The injection or the injection? Restricted contraceptive choices among women living with HIV

Sexual and Reproductive Health Matters

Landon Myer¹  Elaine J. Abrams²  Tamsin K. Phillips³  Kirsty Brittain³  Catriona A. Towriss⁴  Allison Zerbe⁵ 

[1] Professor and Director of School, School of Public Health and Family Medicine, University of Cape Town;Professor and Senior Research Director, ICAP, Columbia University;Research Officer, School of Public Health and Family Medicine, University of Cape Town;Senior Lecturer, Centre for Actuarial Research, University of Cape Town;Senior Project Manager, ICAP, Columbia University;

关键词: contraception;    family planning;    hiv;    childbearing;    reproductive intentions;    art;    pmtct;    reproductive rights;    autonomy;    quality of care;   

DOI  :  10.1080/26410397.2019.1628593

来源: DOAJ

【 摘 要 】

Historically, women living with HIV (WLWH) have been vulnerable to biased advice from healthcare workers regarding contraception and childbearing. However, antiretroviral therapy (ART) has made motherhood safer, prompting a re-examination of whether contraceptive services enable the realisation of WLWH’s reproductive intentions. We use longitudinal quantitative data on contraceptive choice and use, and childbearing intentions collected in (up to) six interviews between entry into antenatal care (ANC) and 18 months post-partum from a cohort of 471 ART-initiated WLWH in Cape Town, South Africa. Thirty-nine of these women were randomly selected for in-depth interview where they described experiences of contraception services and use. We find high prevalence of injectable contraceptive (IC) use after birth (74%). With increasing post-partum duration, greater proportions of women discontinue this method (at 18 months 21% were not using contraception), while desires for another child remain stable. We find little consistency between method choice and use: many women who elected to use the intrauterine device, sterilisation or oral contraceptives at first ANC visit are using IC after birth. Women commonly report receiving an IC shortly after birth, including those who had previously chosen to use another method or no method. Among WLWH, injectables dominated the contraceptive method mix. Despite a human rights-grounded policy and attempts to introduce new methods, contraceptive services in South Africa remain largely unchanged over time. Women are frequently unable to make autonomous contraceptive choices. Despite low desires for future pregnancy, we observed high rates of contraceptive discontinuation, resulting in heightened risk of unintended pregnancy.

【 授权许可】

Unknown