- Title
- Fertility, contraceptive use and client-provider discussions regarding fertility plans among women living with HIV in Western Ethiopia
- Creator
- Feyissa, Tesfaye Regassa
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- In the last decade, there has been improvement in the life expectancy of people living with HIV due to improved drug therapy and care and support programs. Improved health and survival allows women living with HIV (WLHIV) to provide and care for their families. Importantly, WLHIV who intend to have children need information and services focused on safe conception strategies while those who do not desire a child need access to effective contraceptive methods. However, fertility rates, contraceptive use and reproductive plans among this population are largely unknown, as are the ways in which practitioners and WLHIV might discuss fertility. This thesis therefore aimed to assess fertility, contraceptive use and client-provider discussions regarding reproductive plans among WLHIV in western Ethiopia. A multi-method approach comprising of a systematic review, a cross-sectional survey and qualitative study was used. The first aim was to determine the magnitude of unintended pregnancies in WLHIV in sub-Saharan Africa and to summarise findings on factors associated with unintended pregnancies among these women. A high magnitude of unintended pregnancy was found (55.9%) and unintended pregnancy was significantly higher among women living with HIV than for women who do not have HIV. The remaining four aims were based on original data. A facility-based cross-sectional survey was conducted in 2018 among 1,082 reproductive-aged (15-49 years) WLHIV in western Ethiopia. The second aim was to examine fertility (defined as live births) and its associated factors among WLHIV in western Ethiopia in the last 3 years. A total of 12.5% of WLHIV in Ethiopia reported having children in the last 3 years. Among these, 18.2% of pregnancies were reported as mistimed and 26.4% as unwanted suggesting that strengthening family planning programs for WLHIV is important. The third aim was to assess contraceptive use among sexually active WLHIV in western Ethiopia. Among sexually active WLHIV who reported being fecund and sexually active within the previous six months but not wanting to have another child within the next two years (n=360), 75% used contraception and 25% had an unmet need for contraception. Compared to women having no children after HIV diagnosis, having two or more children after HIV diagnosis was associated with increased use of contraception. However, sexually active unmarried women were less likely to use contraception compared to their sexually active married counterparts. Importantly, WLHIV who reported high and medium perceived susceptibility towards pregnancy were associated with higher prevalence of contraceptive use than WLHIV with low perceived susceptibility. The fourth aim assessed discussions between healthcare providers and sexually active WLHIV in western Ethiopia regarding their reproductive plans. Among sexually active WLHIV (n=475), 30.7% reported having had a general discussion regarding pregnancy and HIV with healthcare providers. However, only 16.8% of WLHIV had discussions with their providers regarding their personal reproductive plans. Unmarried sexually active women and women accessing health centers for antiretroviral therapy (ART) were less likely to report both general and personalized discussions than married women and women who accessed ART through hospitals, respectively. Following this, the fifth aim used a qualitative approach to gain deeper insights into the perceptions surrounding fertility plan discussions between WLHIV in western Ethiopia and their healthcare providers. Thirty-one interviews (27 with WLHIV and 4 with healthcare providers working at HIV clinics) were conducted. Training of healthcare providers regarding safer conception, non-judgmental counselling, improving the integration of services along with improved human resources, and improving partner involvement were found to be crucial to client-centered reproductive healthcare. Given WLHIV are both having and intending to have children, it is important to provide safe conception practices that eliminate or lower the chance of HIV being passed on to the child during pregnancy and childbirth. The findings in this thesis highlighted that the delivery of fertility plan discussions occur inconsistently and underscore the need for policy and provider-training in order to provide clear, consistent and sensitive reproductive counselling to WLHIV. Importantly, redirecting tasks such as fertility plan counselling to mother support groups and adherence counsellors could be used as a strategy for people to achieve safer conception. It is also important to strengthen family planning services given the high rate of unplanned pregnancies, and the high rate of unmet needs for contraception.
- Subject
- safer conception; HIV; epidemiology; women; infectious disease; thesis by publication; antiretroviral therapy; communication; counselling; fertility; pregnancy; mother to child transmission; contraception; chronic disease
- Identifier
- http://hdl.handle.net/1959.13/1432855
- Identifier
- uon:39123
- Rights
- Copyright 2020 Tesfaye Regassa Feyissa
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 382 KB | Adobe Acrobat PDF | View Details Download |