Gaps in knowledge and practice among postpartum women living with HIV in Swaziland
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Transcript of Gaps in knowledge and practice among postpartum women living with HIV in Swaziland
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Gaps in knowledge and practice among postpartum
women living with HIV in Swaziland
Charlotte Warren Rachel Shongwe, Nelisiwe Sikhosana, Joshua Kikuvi and Erick Oweya on behalf of INTEGRA Research Team
International FP Conference Senegal 201111.30-13.00 1/12/11
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Background
• Postpartum family planning (FP) programs enable women to achieve their fertility intentions
• However postpartum unmet need for FP is high• Evidence suggests that women living with HIV continue to
have unmet need for FP• This data focuses on interviews with postpartum women
living with HIV • Cohorts are part of the larger study to measure use of
integrated HIV/postnatal service and selected reproductive behaviours
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Methods • Cohorts of postpartum women (0 -10 weeks)
were recruited (N= 1114) from 10 health facilities after receiving postnatal services
• More than a third of the cohort (36%) were women living with HIV (n=402)
• Responses were analyzed among women 0 -4 weeks postpartum and those five weeks or more since childbirth
• Key outcomes compared using Chi Square test of association among postpartum women by HIV status
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Cohort age comparison by HIV status
Age HIV+n=401
HIV-n=708
P value
15-18yrs 3.5% 16.7% <0.00118-25yrs 40.9% 50.1% 0.00325-35yrs 50.4% 27.1% <0.00135-45yrs 5.2% 5.9% 0.631
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Marital status of all postpartum women interviewed by HIV status
married polygamous*
married monogomous*
living with partner*
in relationship**
single
0 10 20 30 40 50 60 70 80 90 100HIV-(n-708) HIV+ (n-401)
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FP methods used when client became pregnant and was not ready to be pregnant
Other methods
Female condom
Hormonal pills
Injectables
Male condom
0 20 40 60 80 100
HIV- (n-204) HIV+ (n-136)
• More HIV+ clients (50.4%) became pregnant when using a method compared to HIV negative clients (40.7%) [p=0.01]
• Only 13% had the correct knowledge regarding the fertile period
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Fertility desires among postpartum women living with HIV
Want another child Index pregnancy wanted0
102030405060708090
100
HIV + (n-401) HIV-
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Postpartum women living with HIV(0-10 weeks) do receive FP in postpartum period• 21.9% of all postpartum WLHIV received FP
method on the day interviewed (compared to 16.5% of HIV negative women)
• 21% had received method on a previous visit.
• For women who were 5 weeks or more postpartum 26% received FP method on the day of interview and 36% were already using a method.
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Postpartum counselling received
Received FP on day
Received FP on previous visit
Received counseling on FP
Received counseling on fertility
Received counseling on sexual activity
0 10 20 30 40 50
HIV- (n-703)HIV+ (n=399)
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FP methods received by postpartum women on the day of the interview
FP method received:
HIV+
n=130
HIV-n=8
4P value
Injectables 66.7%60.8
% 0.414
Hormonal pills 16.7%28.4
% 0.067Male condoms only 2.5% 8.1% 0.117Female condoms
only 6.1% 5.4% 0.847All other methods 0.0% 2.1% 0.503
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Use of condoms among those who received counseling on STI/RTI during ANC visits
(**p<0.001)HIV +
(n-326)HIV-
(n– 531)Use condom every time they have sex** 25.3% 12.7%
Would like to use but sometimes they don’t** 42.8% 45.9%
Uses condoms every now and then** 8.5% 4.9%
Never use condoms** 14% 26%
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Conclusions• These findings suggest that fertility
intentions of HIV positive women are low• There was limited knowledge of fertile period • Incorrect /inconsistent use of FP methods
prior to the pregnancy which might explain why two thirds say their most recent pregnancy was unplanned.
• More than half of women 5-10 weeks postpartum were using a contraceptive method