Fertility Desires and Family Size Preferences of HIV Positive Women Accessing Care in the University of Port Harcourt Teaching Hospital

Introduction: Women living with HIV may or may not intend to bear children. They may also have different preferences in terms of family sizes. The desire of HIV positive women to bear children and their family size preferences has significant implication for horizontal and vertical transmission of this incurable disease. This study, therefore, aims to determine fertility preferences and their predictors among HIV positive women accessing care at UPTH, Port Harcourt, Rivers State. Methods: The study was a descriptive cross-sectional study among 402 women within the reproductive age (15-49 years) who were on Antiretroviral Therapy (ART). Participants were recruited using systematic sampling method and were interviewed with an interviewer-administered questionnaire. A semi-structured, self-administered questionnaire was used to obtain participant’s socio-demographic characteristics, desire for children, use, demand and choice of contraception and reproductive characteristics. With SPSS version 20, data was summarised as descriptive statistics and Chi-square test was used to test for association. Results: The study showed that 81.8% of respondents desire to have children out of which 96 (29.3%) desired one to two children, 169 (51.5%) desired three to four children, and 18 (5.5%) wanted five or more children. Factors such as age, marital status, and disclosure of Sero-status to partner were found to be associated with family size preferences (p<0.05). Conclusion: HIV positive women in Port Harcourt have high fertility desires and moderate family sizes preferences; thus, indicating the need for more support and involvement of the government and relevant stake holders in ensuring better access to ART services in the country. More resources should be channelled towards provision of effective preventive medications and services, people who live with HIV (PLHIVs) should be continuously and adequately sensitised with the necessary knowledge on how to make healthy reproductive decisions, as well as on available practicable reproductive options for HIV-infected women should be made efficient, and easily accessible.

The gap between desired and expected fertility among women in Iran: A case study of Tehran city

The 2016 Iranian Census reveals that 14 of the country’s 31 provinces have sub-replacement fertility. The province of Tehran, where a woman on average gives birth to 1.5 children during her reproductive period, has the lowest fertility in Iran. However, the ‘two-child’ norm prevails in the country and even a woman of young reproductive age still values having at least two children on average. In other words, there exists a gap between a woman’s actual and desired fertility. This paper examines the demographic and socio-economic factors influencing the gap between actual and desired fertility in Tehran city based on a sample survey of 400 married women aged 15–49 years, conducted in 2015. The findings of the study reveal that the women of Tehran would be able to meet their fertility desires of two or more children if they were able to achieve their intended number of children they stated in the survey. However, should these women face any socio-economic constraint, they would be very likely to restrain their fertility desires and have fewer additional children than they initially intended, and thus continue with the sub-replacement fertility as being observed in Iran today.

Fertility desires of people living with HIV: does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

Background There is a need for information and healthcare support for the fertility desires and contraceptive needs of people living with HIV (PLHIV) in order to provide safer conception support for sero-discordant couples wanting to safely conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in the eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation of the model. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and antiretroviral treatment (ART) access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health negatively impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.

Fertility Desires and Intentions of HIV-Positive Women of Reproductive Age in Ontario, Canada: A Cross-Sectional Study

Background: Improvements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada. Methodology/Principal Findings: A cross-sectional study with recruitment stratified to match the geographic distribution of HIV-positive women of reproductive age (18–52) living in Ontario was carried out. Women were recruited from 38 sites between October 2007 and April 2009 and invited to complete a 189-item self-administered survey entitled ‘‘The HIV Pregnancy Planning Questionnaire’’ designed to assess fertility desires, intentions and actions. Logistic regression models were fit to calculate unadjusted and adjusted odds ratios of significant predictors of fertility intentions. The median age of the 490 participating HIV-positive women was 38 (IQR, 32–43) and 61%, 52%, 47% and 74% were born outside of Canada, living in Toronto, of African ethnicity and currently on antiretroviral therapy, respectively. Of total respondents, 69% (95% CI, 64%–73%) desired to give birth and 57% (95% CI, 53%–62%) intended to give birth in the future. In the multivariable model, the significant predictors of fertility intentions were: younger age (age,40) (p,0.0001), African ethnicity (p,0.0001), living in Toronto (p = 0.002), and a lower number of lifetime births (p = 0.02). Conclusions/Significance: The proportions of HIV-positive women of reproductive age living in Ontario desiring and intending pregnancy were higher than reported in earlier North American studies. Proportions were more similar to those reported from African populations. Healthcare providers and policy makers need to consider increasing services and support for pregnancy planning for HIV-positive women. This may be particularly significant in jurisdictions with high levels of African immigration.

Fertility Desires and Intentions of HIV-Positive Women of Reproductive Age in Ontario, Canada: A Cross-Sectional Study

Background: Improvements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada. Methodology/Principal Findings: A cross-sectional study with recruitment stratified to match the geographic distribution of HIV-positive women of reproductive age (18–52) living in Ontario was carried out. Women were recruited from 38 sites between October 2007 and April 2009 and invited to complete a 189-item self-administered survey entitled ‘‘The HIV Pregnancy Planning Questionnaire’’ designed to assess fertility desires, intentions and actions. Logistic regression models were fit to calculate unadjusted and adjusted odds ratios of significant predictors of fertility intentions. The median age of the 490 participating HIV-positive women was 38 (IQR, 32–43) and 61%, 52%, 47% and 74% were born outside of Canada, living in Toronto, of African ethnicity and currently on antiretroviral therapy, respectively. Of total respondents, 69% (95% CI, 64%–73%) desired to give birth and 57% (95% CI, 53%–62%) intended to give birth in the future. In the multivariable model, the significant predictors of fertility intentions were: younger age (age,40) (p,0.0001), African ethnicity (p,0.0001), living in Toronto (p = 0.002), and a lower number of lifetime births (p = 0.02). Conclusions/Significance: The proportions of HIV-positive women of reproductive age living in Ontario desiring and intending pregnancy were higher than reported in earlier North American studies. Proportions were more similar to those reported from African populations. Healthcare providers and policy makers need to consider increasing services and support for pregnancy planning for HIV-positive women. This may be particularly significant in jurisdictions with high levels of African immigration.