Unintended Pregnancy among HIV Positive Couples Receiving Integrated HIV Counseling, Testing, and Family Planning Services in Zambia

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Abstract

Objective

We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort.

Design

Data were analyzed from couples randomized in a factorial design to two family planning intervention videos.

Methods

Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling.

Results

The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom.

Conclusions

Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users.

Trial registration

ClinicalTrials.gov NCT00067522

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Most cited references 29

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Family planning: the unfinished agenda.

John Cleland, Stan Bernstein, Alex Ezeh … (2006)

Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.

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Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project.

Dominick Shattuck, Brad Kerner, Kate Gilles … (2011)

We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples' contraceptive uptake. We based the intervention design on the information-motivation-behavioral skills (IMB) model. In 2008 we recruited 400 men from Malawi's Mangochi province who reported not using any method of contraception. We randomized them into an intervention arm and a control arm, and administered surveys on contraceptive use at baseline and after the intervention. We also conducted in-depth interviews with a subset of intervention participants. After the intervention, contraceptive use increased significantly within both arms (P < .01), and this increase was significantly greater in the intervention arm than it was in the control arm (P < .01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P < .01). Our findings indicate that men facilitated contraceptive use for their partners. Although the IMB model does not fully explain our findings, our results show that the intervention's content and its training in communication skills are essential mechanisms for successfully enabling men to help couples use a contraceptive.

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Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives

Gorrette Nalwadda, Florence Mirembe, Josaphat Byamugisha … (2010)

Background High fertility among young people aged 15-24 years is a public health concern in Uganda. Unwanted pregnancy, unsafe induced abortions and associated high morbidity and mortality among young women may be attributed to low contraceptive use. This study aims at exploring reasons for low contraceptive use among young people. Methods In 16 focus group discussions, the views of young people about obstacles and enabling factors to contraceptive use in Mityana and Mubende districts, Uganda were explored. The groups were homogeneously composed by married and unmarried men and women, between the ages of 15-24. The data obtained was analyzed using qualitative content analysis. Results Young men and women described multiple obstacles to contraceptive use. The obstacles were categorized as misconceptions and fears related to contraception, gender power relations, socio-cultural expectations and contradictions, short term planning, and health service barriers. Additionally, young people recounted several enabling factors that included female strategies to overcome obstacles, changing perceptions to contraceptive use, and changing attitude towards a small family size. Conclusions Our findings suggest changing perceptions and behavior shift towards contraceptive use and a small family size although obstacles still exist. Personalized strategies to young women and men are needed to motivate and assist young people plan their future families, adopt and sustain use of contraceptives. Reducing obstacles and reinforcing enabling factors through education, culturally sensitive behavior change strategies have the potential to enhance contraceptives use. Alternative models of contraceptive service delivery to young people are proposed.

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Author and article information

Contributors

Willem Daniel Francois Venter: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 30 September 2013

Volume: 8

Issue: 9

Electronic Location Identifier: e75353

Affiliations

[1 ]Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America

[2 ]Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

[3 ]Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, United States of America

[4 ]Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia

[5 ]Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America

[6 ]Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

[7 ]Ministry of Community Development, Mother and Child Health, Lusaka, Zambia

Wits Reproductive Health and HIV Institute, South Africa

Author notes

* E-mail: kmwall@ 123456emory.edu

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: BV WK EC CV AT SA. Performed the experiments: BV WK EC CV AT SA. Analyzed the data: KW LH NHK IB RS SA. Wrote the paper: KW LH BV NHK IB WK RS EC CV AT SA. Contributed to the conception and design of the study: BV WK EC CV AT SA. Contributed to the analysis and interpretation of data: KW LH NHK IB RS. Drafted the article: KW LH NHK IB RS. Revised article critically for important intellectual content and gave final approval of the version to be published: KW LH NHK IB RS BV WK EC CV AT SA.

Article

Publisher ID: PONE-D-13-21733

DOI: 10.1371/journal.pone.0075353

PMC ID: 3787093

PubMed ID: 24098692

SO-VID: d7c760c0-7f3a-48f9-a058-22c26a73f772

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 27 May 2013

Date accepted : 12 August 2013

Page count

Pages: 10

Funding

This work was supported by funding from the National Institutes of Child Health and Development (NICHD RO1 HD40125); National Institute of Mental Health (NIMH R01 66767); the AIDS International Training and Research Program Fogarty International Center (D43 TW001042); the Emory Center for AIDS Research (P30 AI050409); National Institute of Allergy and Infectious Diseases (NIAID R01 AI51231); and the International AIDS Vaccine Initiative. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Unintended Pregnancy among HIV Positive Couples Receiving Integrated HIV Counseling, Testing, and Family Planning Services in Zambia

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Abstract

Objective

Design

Methods

Results

Conclusions

Trial registration

Related collections

PLOS Climate

Most cited references 29

Family planning: the unfinished agenda.

Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project.

Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives

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