Background
Methods
Quantitative data
Statistical analysis
Qualitative data
Results
Description of quantitative sample
Study cohort | |||
---|---|---|---|
Factor | Central Province N = 204 (%) | Eastern Province N = 36 (%) |
χ
2/Fisher’s p-value
|
Age | |||
16–25 | 15 (7) | 8 (22) |
<0.001
|
26–35 | 114 (56) | 26 (72) | |
36–45 | 75 (37) | 2 (6) | |
Marital status | |||
Single | 75 (37) | 4 (11) |
0.003
|
Married | 129 (63) | 32 (89) | |
Religion | |||
Roman Catholic | 58 (28) | 13 (36) |
0.352
|
Other | 146 (72) | 23 (64) | |
Education | |||
Up to primary | 169 (83) | 29 (81) |
0.739
|
Above primary | 35 (17) | 7 (19) | |
Employment | |||
Unemployed | 50 (24) | 26 (72) |
<0.001
|
Regular | 145 (72) | 9 (25) | |
Professional | 9 (4) | 1 (3) | |
Breadwinner status | |||
Herself | 76 (37) | 3 (8) |
0.001
|
Partner | 114 (56) | 29 (81) | |
Other | 14 (7) | 4 (11) | |
Breadwinner occupation | |||
Unemployed | 8 (4) | 0 (0) |
0.739
|
Regular | 178 (87) | 33 (92) | |
Professional | 18 (9) | 3 (8) | |
Has health insurance | |||
No | 171 (84) | 31 (86) |
0.729
|
Yes | 33 (16) | 5 (14) | |
Household income | |||
< KSh3000 | 46 (23) | 13 (36) |
0.216
|
3000–9999 | 113 (55) | 16 (44) | |
10,000+ | 45 (22) | 7 (19) | |
Can raise KSh1000 for emergency | |||
Easy to | 38 (19) | 7 (19) |
0.908
|
Difficult to | 166 (81) | 29 (81) | |
Can access FP voucher | |||
No | 182 (91) | 27 (90) |
0.732
|
Yes | 17 (9) | 3 (10) | |
Currently on ART | |||
No | 42 (21) | 17 (47) |
0.001
|
Yes | 162 (79) | 19 (53) | |
On Co-trimoxazole prophylaxis | |||
No | 22 (11) | 7 (19) |
0.164
|
Yes | 182 (89) | 29 (81) | |
Knowledge of partner’s HIV status | |||
No | 55 (28) | 9 (28) |
0.112
|
Yes | 145 (72) | 23 (72) | |
Ever experienced stigma | |||
No | 146 (72) | 33 (92) |
0.011
|
Yes | 58 (28) | 3 (8) | |
Sexually active | |||
No | 55 (28) | 11 (37) |
0.135
|
Yes | 144 (72) | 19 (63) | |
Number of sex partners in last 1 month | |||
0 | 0 (0) | 7 (22) |
<0.001
|
1 | 116 (97) | 25 (78) | |
> 1 | 3 (3) | 0 (0) | |
Number of sex partners in last 12 months | |||
0 | 0 (0) | 5 (16) |
<0.001
|
1 | 131 (97) | 26 (81) | |
> 1 | 4 (3) | 1 (3) | |
Fertility Variables | |||
Number of previous pregnancies | |||
Once | 26 (13) | 1 (3) |
0.173
|
Two times | 69 (34) | 10 (28) | |
Three times | 47 (23) | 9 (25) | |
More than three times | 62 (30) | 16 (44) | |
Number of living children | |||
1 child | 34 (17) | 1 (3) |
0.007
|
2 children | 75 (38) | 11 (31) | |
3 children | 53 (27) | 9 (25) | |
> 3 children | 37 (19) | 15 (42) | |
Desired number of children | |||
2 children | 66 (32) | 6 (20) |
0.051
|
3 children | 75 (37) | 8 (27) | |
> 3 children | 63 (31) | 16 (53) | |
Partner desires same number children | |||
No | 23 (12) | 4 (13) |
0.674
|
Yes | 101 (51) | 18 (60) | |
Has no partner | 45 (23) | 4 (13) | |
Don’t know | 30 (15) | 4 (13) | |
Parity balance | |||
More children than number desired | 31 (15) | 5 (14) |
0.228
|
Desired number of children fulfilled | 72 (35) | 18 (50) | |
Less children than number desired | 101 (50) | 13 (36) | |
Wants another child | |||
No | 143 (70) | 24 (80) |
0.263
|
Yes | 61 (30) | 6 (20) | |
Intended the last pregnancy | |||
No | 26 (13) | 5 (14) |
0.901
|
Wanted to wait | 58 (28) | 9 (25) | |
Yes | 120 (59) | 22 (61) | |
Feeling if unexpectedly pregnant today | |||
I would feel sad | 118 (60) | 22 (65) |
0.276
|
I would feel happy | 17 (9) | 5 (15) | |
Indifferent | 62 (31) | 7 (20) | |
Family Planning variables | |||
Uses family planning | |||
No | 10 (5) | 8 (27) |
0.001
|
Yes | 189 (95) | 22 (73) | |
Type of family planning method used | |||
Short-term | 97 (51) | 10 (45) |
0.311
|
Long-term | 27 (14) | 6 (27) | |
Condom | 65 (34) | 6 (27) | |
Dual protection | |||
No | 61 (32) | 12 (55) |
0.038
|
Yes | 128 (68) | 10 (45) | |
Provider explained FP methods | |||
No | 113 (58) | 9 (69) |
0.296
|
Yes | 82 (42) | 4 (31) | |
Stopped family planning | |||
Not stopped | 168 (84) | 28 (78) |
0.324
|
Stopped | 31 (16) | 8 (22) | |
Pregnant at baseline or over follow-up | |||
No | 1 (0.5) | 0 (0) |
1.000
|
Yes | 197 (99.5) | 36 (100) | |
Got pregnant while on Family Planning | |||
No | 150 (78) | 22 (63) |
0.060
|
Yes | 43 (22) | 13 (37) | |
FP method in use when she got pregnant | |||
Short-term & condoms | 43 (100) | 13 (100) |
−
|
Long-term & permanent | 0 (0) | 0 (0) |
Influences on fertility desires among WLHIV
Fertility desire | ||||
---|---|---|---|---|
Factor | Did not want another child, N = 167 (%) | Wanted another child, N = 67 (%) |
χ
2
p-value
| AOR [95% CI] |
Group | ||||
Central Province | 143 (70) | 61 (30) |
0.263
| |
Eastern Province | 24 (80) | 6 (20) | ||
Education | ||||
Up to primary | 145 (75) | 49 (25) |
0.012
| 1.00 |
Above primary | 22 (55) | 18 (45) | 0.84 [0.27, 2.62] | |
Breadwinner status | ||||
Herself | 64 (81) | 15 (19) |
0.007
| 1.00 |
Partner | 96 (61) | 43 (39) | 2.69 [0.92, 7.89] | |
Other | 7 (44) | 9 (56) | 19.21 [2.81, 131.33]* | |
Breadwinner occupation | ||||
Unemployed & Regular | 161 (75) | 53 (25) |
<0.001
| 1.00 |
Professional | 6 (30) | 14 (70) | 2.59 [0.54, 12.46] | |
Has health insurance | ||||
No | 148 (75) | 49 (25) |
0.003
| 1.00 |
Yes | 19 (51) | 18 (49) | 2.03 [0.73, 5.69] | |
Can raise KSh1000 for emergency | ||||
Easy to | 24 (56) | 19 (44) |
0.013
| 1.00 |
Difficult to | 143 (75) | 48 (25) | 0.68 [0.24, 1.90] | |
Number of living children | ||||
1 child | 10 (29) | 25 (71) |
<0.001
| 1.00 |
2 children | 55 (66) | 28 (34) | 0.30 [0.07, 1.25] | |
3 children | 51 (84) | 10 (16) | 0.37 [0.07, 1.98] | |
> 3 children | 47 (94) | 3 (4) | 0.17 [0.02, 1.78] | |
Partner desires same number children | ||||
No | 15 (56) | 12 (44) |
0.001
| 1.00 |
Yes | 88 (74) | 31 (26) | 0.41 [0.13, 1.31] | |
Has no partner | 43 (88) | 6 (12) | 0.15 [0.03, 0.75]** | |
Don’t know | 17 (50) | 17 (50) | 0.80 [0.21, 3.06] | |
Parity balance | ||||
More children than number desired | 33 (92) | 3 (8) |
<0.001
| 1.00 |
Desired number of children fulfilled | 82 (91) | 8 (9) | 0.70 [0.14, 3.49] | |
Less children than number desired | 52 (48) | 56 (52) | 6.33 [1.17, 34.37]† | |
Number of previous pregnancies | ||||
Once | 10 (37) | 17 (63) |
<0.001
| 1.00 |
Two times | 46 (61) | 30 (39) | 2.41 [0.44, 13.36] | |
Three times | 45 (82) | 10 (18) | 0.78 [0.12, 4.89] | |
More than three times | 66 (87) | 10 (13) | 1.20 [0.17, 8.58] |
Factor | AOR | Standard error | [95% CI] | Standardized Beta |
---|---|---|---|---|
Breadwinner status | ||||
Herself | 1.00 | - | - | - |
Partner | 2.33 | 1.175 | [0.87, 6.26]†
| 0.17 |
Other | 15.53 | 14.110 | [2.62, 92.17]**
| 0.27 |
Number of living children | ||||
1 child | 1.00 | - | - | - |
2 children | 0.15 | 0.080 | [0.05, 0.43]*
| −0.36 |
3 children | 0.04 | 0.026 | [0.01, 0.14]*
| −0.56 |
> 3 children | 0.01 | 0.010 | [0.002, 0.05]*
| −0.73 |
Desired number of children | ||||
>3 children | 1.00 | - | - | - |
2 children | 0.26 | 0.135 | [0.09, 0.72]§
| −0.25 |
3 children | 0.90 | 0.403 | [0.37, 2.17] | −0.02 |
Partner desires same number of children | ||||
No | 1.00 | - | - | - |
Yes | 0.53 | 0.293 | [0.18, 1.57] | −0.13 |
Has no partner | 0.13 | 0.106 | [0.03, 0.63]‡
| −0.33 |
Don’t know | 0.91 | 0.596 | [0.25, 3.28] | −0.01 |
Influences on family planning use among WLHIV
Family planning method type | |||
---|---|---|---|
Short-term method
N = 107 (%)* | Long-term method
N = 33 (%)* | Condom
N = 71 (%)* | |
Fertility Intention: | |||
Did not want another child | 74 (69) | 26 (79) | 50 (70) |
Wanted another child | 33 (31) | 7 (21) | 21 (30) |
Parity: | |||
1 child | 13 (12) | 6 (18) | 13 (18) |
2 children | 41 (38) | 10 (30) | 26 (37) |
3 children | 27 (25) | 10 (30) | 19 (27) |
>3 children | 26 (24) | 7 (21) | 13 (18) |
Factor | Short-term method, N = 179 (%) | Long-term method, N = 32 (%) |
χ
2/Fisher’s p-value
| Adjusted odds ratio | 95% confidence interval | Standardized beta |
---|---|---|---|---|---|---|
Group | ||||||
Central Province | 163 (86) | 26 (14) |
0.114
|
Excluded
|
Excluded
|
Excluded
|
Eastern Province | 16 (73) | 6 (27) | ||||
Age | ||||||
16–25 | 15 (100) | 0 (0) |
0.007
| 1.00 | - | - |
26–35 | 100 (79) | 27 (21) | 7.06 | [0.89, 55.93]§
| 0.48 | |
36–45 | 64 (93) | 5 (7) | 1.67 | [0.19, 14.98]†
| 0.12 | |
Marital status | ||||||
Single | 49 (82) | 11 (18) |
0.007
| 1.00 | - | - |
Married | 112 (90) | 12 (10) | 0.93 | [0.34, 2.52]‡
| −0.02 | |
Separated/Divorced/Widowed | 18 (67) | 9 (33) | 3.59 | [1.09, 11.88]*
| 0.22 |
Exploring fertility intentions and motivators for contraception: Insights from qualitative data
Study cohort | ||
---|---|---|
Factor | Central Province
N = 25 (%) | Eastern Province
N = 23 (%) |
Age | ||
16–25 | 1 (4) | 3 (13) |
26–35 | 15 (60) | 19 (83) |
36–45 | 9 (36) | 1 (4) |
Marital status | ||
Single | 15 (60) | 2 (9) |
Married | 10 (40) | 21 (91) |
Education | ||
Up to primary | 23 (92) | 19 (83) |
Above primary | 2 (8) | 4 (17) |
Employment | ||
Unemployed | 6 (24) | 16 (70) |
Regular | 18 (72) | 6 (26) |
Professional | 1 (4) | 1 (4) |
Currently on ART | ||
No | 5 (20) | 8 (35) |
Yes | 20 (80) | 15 (65) |
Knowledge of partner’s HIV status | ||
No | 8 (32) | 6 (29) |
Yes | 17 (68) | 15 (71) |
Number of previous pregnancies | ||
Once | 2 (8) | 1 (4) |
Two times | 8 (32) | 5 (22) |
Three times | 5 (20) | 5 (22) |
More than three times | 10 (40) | 12 (52) |
Number of living children | ||
< 2 children | 3 (12) | 1 (4) |
2 children | 10 (40) | 6 (26) |
> 2 children | 12 (48) | 16 (70) |
My desire for children affected when I tested HIV+ | ||
No | 7 (41) | 7 (41) |
Yes | 10 (59) | 10 (59) |
Desire for children after testing HIV+ | ||
Never have a child again | 7 (70) | 8 (80) |
Have a child after careful planning | 2 (20) | 2 (20) |
Quickly have another child | 1 (10) | 0 (0) |
Disclosure of HIV statusa
| ||
Disclosed to partner | 20 | 17 |
Disclosed only to other family member | 0 | 4 |
Have not disclosed | 3 | 2 |
Influences on fertility intentions among WLHIV
“I would not want to have another child because now I have three and am the one feeding them and if I add another one it will be a burden […] It was my wish I get the children while am with a husband […] but now the way it [HIV] came and we separated [after HIV diagnosis] you can see now it’s a burden.” [Central Province, 3 children, separated, no current FP method].
“I am afraid that I may infect the child.” [Central Province, 2 children, married, condoms]
“We were told that your blood continues to reduce, your body deteriorates badly. Now we were told that giving birth so much is not good.” [Eastern Province, 3 children, married, injection]
“[It] is a problem if you get a child and you do not breastfeed [Silence] … They [community] conclude for themselves… […] They just know you are positive”. [Central Province, no children, has partner, condoms]
“They [people in the community] say, she [HIV positive woman] […] should do family planning not to continue giving birth to sick children”. [Eastern Province, 3 children, married, condoms]
Good degree of understanding of the need to seek advice on how to bear children safely
“there are ways that you will come and follow and the doctor will explain to you, you will be able to carry the pregnancy, you will be able to give birth, and prevent infecting the baby with the virus.” [Central Province, 3 children, separated, no FP method]
“When the CD4 rises, we shall get a child.” [Central Province,1 child, married, condoms]
“[doctors] told […] if it [immunity] is too low and you want to give birth, that child will have the AIDS virus. [...] If your immunity is good, the doctor can allow you to get pregnant, but he will be checking on you as required until you give birth properly.” [Eastern Province, 5 children, married, tubal ligation]
“it will be a difficult process to get another child to go to the hospital again so that the child doesn’t contract the virus […] so maybe you prefer to only get two [children].” [Central Province, 2 children, married, injection]
Contraceptive practices and motivations among WLHIV
‘We are using condoms and I still use that pill, because condoms prevent germs to enter into me and to him, but this pill for family-planning prevents that condom if it bursts I will get pregnant.’ [Central Province, 4 children, married, pill and condoms]
“The one for three months is for a shorter period that is after every three months one has to go back, therefore the one for 5 years is cost effective and also saves time.” [Eastern Province, 1 child, married, no post-partum FP use but wants Norplant]
“Norplant is good, because….it has no side effects that may harm my body.” [Central Province, 1 child, abandoned by partner, Norplant].
“[…] you know when I gave birth I was told not to bear again ... now I decided to check this [coil] and let me put this one”. [Eastern Province, 2 children, married, IUD]
“he is happy to use [condoms] because he does not want us to give birth fast.” [Central Province, 2 children, has partner, pill and condoms]
“…if you want family planning ...you have to tell your husband ... if he tells you it is okay... you are going to plan”. [Eastern Province, 5 children, married, Tubal ligation]
“…he said that I should use a family planning method. And I chose injection and I have never heard him with a problem with the injection.” (Central Province, 3 children, married, injection and condoms]
“He was insisting I get another child […] so I saw if I don’t use family planning method I would get hurt by those children and also they would get hurt. He wanted me to get five children […] Now it was a must to use a method that didn’t require me to be going to the hospital because he would know. So it was a secret plan that I would use without his knowledge when I have that Norplant for five years he can’t know.” [Central Province, 3 children, separated, no FP method since separation]
Limited medical advice on contraception
“There are women who can have side effects [from the pill]. I was told if I get side effects I go back for a check-up if there is injection.” [Central Province, 1 child, single, IUD]
“I told them [I wanted] Norplant – they told me to wait.” [Central Province, children (number not known), married, condoms]