ABSTRACT This study is the first of a series of community-based surveys that the City of Tshwane Metropolitan Municipality (CTMM) has planned to conduct in the next 15 years to fulfill its provincial mandate (being the provider of primary health care services) in accordance with the Gauteng District Health Services Act (Act No 8 of 2000)1. The study determined the prevalence rate of contraceptive use and method choice, and the effects of the availability of reproductive health services on contraceptive use and method choice in the CTMM in 2004. The study used a descriptive cross-sectional population-based study design and a sample of 3, 547 women of childbearing age (15-49 years) using a multi-stage cluster sampling with probability proportional to size to determine these effects. A modified 1998 SADHS questionnaire helped to collect information on selected individuals, programmes and district explanatory variables from women living in the four health sub-districts and data were used in three B (4 variables), C (six variables) and D (eight variables) unconditional binary logistic regression models and a multinomial logistic model to estimate their effects (odds ratios and pvalue at 5% level) on contraceptive use and method choice. The selection of these variables is based on the conceptual framework that recognizes that contraceptive use or method choice is the consequence of service utilization, which, in turn, is influenced by individual, service/programme and community factors2,3. The availability of reproductive health services was measured by the presence or absence of the supply source of contraceptive methods in a district. After controlling for the effects of individual (social and demographic) variables, none of the programmatic variables was independently associated with contraceptive use. By contrast, district/place of residence predictor was associated with reduced odds of contraceptive use and with reduced odds of condom, injection and IUD’s choice against pill in all the models and districts, respectively. In terms of the source of first information on contraceptive methods and the differences between IUD and injection, the study shows that nurses (odds ratio, 1.80, p<0.05) are more likely than mothers to be the providers of information on IUD while physicians (odds ratio, 0.65, p<0.05) are shown to be less likely than mothers to be the providers of information on injection as opposed to the pill. The private sector ( odds ratio, 2.12, p<0.01) is shown to be more likely than the public sector to be the supply source of IUD methods rather than the pill, and also more likely (odds ratio, 1.97, p<0.01) than the public sector to be the supply source of IUD instead of injection. Private pharmacies (odds ratio, 2.25, p<0.05) are more likely than the public sector to supply condoms rather than the pill. The presence or absence of reproductive health services in a district was significantly associated with reduced odds of both contraceptive use and choice of condom, injection and IUD methods against pill. This may be attributable to women’s willingness to travel outside their place of residence to get their preferred method. Thus availability of reproductive health services in the district seems not to have an important effect on use and choice of modern contraception in the City of Tshwane in 2004.

Master of Public Health - MPH / Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services. / South Africa

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>