Factors Associated with Fertility Desires, Intentions and Contraceptive Use Among HIV-infected and Uninfected Women Attending Selected Hospitals in Kenya

Abstract

Of the total number of people infected with HIV globally, more than half are women 15 years and above and 2.1 million are children less than 15 years. In Eastern and Southern Africa, women and girls account for more than half (59%) of the total number of people living with HIV. Kenya continues to have high number of new infections among different population group. In 2017 8,000 children were infected with HIV through mother-to.child transmission (MTCT). Eliminating mother- to- child transmission of HIV is part of sustaining prevention focus to consolidate gains. The main objective of this study was to determine factors associated with fertility desire, intentions and contraceptive use among HIV-infected and uninfected women of reproductive age at selected hospitals in Nyanza and Central regions of Kenya. The study adopted a mixed method design. The study population included HIV-infected women of reproductive age attending Comprehensive Care Clinic and antenatal clinic and HIV-uninfected women attending Maternal Child Health (MCH) clinic. Total sample size was 802 (100 %) women, 437 (54.5 %) were HIV-infected while 365 (45.5 %) were HIV- uninfected. Quantitative data was collected from HIV-infected and HIV-uninfected women from all the six hospitals using semi-structured questionnaire while qualitative data was collected through FGD with HIV-infected and uninfected women and KII with health workers from CCC and PMTCT clinics from two hospitals in each region (a faithbased and a provincial hospital). Ethical clearance and approval was obtained from Scientific Steering Committee (SSC) and the Ethical Review Committee (ERC) of KEMRI. Women aged 30 to 34 years were 4.8 times more likely to intend to have more children than 15 to 19 years (OR=4.77, P< 0.001). Women residing in urban areas were 34% more likely to intend to have more children than those in rural (OR=1.34, P=0.028). While HIV uninfected women were 62% less likely than HIV infected women to intend to have children (OR=1.62, P=0.001). Age, employment status, marital status, region of residence and HIV status was significantly associated with intenton to use contraceptives. Regardless of region, whether HIV-infected or uninfected, fertility desire and intention was high among women. Ministry of Health should consider incorporating psychosocial approaches to PMTCT and enhance health education and promotion for HIV infected women as majority of HIV-infected women desired to have more children.