Research consultancy
FACTORS INFLUENCING FAMILY PLANNING USE AMONG HIV POSITIVE MOTHERS OF CHILD BEARING AGE IN HOIMA DISTRICT
CHAPTER TWO
LITERATURE REVIEW
This chapter highlights the literature review cited by other scholars about the factors influencing family planning use among HIV positive mothers. The literature is presented in sequence of the specific objectives thus socioeconomic, knowledge and individual factors.
2.2 Socioeconomic factors influencing family planning services uptake among HIV positive mothers
Findings from a study on the impact of antiretroviral therapy on incidence of pregnancy among HIV infected women in sub-Saharan Africa revealed that the rate of new pregnancies was significantly higher among women receiving ART compared to women not on ART; the chance of pregnancy was 80% greater among ART group than the pre-ART group. Other factors that were cited to be independently associated with increased risk of incident pregnancy were younger age, lower educational attainment, being married, cohabiting, failure to use non barrier contraception, (Myer et al., 2010)
Preventing unintended pregnancies among women living with HIV is a critical step towards elimination of mother-to-child transmission (eMTCT), and is a core component of the international standards for a comprehensive approach; all women, irrespective of HIV status, need services that can help them make informed reproductive decisions and provide contraceptive options, if and when they are desired, by enabling women living with HIV to prevent or delay pregnancies, access to these services could avert its infection in infants, (MOH Uganda 2012)
Use of FP among HIV positive clients is supportive in preventing high-risk and unintended pregnancies, which limits births by these clients; in some cases women with unintended pregnancies are more likely to carry out unsafe abortion, which predisposes them to infections such as puerperal sepsis, (WHO, 2009).
FP among HIV positive females who never desired children were less likely to use the methods compared to those who still desire children, those who never wanted children said FP has side effects like constant bleeding and others feared ARVs and contraceptive pill burden, (MOH/ACP 2012)
In Africa, studies have revealed that societal expectations in relation to childbearing, specifically, pressures to have children, the need to have boys as heirs, and large families (Beyeza-Kashesya J, 2009)
Expectations of child bearing also influence the fertility desires among PLHIV especially women who are HIV-positive, (Nattabi B, 2009)
2.3 Knowledge of HIV positive mother on the use of family planning methods
A study done in South Africa to assess the level of use of family planning services among both HIV-positive women and HIV-negative women revealed that there is a higher pregnancy desire and lower contraception and condom use in HIV-positive women than in HIV-negative women (Peltzier, Chao, & Dana, 2009).
Study done in the Kabarole district of Uganda revealed that the probability of HIV-positive women wanting to stop childbearing was 6.25 times higher than it was for HIV-negative women, HIV-positive women tended to want fewer children than their HIV-negative counterparts mainly because they are aware of the risks of MTCT and they do not want to go through the difficulties of having an HIV-positive child (Hey, et al., 2011).
The observation made at Katutura CDC noted that HIV-positive women were falling pregnant despite knowing that they run the risk of having an HIV-positive baby; this finding pointed to the need to respect the reproductive needs and desires of HIV-positive women according to Ikerra, H.T, (2014)
According to UNAIDS, (2010), in many countries women are less likely to be able to negotiate condom use, therefore they are more likely to be subjected to unprotected sexual intercourse and, thus, to HIV and other sexually transmitted infections STIs
However, HIV-positive women have a need for and a right to children, it is important for their pregnancies to be planned, planning in this context means making sure that their CD4 is equal or above 500 and that their viral loads are at the minimum level; this is one of the most important interventions for reducing MTCT of HIV, as unplanned pregnancy could pose a high risk it, (MOH, 2008).
Family planning is the key strategy for reducing the number of babies born to HIV-positive women. According to MOH, (2010), if they make an informed choice about contraceptive use it will involve recognizing and acknowledging different methods and their effectiveness against pregnancy, as well as the need to prevent STIs and HIV,
Though FP interventions have been under utilized in HIV care, it is more beneficial than antiretroviral prophylaxis (MOH ACP 2007), the Ugandan data for 2007 estimated FP to be responsible for the prevention of 6,100 infant infections in the country compared with 2,200 infections prevented by antiretroviral prophylaxis
2.4 The individual related factors influencing the use of family planning among HIV positive mothers
According to Reynolds HW, (2006) Most children with HIV are infected by mother-to-child transmission (MTCT) of the virus, and especially across Africa, up to 1,900 children are infected daily with HIV, and three million children younger than 15 years are living with the disease, effective contraception has been shown to reduce MTCT of HIV by preventing unwanted pregnancies
Beyeza-Kashesya J et al., (2009) stressed further that PLHIV are more likely not to want to have more children once diagnosed with HIV, literature also shows that a substantial proportion (20-50%) of men and women living with HIV desire to have children
Furthermore, Reynolds HW and Rutenberg N, et al., (2006) estimated that approximately 120,000 HIV-positive births per year would be averted if the family planning needs of all HIV-positive women in sub-Saharan Africa could be met, however, most antiretroviral therapy (ART) programs focus on providing ART to HIV-positive women without integration with contraceptive services,
Anand A, and Shiraishi RW et al., (2009) noted in a study that the desire to reproduce, lack of information on MTCT and poor outcome of previous pregnancies were among the factors that prompted parents living with HIV to desire children Berhan Y, et al., (2013), and several HIV-positive women encounter unintended pregnancies with a concomitant risk of MTCT
Studies have demonstrated that HIV-infected women who know their status have a lower fertility desire and better use of contraceptives as compared to their HIV-negative counterparts (Taulo F et al., (2009); a study done by (Tweya H, et al., 2013) in Malawi indicated that women with longer follow up time on ART were associated with increased chance of becoming pregnant.
