Fertility intentions and contraceptive use among HIV-positive women of reproductive age, (15-49) in Zambia: evidence from demographic and health survey 2013-14.
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HIV infection is a strong predictor of fertility as it might influence one’s fertility desire. HIV-positive women may have fertility desires and may intend to have children but these vary by socio-economic, socio-cultural and demographic characteristics. Studies of fertility intentions among HIV-positive individuals report a strong desire to have children. With the advent of Antiretroviral Therapy [ART], the quality of life for people living with HIV has also been improved potentially impacting fertility intentions among HIV-infected individuals. However, little is known about their fertility intentions. Thus, this study examines the fertility intentions and contraceptive use among HIV-positive women (15-49 years) in Zambia. The analyses are based on women with linkable information on HIV testing, fertility preferences and contraceptive use from the nationally representative 2013-14 Zambia and Demographic Health Survey data. HIV data was merged with each woman’s individual file which also contained household variables to create an analytical file. Analyses were carried out after merging the HIV test results and women’s file. Cross-tabulations with Chi-square tests were conducted to ascertain the crude relationship and finally multiple logistic regressions were employed to identify the major independent predictors of fertility intention using STATA 14.0 with 5% level of significance. Findings reveal that out of the total number of women (9,688) with linkable information on HIV testing and fertility preferences, 1,654 (17.1%) were HIV-positive. Among the HIV-positive women, a considerable proportion (46%) still has intentions for having children in future. However, the study findings indicate a 14% significant difference in fertility intentions between HIV-negative (60%) and HIV-positive (46%) women. This study has also found that majority (58%) of the HIV-positive women are not contraceptive users. Multivariate analyses revealed that HIV-positive women have lower odds of wanting more children when compared to their HIV-negative counterparts. The study has concluded that predictors of fertility intentions and use of contraceptive among women are different by HIV status. From the findings, age, education level, marital status and parity were found to be the major predictors of fertility intentions among HIV-positive women while among the HIV-negatives; age, education level, parity, marital status, employment status, wealth quintile and region explained their fertility intentions. Predictors of contraceptive use among HIV-positive women include; marital status, parity, ethnicity, fertility intention, education level and age. The fact that many HIV-infected women expect to have children has important implications for the prevention of vertical and horizontal transmission of HIV. There is therefore, the need for comprehensive and continuous expansion of family planning, voluntary counseling and prevention of mother-to-child transmission (PMTCT) and integration of HIV treatment care among HIV-positive mothers to meet diverse reproductive intentions. Key Words: Fertility intentions; contraception; HIV status, women; Zambia
The University of Zambia