Addressing the Family Planning Needs Of HIV-Positive PMTCT Clients

This is a research update that presents key findings about family planning research of the programme for prevention of mother-to-child transmission of HIV (PMTCT) sites in Kenya. This includes the interaction between providers and clients, as well as HIV-positive women’s fertility desires and demand for contraceptives, from the baseline cross-sectional survey and qualitative interviews with postpartum women.

The Horizons Programme, in collaboration with International Medical Corps (IMC) and Steadman Research Services International (SRSI), conducted an operations research study testing several community-based strategies to reduce mother-to-child transmission of HIV in a densely settled urban slum area in Nairobi, Kenya.

The strategies being piloted by IMC included moving PMTCT services closer to the population via a mobile clinic, and increasing psychosocial support for HIV-positive women through the use of traditional birth attendants and peer counselors. Peer counselors were HIV-positive women who had already received PMTCT services. The effectiveness of each of these strategies on women’s utilisation of key PMTCT services, including family planning, were measured by comparing baseline to follow-up data.


An excerpt from the Conclusions and Programme Recommendations section follows:

"These baseline data highlight that most HIV-positive women do not plan to have additional children. Yet these findings must be interpreted in the context of several characteristics of this setting. In this study, HIV-positive women who indicated that they did not want more children already had on average 2.8 children. More research is needed about demand for family planning among HIV-positive women who have no children or just one child.

Providers play a large role in influencing how women feel about future childbearing. These data demonstrate that providers have steered HIV-positive women away from future childbearing mainly due to concern about the woman’s health given her serostatus. Moreover, the lack of accurate information given to clients about the possibility of vertical transmission may also deter women from wanting another child. HIV-positive women expressed various considerations that are involved in their desire not to have further children, such as their own health concerns, already having a sufficient number of children, not wanting to pass on the virus, and economic vulnerability.

In this setting, there is significant demand by HIV-positive women for family planning in general, and condoms in particular. Yet, side effects are identified as the most important reason why women in these communities may not use contraceptives even if they do not want to become pregnant. These results provide important information that can be used by programme managers providing family planning counseling and services to HIV-positive women. Programme recommendations are as follows:

• Interventions should focus on providers since these data suggest that they have an instrumental role in affecting women’s decision-making regarding family planning. Providers should be trained to support HIV-positive women in achieving their sexual and reproductive health goals.
• Side effects continue to be a major issue for these women. Peer approaches, e.g. satisfied users, may be effective in reassuring women about the safety of contraceptive methods.
• Women are concerned about their own health as well as their ability to take care of existing children. Programmes should give care and support to women and their children by offering PMTCT+ services."