Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study

BMC Public Health

Research Article

Betsy Kammerer¹  Jane Dipuo Magetse²  Gbolahan Ajibola²  Maureen Sakoi²  Kebaiphe Moabi²  Modiegi Diseko²  Gloria K. Mayondi²  Sikhulile Moyo²  Joseph Makhema³  Shahin Lockman⁴  Chelsea Morroni⁵  Jean Leidner⁶  Kathleen Wirth⁷ 

[1] Boston Children’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana;Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana;Harvard School of Public Health, Boston, MA, USA;Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana;Harvard School of Public Health, Boston, MA, USA;Brigham and Women’s Hospital, 15 Francis Street, PBB 4A, 02115, Boston, MA, USA;EGA Institute for Women’s Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK;University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana;Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana;Goodtables Data Consulting, 3101 Tisbury Rd., 73071, Norman, OK, USA;Harvard School of Public Health, Boston, MA, USA;

关键词: Unintended pregnancy;    Contraception;    Family planning;    HIV;    Africa;    Botswana;    Tshipidi;   

DOI  :  10.1186/s12889-015-2498-3

 received in 2015-04-01, accepted in 2015-11-17,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundLittle is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability.MethodsWe analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires.ResultsThe median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8).ConclusionsThe high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.

【 授权许可】

CC BY   
© Mayondi et al. 2016