findings suggest a gap in on the provision of long-term family planning methods that will meet fertility intentions of women living with HIV. This is a particular concern for women who have already achieved their desired family size. Findings on dual protection resonate with qualitative findings which potentially demonstrate an increase in awareness in protecting against HIV re-infection and pregnancy prevention.

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