The impact of antenatal HIV diagnosis on postpartum childbearing desires in northern Tanzania: A mixed methods study
Reproductive Health Matters
Department of Anthropology, University College London, London, United Kingdom; National Institute for Medical Research, Mwanza, Tanzania; Barcelona Centre for International Health Research, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Institute for Medical Research, Mwanza, Tanzania; National Institute for Medical Research, Mwanza, Tanzania; Population Studies Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
With the expansion of routine antenatal HIV testing, women are increasingly discovering they are HIV-positive during pregnancy. While several studies have examined the impact of HIV on childbearing in Africa, few have focused on the antenatal/postpartum period. Addressing this research gap will help tailor contraceptive counseling to HIV-positive women's needs. Our study measures how antenatal HIV diagnosis affects postpartum childbearing desires, adjusting for effects of HIV before diagnosis. A baseline survey on reproductive behavior was administered to 5,284 antenatal clients before they underwent routine HIV testing. Fifteen months later, a follow-up survey collected information on postpartum reproductive behavior from 2,162 women, and in-depth interviews with 25 women investigated attitudes toward HIV and childbearing. HIV diagnosis was associated with a long-term downward adjustment in childbearing desires, but not with changes in short-term postpartum desires. The qualitative interviews identified health concerns and nurses' dissuasion as major factors discouraging childbearing post-diagnosis. At the same time, pronatalist social norms appeared to pressure women to continue childbearing. Given the potential for fertility desires to change following antenatal HIV diagnosis, contraceptive counseling should be provided on a continuum from antenatal through postpartum care, taking into account the conflicting pressures faced by HIV-positive women in relation to childbearing.
antiretrovirus agent; age distribution; article; attitude to pregnancy; educational status; family decision making; family size; female; follow up; HIV test; human; Human immunodeficiency virus infection; infection risk; maternal attitude; parity; paternal attitude; prenatal diagnosis; prevalence; priority journal; puerperium; qualitative analysis; reproductive rights; risk reduction; rural population; sexual behavior; Tanzania; virus transmission; women's health; women's rights; Adolescent; Adult; Contraception; Family Planning Services; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Intention; Middle Aged; Motivation; Pregnancy; Prenatal Diagnosis; Prevalence; Qualitative Research; Reproductive History; Tanzania; Young Adult