A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background and Significance: Both HIV and unintended pregnancies have been associated with adverse maternal, perinatal, and infant outcomes. Malawi is a country with both high HIV prevalence and rates of unintended pregnancy, where 13% of women aged 15‐49 years have HIV, and 41% of pregnancies are unintended.
Research Question: The objectives of this study were to describe the most recent pregnancy
intentions and family planning preferences of HIV‐infected and HIV‐uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. Methods: We conducted a cross‐sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and
knowledge of IUC and the implant. We used Pearson’s chi‐square tests to compare
these parameters between HIV‐infected and HIV‐uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant.
Results: Of 634 postpartum women surveyed, HIV‐infected women were more likely to
report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV‐infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV‐ infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61,
0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during
breastfeeding.
Conclusion: Postpartum women strongly desire family spacing and many HIV‐infected postpartum women desire no more children, suggesting an important role for these long‐acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/536225 |
| Date | 13 April 2015 |
| Creators | OShea, Michele |
| Contributors | The University of Arizona College of Medicine - Phoenix, Tang, Jennifer MD, MSCR |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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