2011 International Conference on Family Planning
29 November–2 December 2011
"Gaps in knowledge and practice among postpartum women living with HIV in Swaziland"
Rachel Shongwe, Nelisiwe Sikhosana, Joshua Kikuvi, Erick Oweya, and Charlotte Warren
Although postpartum family planning (FP) programs enable women to achieve their fertility intentions, postpartum unmet need for FP is widespread. Evidence from recent studies has shown that substantial proportions of women living with HIV continue to have unmet need for FP. This paper explores fertility desires and FP use among postpartum women living with HIV in Swaziland.
Representative samples of cohorts of postpartum women (0–10 weeks after childbirth) were recruited (N= 1114) at baseline from 11 health facilities as part of a study to measure use of integrated HIV/postnatal service and selected reproductive behaviours. Thirty-six percent of this sample were women living with HIV (n=402) and are the focus of this paper. Responses were analyzed among postpartum women less than 4 weeks since childbirth and those five weeks or more.
Preliminary findings suggest that some level of integration of HIV/postpartum FP services is already taking place. On the day of recruitment into the cohort, 16% of all postpartum women living with HIV (0–10 weeks postpartum) received a FP method and 21% were already using a FP method prior to the visit. For women who gave birth more than a month ago (5–10 weeks), FP use was even higher: 26% received an FP method that day and 36% were already using an FP method prior to the clinic visit. Three quarters of postpartum WLHIV interviewed said they did not want any more children even though 29% have experienced the loss of a child and may potentially wish to replace that child. Only a third reported their most recent pregnancy as intended at that time even though almost half (46%) said they had used a FP method prior to the index pregnancy: 51% used condom, 37% used the injectable and 15% used oral contraceptives. A quarter reported consistent condom use, but the rest were either inconsistent or never users. Only 13% had the correct knowledge regarding the fertile period.
These findings suggest that while fertility intentions of HIV positive women are low, there was limited knowledge of fertile period and correct use of FP methods. This might explain why two thirds say their most recent pregnancy was unplanned. Nevertheless, more than half of women 5–10 weeks postpartum were using a contraceptive method, which is encouraging.
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