Sponsor
This work was supported by the National Institutes of Health R21HD069194 (A.K), R01MH054907 (D.R.B.), K23 MH095655 (L.T.M), P30AI027763 (J.N.M.), U01CA066529 (J.N.M.), and the Sullivan Family Foundation.
Published In
PLoS ONE
Document Type
Article
Publication Date
10-25-2019
Subjects
Family planning -- Uganda, HIV-positive women -- Uganda, HIV infections -- Uganda, Unplanned pregnancy, Contraceptives
Abstract
Background: Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.
Study design: This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count.
Results: Among 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3 , and were living with HIV for 3.8 years. Fifty pregnancies (45%) were reported as unintended and 60 (55%) as intended. Postpartum, 64% of women with unintended and 51% with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95% CI 1.12–3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95% CI 0.90– 0.99, p = 0.02).
Conclusions: Almost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.
DOI
10.1371/journal.pone.0206325
Persistent Identifier
https://archives.pdx.edu/ds/psu/27928
Publisher
Public Library of Science
Citation Details
Jarolimova J, Kabakyenga J, Bennett K, Muyindike W, Kembabazi A, Martin JN, et al. (2018) Contraceptive use following unintended pregnancy among Ugandan women living with HIV. PLoS ONE 13(10): e0206325. https://doi.org/ 10.1371/journal.pone.0206325
Included in
Community Health and Preventive Medicine Commons, Infectious Disease Commons, Women's Health Commons
Description
Copyright: © 2018 Jarolimova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.