Background
Methods
Study design and study sites
Recruitment of participants and data collection
Characteristics of participants | Manhiça (n = 34) | Namaacha (n = 25) | Total |
---|---|---|---|
n/% | n/% | n/% | |
Age range | |||
18–24 | 14 (41.2) | 10 (40.0) | 24 (40.7) |
25–34 | 17 (50) | 11 (44.0) | 28 (47.5) |
35–39 | 3 (8.8) | 4 (16.0) | 7 (11.8) |
Educational Level | |||
None | 10 (29.4) | 4 (16.0) | 14 (23.7) |
Less than primary education (1–6 years) | 8 (23.5) | 6 (24.0) | 14 (23.7) |
Primary education completed or more (7–9 years) | 15 (44.1) | 12 (48.0) | 27 (45.8) |
Secondary education completed (12 years) | 1 (2.9) | 3 (12.0) | 4 (6.8) |
Marital Status | |||
Single | 5 (14.7) | 7 (28.0) | 12 (20.3) |
Married/Living with a partner | 27 (79.4) | 17 (68.0) | 44 (74.6) |
Divorced/Widow | 2 (5.9) | 1 (4.0) | 3 (5.1) |
Number of Children | |||
1–2 | 20 (58.8) | 14 (56.0) | 34 (57.6) |
3–4 | 11 (32.4) | 7 (28.0) | 18 (30.5) |
5–6 | 3 (8.8) | 4 (16.0) | 7 (11.8) |
Occupation | |||
Factor worker | 0 | 1 (4.0) | 1 (1.7) |
Farmer | 24 (70.6) | 19 (76.0) | 43 (72.9) |
Housemaid | 2 (5.9) | 1 (4.0) | 3 (5.1) |
Own business/sale | 6 (17.6) | 1 (4.0) | 7 (11.8) |
Student | 2 (5.9) | 1 (4.0) | 3 (5.1) |
Teacher | 0 | 2 (8.0) | 2 (3.4) |
Interview guide
Procedures
Data analysis
Results
HIV test and adherence to antiretroviral therapy prior to pregnancy among HIV positive women
HIV test prior to pregnancy
Characteristics of participants | Manhiça (n = 34) | Namaacha (n = 25) | ||
---|---|---|---|---|
HIV test prior to pregnancy | HIV test prior to pregnancy | |||
Yes (n/%) | No (n/%) | Yes (n/%) | No (n/%) | |
Age range | ||||
8–24 | 5 (14.7) | 9 (26.5) | 3 (12.0) | 7 (28.0) |
25–34 | 13 (38.2) | 4 (11.8) | 5 (20.0) | 6 (24.0) |
35–39 | 3 (8.8) | 0 | 4 (16.0) | 0 |
Educational Level | ||||
None | 5 (14.7) | 5 (14.7) | 1 (4.0) | 3 (12.0) |
Less than primary education (1–6 years) | 6 (17.6) | 2 (5.9) | 3 (12.0) | 3 (12.0) |
Primary education completed or more (7–9 years) | 9 (26.5) | 6 (17.6) | 6 (24.0) | 6 (24.0) |
Secondary education completed (12 years) | 1 (2.9) | 0 | 2 (8.0) | 1 (4.0) |
Marital Status | ||||
Single | 3 (8.8) | 2 (5.9) | 3 (12.0) | 4 (16.0) |
Married/Living with a partner | 17 (50) | 10 (29.4) | 8 (32.0) | 9 (36.0) |
Divorced/Widow | 1 (2.9) | 1 (2.9) | 1 (4.0) | 0 |
Number of Children | ||||
1–2 | 11 (32.4) | 9 (26.5) | 5 (20.0) | 9 (36.0) |
3–4 | 7 (20.6) | 4 (11.8) | 5 (20.0) | 2 (8.0) |
5–6 | 3 (8.8) | 0 | 2 (8.0) | 2 (8.0) |
Occupation | ||||
Factor worker | 0 | 0 | 1 (4.0) | 0 |
Farmer | 15 (44.1) | 9 (26.5) | 10 (40.0) | 9 (36.0) |
Housemaid | 1 (2.9) | 1 (2.9) | 0 | 1 (4.0) |
Own business/sale | 3 (8.8) | 3 (8.8) | 0 | 1 (4.0) |
Student | 2 (5.9) | 0 | 0 | 1 (4.0) |
Teacher | 0 | 0 | 1 (4.0) | 1 (4.0) |
Knew HIV positive prior to pregnancy | ||||
Yes | 6 (17.6) | 0 | 7 (28.0) | 0 |
No | 15 (44.1) | 13 (38.2) | 5 (20.0) | 13 (52.0) |
I had an HIV test, but it was long time before I got married. I wanted to know my situation as I heard many people had HIV. Fortunately, I was negative. By that time, I was not planning to have a baby. I got married and I did another test when I was pregnant. (Married, 1 child).
I did not do an HIV test because I did not plan to get pregnant. I did not think I could be HIV positive. I had never taken the HIV test before pregnancy. (Single, 1 child).
HIV status disclosure prior to pregnancy
I am afraid to disclose my HIV positive status to my husband because he will not go to healthcare facility for HIV testing. I do not know what will happen to me if I disclose my HIV positive status. Besides, most men in this community [Manhiça district] reject and abandon their wives as soon they disclose their HIV positive status. I don’t want to lose my children and home. (Married, 3 children).
My husband knows that I live with this disease [HIV] because we went to the healthcare facility to do an HIV test together when I was pregnant for the first time. (Married, 2 children).
Adherence to antiretroviral therapy prior to pregnancy
I did not often take antiretroviral before pregnancy because I had no money for transport. The healthcare facility is a long way from my home and the transport is very expensive. There was a time when I would go one or two months without drugs because I had no money to pay for the transport, and the healthcare providers only give you antiretroviral drugs for one month. (Married, 2 children).
I knew I was HIV positive in 2010. I started taking antiretroviral drugs at that time, but I stopped in 2012 because I was too tired taking these pills every day. Besides, at that time I was not pregnant and feeling very well. I did not know it was important to take antiretroviral drugs every day. (Single, 1 child).
When I started antiretroviral treatment, I felt hungry and dizzy shortly after taking the antiretroviral drugs because I did not have enough food. Sometimes, I would take tea as my main supper, on other days I would sleep without eating at all. But I still had to take antiretroviral drugs. I could not manage this situation because I had not money to buy food. So, I stopped taking antiretroviral drugs sometimes. I restarted antiretroviral therapy when I was pregnant. (Married, 5 children, FGD).
HIV test and adherence to antiretroviral therapy during pregnancy
HIV test during pregnancy
I did not know I was HIV positive before the test at the antenatal care clinic. When the nurse told me about it, I was shocked and scared. I was very sad because I did not expect this result. (Married, 1 child).
I did not do an HIV test at the antenatal care because I already knew I was HIV positive. When the nurse wanted to do it, I told her I was HIV positive and I showed her the documents showing that I was already taking antiretroviral drugs. (Single, 1 child).
HIV status disclosure during pregnancy
No, I have not yet disclosed my HIV positive status to my husband because when I gave him the letter from health facility he read and kept it. He often says he has no time due to work. He has never been to the health facility for an HIV test. I do not know what he will say or do when I disclose my HIV status. It is better he goes for the HIV test and find out for himself. (Married, 1 child).
The nurses gave me a letter inviting my husband to the healthcare facility. I gave him the letter and some days later, we went to the healthcare facility and we did the HIV test together. I repeated the test. It was found that we were both HIV positive, and the nurse explained us how to follow treatment. (Married, 5 children).
Adherence to antiretroviral therapy during pregnancy
In the beginning, I felt it was very complicated to follow the treatment and take antiretroviral drugs every day. Nurses advised me to do this in order to prevent HIV infection to my baby. I followed the treatment and I took antiretroviral drugs. Fortunately, my baby was born HIV negative (…). I am still following treatment for my baby and me. (Married, 3 children).
I took antiretroviral drugs during my pregnancy and I am still taking it to prevent HIV infection to my baby. The nurses told me that I have to take the medication to avoid passing the disease [HIV] to my child. I have no choice but to follow it. (Single, 2 children).
I take antiretroviral drugs with no problems because I tell my husband that the medication is for the health of the baby. Apart from antiretroviral drugs, nurses give us tablets for anaemia, malaria and pills to prevent pregnancy. My husband never checks the medication I bring from the healthcare facility, and he has never consented to go to the healthcare facility with me. (Married, 4 children).
Perception of pregnancy among HIV positive women
Pregnancy means that a woman is already adult and is responsible for taking care of her child. A woman is no longer a child. She becomes an adult and responsible for taking care of the child that will be born. (Single, 1 child).
Pregnancy means I am a woman. Every woman is supposed to become pregnant if she has a husband. When a woman is bearing children, she is fulfilling her task as a spouse. (Married, 1 child).
Pregnancy means that I am a woman that bears children and that I dignify and expand the surname of my husband’s family. I also contribute to the development of the country because I bear children to the family where I am married to. These children will grow up, work and contribute to the wellbeing of the country. (Married, 5 children).
When I knew I was pregnant I was very happy because I tried to get pregnant several times, but I could not conceive. When it was finally confirmed, it was the best moment of my life because I was going to have a child. It meant that I could bear children and have a family. (Married, 1 child).
Pregnancy means to have children. But becoming pregnant nowadays does not help me a lot because we [my husband and I] are sick [HIV positive]. Apart from that, we also have to raise the children we already have. Although I felt good during pregnancy because I could not feel pain in my body, I did not want more children. But that is it. My husband wanted it and I became pregnant. (Married, 3 children).
Perception of risk of pregnancy after HIV diagnosis
When I was pregnant, I was always sick and often not well... I started feeling unwell when I was 5 months pregnant and I only felt better after childbirth. I was afraid because I thought I could die during pregnancy or while giving birth. (Married, 4 children).
Being pregnant was complicated because besides managing my health, I was worried that the baby would be born with my disease [HIV]. I only felt happy when the baby was worn. (Married, 3 children).
When I knew I was HIV positive I was worried about my children. My parents have already died and I thought I could die and nobody would take care of my children. I live with my children and my husband. That worries me. I would like to be alive and see my children grow up to be eighteen years old when they can take care of themselves. (Married, 4 children).
I would say pregnancy is normal when a woman does not get sick from the time she gets pregnant until childbirth. But, if she is often sick, then that is not normal. It is an illness because a woman is always in the healthcare facility to get treatment. For me, for example, pregnancy is normal because in my experience I have never been sick during pregnancy. (Married, 3 children, FGD).
Experience of illnesses during pregnancy among HIV positive women
I got sick. I often felt pain in my body, was vomiting, and experienced diarrhoea. I think these were symptoms of the disease I have [HIV]. This is because since I started taking antiretroviral drugs, I no longer have such illnesses. (Married, 2 children).
Before being pregnant I did not get sick, I was vomiting and feeling dizzy because I was pregnant. I was already taking antiretroviral drugs when I got pregnant. I know some women who were HIV negative and they often got sick when they were pregnant. (Married, 3 children).
The decision-making process with regard to pregnancy
Planning pregnancy
Pregnancy is something that appears suddenly, even if you do not want it. As soon as you have a husband, you have to give him children. (Married, 1 child).
Characteristics of participants | Manhiça (n = 34) | Namaacha (n = 25) | ||
---|---|---|---|---|
Planned pregnancy | Planned pregnancy | |||
Yes (n/%) | No (n/%) | Yes (n/%) | No (n/%) | |
Age range | ||||
18–24 | 3 (8.8) | 11 (32.4) | 2 (8.0) | 8 (32.0) |
25–34 | 6 (17.6) | 11 (32.4) | 3 (12.0) | 8 (32.0) |
35–39 | 0 | 3 (8.8) | 1 (4.0) | 3 (12.0) |
Educational Level | ||||
None | 4 (11.8) | 6 (17.6) | 0 | 4 (16.0) |
Less than primary education (1–6 years) | 2 (5.9) | 6 (17.6) | 2 (8.0) | 4 (16.0) |
Primary education completed or more (7–9 years) | 2 (5.9) | 13 (38.2) | 1 (4.0) | 11 (44.0) |
Secondary education completed (12 years) | 1 (2.9) | 0 | 3 (12.0) | 0 |
Marital Status | ||||
Single | 0 | 5 | 0 | 7 |
Married/Living with a partner | 8 (23.5) | 19 (55.9) | 6 (24.0) | 11 (44.0) |
Divorced/Widow | 1 (2.9) | 1 (2.9 | 0 | 1 (4.0) |
Number of Children | ||||
1–2 | 7 (20.6) | 13 (38.2) | 4 (16.0) | 10 (40.0) |
3–4 | 2 (5.9) | 9 (26.5) | 2 (8.0) | 5 (20.0) |
5–6 | 0 | 3 (8.8) | 0 | 4 (16.0) |
Occupation | ||||
Factor worker | 0 | 0 | 0 | 1 (4.0) |
Farmer | 7 (20.6) | 17 (50.0) | 4 (16.0) | 15 |
Housemaid | 1 (2.9) | 1 (2.9 | 0 | 1 |
Own business/sale | 0 | 6 (17.6) | 0 | 1 |
Student | 1 (2.9) | 1 (2.9 | 0 | 1 |
Teacher | 0 | 0 | 2 (8.0) | 0 |
Knew HIV positive status prior to pregnancy | ||||
Yes | 0 | 6 (17.6) | 4 (16.0) | 3 (12.0) |
No | 9 (26.5) | 19 (55.9) | 2 (8.0) | 16 (64.0) |
I planned my last pregnancy because I wanted to have a third baby. The previous two have already grown up. (Married, 3 children).
I became pregnant because I wanted a child. I wanted to be a mother. I was married, and I had no child. (Married, 1 child).
When I became pregnant I felt good and emotional because in my family [father’s family] my sisters who were married already had a child. I was the only one who had not yet had a child. My family [father’s family] were already worried about why I could not get pregnant, so they [father’s family] were happy when they knew I was pregnant. (Married, 1 child).
Decision on pregnancy
I decided to become pregnant myself because I was an adult and married. I was 30 years old and I had not a child yet. (Married, 1 child).
My husband and I decided to have a baby. We talked about it and I felt I was ready to get pregnant. (Married, 1 child).
My husband decided that I should get pregnant. He wanted another child. We had one. This is the second child. (Married, 2 children).
I was not feeling very well when I became pregnant. I was scared because I did not want to become pregnant, as I already knew that I was sick [HIV positive]. Besides, we [my husband and I] were not [doing] very well in our relationship. But, when you become pregnant you cannot abort it. (Divorced, 6 children).
This thing of deciding pregnancy is difficult. As long as you are married, and your child is grown up, you can get pregnant any time. Even if you get pregnant while you are still breastfeeding you cannot abort it. Once it happened to myself. I had to cease breastfeeding my baby at 8 months old because I was pregnant. (Married, 3 children).
Modern contraceptive use among HIV positive women
Knowledge and use of modern contraceptives
I know about tablets that prevent pregnancy. Nurses often talk about it during pregnancy and breastfeeding. You can choose to have pills or an injection. When you are pregnant they give and advise us to use a condom. They give us male condoms. Now that I am breastfeeding, they give me pills and male condoms. (Married, 1 child).
Sometimes I get pills from the private pharmacy near my home. This happens when I finish pills that the nurses give me and I have no time to go to the healthcare facility. Nurses give me pills for one month, meaning that I have to go to the healthcare facility every month to access it. (Married, 2 children).
Reasons to use modern contraceptives
Before getting pregnant I was using pills to prevent pregnancy because I had not decided to get pregnant again. I stopped using pills when I wanted to get pregnant. (Married, 4 children).
I started using a male condom when I was pregnant. My husband accepted it because the nurses advised a condom would prevent passing HIV infection from me to the baby. (Married, 2 children).
I use male condom now that I am breastfeeding. My husband accepts it. He knows I am HIV positive and I am taking antiretroviral drugs. I cannot do anything without informing him [husband]. (Married, 1 child).
I am using injections to prevent pregnancy because the baby is still only eight months years old. Nurses advised me to prevent pregnancy until the baby is 24 months old. (Married, 1 child).
Women must space pregnancies. For a woman to become pregnant, a child should have 18 months or 24 months. It is a responsibility because it is necessary to take care of the baby (…). Women should not become pregnant before a baby has grown up enough. It is bad because if a woman does not space pregnancies children will not grow healthy. (Married, 2 children, FGD).
Reason for not using modern contraceptives
I do not use any contraceptive method because I am still breastfeeding (…). My husband works and lives in South Africa and comes home once a year, especially at the end of the year. (Married, 1 child).
My husband does not accept to use condoms (…). He does not allow me to take pills; he says these things are not useful. (Married, 2 children).
I was not using a condom during pregnancy because my husband does not accept it. Besides, I have not yet told him I am HIV positive. (Married, 1 child).
I used to take pills … but I think I forgot to take it some days… I got pregnant. (Single, 1 child).
I do not use contraceptives to prevent pregnancy because I am still breastfeeding. My mother-in-law advised me not to engage in sexual activities before the baby completes six months. She said the baby will have diarrhoea or he will not grow up very well. He will be six months next month [April 2015]. (Married, 2 children).
We have resumed sexual activities because the baby has grown up. He is 7 months now, but I am still breastfeeding. I do not use contraceptive and condom because my husband does not accept these things. He says sexual activity is no longer prohibited. (Married, 1 child).
Problems experienced during the use of modern contraceptives
I started using injections two months after childbirth. But I was not feeling well. I stayed two months without seeing menstruation. I decided to give up. Then, I changed to pills. But I am now having problems again. My menstruation has been coming out for one month now. It does not stop. I have not yet gone to the health facility to explain it. (Mother, 2 months).
Sometimes the injection is not strong enough to prevent pregnancy. Maybe it depends from a person to person. I was applying injection, but after some time, I started feeling something in my belly. Four months later, I went to the healthcare facility and the nurses told me I was pregnant. How was I pregnant if I was taking injections?... I do not understand. (Married, 4 children).
Consulting a healthcare provider prior to pregnancy
Knowledge and practice of seeking a health provider prior to pregnancy
I did not know I had to consult a healthcare provider before pregnancy. I have never been advised about that. (Widow, 1 child).
I went to the healthcare facility to consult a healthcare provider before pregnancy because I know I am sick [HIV positive]. In my status, when CD4 is low it is not allowed to become pregnant. After analysing my situation, a healthcare provider advised me to become pregnant. (Married, 3 children).
Characteristics of participants | Manhiça (n = 34) | Namaacha (n = 25) | ||
---|---|---|---|---|
Consulted a health provider | Consulted a health provider | |||
Yes (n/%) | No (n/%) | Yes (n/%) | No (n/%) | |
Age range | ||||
18–24 | 1 (2.9) | 13 (38.2) | 0 | 10 (40.0) |
25–34 | 2 (5.9) | 15 (44.1) | 2 (8.0) | 9 (36.0) |
35–39 | 1 (2.9) | 2 (5.9) | 1 (4.0) | 3 (12.0) |
Educational Level | ||||
None | 1 (2.9) | 9 (26.5) | 0 | 4 (16.0) |
Less than primary education (1–6 years) | 1 (2.9) | 7 (20.6) | 1 (4.0) | 5 (20.0) |
Primary education completed or more (7–9 years) | 2 (5.9) | 13 (38.2) | 1 (4.0) | 11 (44.0) |
Secondary education completed (12 years) | 0 | 1 (2.9) | 1 (4.0) | 2 (8.0) |
Marital Status | ||||
Single | 1 (2.9) | 4 (11.8) | 1 (4.0) | 6 (24.0) |
Married/Living with a partner | 3 (8.8) | 24 (70.6) | 2 (8.0) | 15 (60.0) |
Divorced/Widow | 0 | 2 (5.9) | 0 | 1 (4.0) |
Number of Children | ||||
1–2 | 3 (8.8) | 17 (50.0) | 1 (4.0) | 13 (52.0) |
2–4 | 1 (2.9) | 10 (29.4) | 2 (8.0) | 5 (20.0) |
5–6 | 0 | 3 (8.8) | 0 | 4 (16.0) |
Occupation | ||||
Factor worker | 0 | 0 | 0 | 1 (4.0) |
Farmer | 3 (8.8) | 21 (61.8) | 2 (8.0) | 17 (68.0) |
Housemaid | 0 | 2 (5.9) | 0 | 1 (4.0) |
Own business/sale | 1 (2.9) | 5 (14.7) | 0 | 1 (4.0) |
Student | 0 | 2 (5.9) | 0 | 1 (4.0) |
Teacher | 0 | 0 | 1 (4.0) | 1 (4.0) |
Knew HIV positive status prior to pregnancy | ||||
Yes | 0 | 6 (17.6) | 3 (12.0) | 4 (16.0) |
No | 4 (11.8) | 24 (70.6) | 0 | 18 (72.0) |
Yes, I consulted a nurse who is one of my family members. I wanted to know about tablets of fertilization because I could not get pregnant. (Married, 1 child).
My husband and I did not consult a healthcare provider before I got pregnant because we thought there was no need. I do not have a problem of fertility because this is my second child. Even with the first child we did not seek a healthcare provider before pregnancy. (Married, 2 children).
I heard that some women consult a healthcare provider to become pregnant, but I did not do so. I could not become pregnant for a long time, but I used only traditional remedies. After some time, I became pregnant. (Married, 1 child).
Perceptions regarding seeking a healthcare provider prior to pregnancy
For me, there is no problem to consult a healthcare provider before pregnancy. It is not difficult. But, the problem is with my husband. He does not know that I am HIV positive. I gave him the invitation letter when he came from South Africa, but he did not go for an HIV test yet. He kept it and whenever he comes back, he says he will go to the healthcare facility. Maybe that could make the process difficult. (Married, 2 children).
If a healthcare provider advises me to consult him before pregnancy, I will do that. But deciding when to become pregnancy is my private issue. (Married, 3 children).
To decide to become pregnant is an issue between my husband and me. I only get pregnant when I am happy and when I want. It is my option. (Married, 4 children).
The practice of maternal and child health nurses when counselling on HIV tests and antiretroviral therapy
The practices of maternal and child health nurses on counselling for HIV testing and antiretroviral therapy prior to pregnancy
We often give lectures to all people who come to the healthcare facility for consultation. We talk about the different type of diseases, including HIV and AIDS. We talk about prevention methods and treatment. We also advise all participants to adhere to an HIV test. (MCH nurse).
Few people adhere to the HIV test. When I was working in the department of counselling and voluntary testing, I could stay one or two days without a single person requesting an HIV test. It is rare to see people coming voluntarily for an HIV test. I do not remember to have attended a woman who was looking for an HIV test because she was planning to become pregnant. (MCH nurse).
Some women know their HIV positive status before they get pregnant. They adhere to antiretroviral drugs mostly when they are sick. But, after they feel better, they abandon it. I have several experiences of women who abandoned antiretroviral therapy. When I meet them in the community, I talk to them about the importance of continuing with HIV treatment. Some say they are feeling physically good, and promise to come back, while others say they are continuing treatment in another healthcare facility. (MCH nurse).
Sometimes, women follow HIV treatment and they pick antiretroviral drugs, but when they arrive at their homes they do not take it. We discover it when they become sick and we ask if they really take antiretroviral therapy regularly; and some reveal that [they] have some antiretroviral drugs kept at home. They did not take it as recommended. (MCH nurse).
Practices of maternal and child health nurses counselling on HIV test and antiretroviral therapy during pregnancy
All pregnant women have to do an HIV test on their first antenatal care visit. We counsel them, and we explain about the need of the test and its importance to their health and that of the baby. But, most women do not reveal their HIV positive status. In this case, we test them. Some already know their HIV positive status, but they do not believe it, and others do not reveal it because they have abandoned antiretroviral drugs. A woman who is taking antiretroviral drugs has documents that show she often complies with HIV treatment. Most women hide these documents when they come to the first antenatal care visit. (MCH nurse).
Women comply with antiretroviral therapy during pregnancy and breastfeeding. But, once they stop breastfeeding and know the final result of the HIV status of their babies, most abandon HIV treatment. They most often restart it when they get pregnant again. Some even move to another healthcare facility when they get pregnant and when they arrive there, they do not disclose their HIV positive status. (MCH nurse).
Every pregnant woman receives a letter of invitation after an HIV test regardless of the result. The letter requests a male partner to go to the healthcare facility to learn about the health of the foetus. We never mention an HIV test in the letter, but very few come here after receiving it. The majority do not come because they already know they will be requested to do an HIV test. (MCH nurse).
Most women who test HIV positive say they are afraid to tell their husbands about it. This is the reason why we invite their husbands to the healthcare facility. Besides, I have witnessed that most women and men who live with HIV do not come to this healthcare facility. They go to another healthcare facility far from their community because they do not want to be seen by their neighbours and family members that they are receiving HIV treatment. They go to another healthcare facility where nobody knows them. (MCH nurse).
Practices and perceptions of maternal and child health nurses regarding counselling on pregnancy planning and adherence to medical advice prior to pregnancy
Practices of maternal and child health nurses regarding women’s adherence to modern contraception
We talk about modern contraceptives in every meeting with women; during pregnancy, prenatal, breastfeeding or other meetings. We advise women to choose to use pills, injections or intra-uterine device. We advise them to use contraceptives to prevent pregnancy. We tell women to avoid pregnancy before the baby completes 24 months. We also give, and teach them how to use, a male condom. When they are pregnant we advise them to use a condom. We give them contraceptives including male condoms every month when they come to the healthcare facility. (MCH nurse).
When we give male condoms, women throw them away before they arrive at their homes. They often say their husbands do not accept to use condoms. They also say their husbands do not allow them to use contraceptives because they think their wives may engage into sexual activities with other men. (MCH nurse).
I have many family planning cards in my drawer that women asked me to keep for them to avoid that their husbands discovering that they use contraceptive methods (…). I give them pills and they take it at home without disclosing to their partners. When their husbands do not see the family planning card, they have less chance to discover that their wives take pills. (MCH nurse).
Some women that use implants also get problems with their husbands. Once I fitted an implant to a woman after childbirth, and when her husband discovered [it] he told her to take it away. I invited her husband and I explained him that if his wife did not use an implant she would get pregnant before the baby was 2 months old and that would harm the baby. I told him I would take out the implant after the baby completed 24 months. After this explanation, he accepted my advice and only by this way the woman kept the implant. (MCH nurse).
Perceptions of maternal and child health nurses regarding women’s adherence to medical advice prior to pregnancy
We often don’t advise women to seek a healthcare provider before pregnancy because they come to the healthcare facility already pregnant. Here, we advise women about treatment and preventing vertical transmission of HIV and contraceptive use. (MCH nurse).
Even if we tell women to seek a healthcare provider before pregnancy, they might not follow this advice. Women often come to the healthcare facility when they are sick, pregnant or breastfeeding. You mostly see women because they are pregnant, and they are coming for the first antenatal care. (MCH nurse).
I know I can counsel HIV positive women about when to have a safe pregnancy. We first check if her CD4 allows it. She can only get pregnant if her CD4 is equal or more than 350 cells. This is the recommended CD4 level. If the CD4 is less than 350 cells, she should wait because the lower the CD4 the higher the chance of passing HIV to [the] infant. (MCH nurse).