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The injection or the injection? Restricted contraceptive choices among women living with HIV

Authors :
Catriona A. Towriss
Tamsin K. Phillips
Kirsty Brittain
Allison Zerbe
Elaine J. Abrams
Landon Myer
Source :
Sexual and Reproductive Health Matters, Vol 27, Iss 1, Pp 215-227 (2019)
Publication Year :
2019
Publisher :
Taylor & Francis Group, 2019.

Abstract

Historically, women living with HIV (WLWH) have been vulnerable to biased advice from healthcare workers regarding contraception and childbearing. However, antiretroviral therapy (ART) has made motherhood safer, prompting a re-examination of whether contraceptive services enable the realisation of WLWH’s reproductive intentions. We use longitudinal quantitative data on contraceptive choice and use, and childbearing intentions collected in (up to) six interviews between entry into antenatal care (ANC) and 18 months post-partum from a cohort of 471 ART-initiated WLWH in Cape Town, South Africa. Thirty-nine of these women were randomly selected for in-depth interview where they described experiences of contraception services and use. We find high prevalence of injectable contraceptive (IC) use after birth (74%). With increasing post-partum duration, greater proportions of women discontinue this method (at 18 months 21% were not using contraception), while desires for another child remain stable. We find little consistency between method choice and use: many women who elected to use the intrauterine device, sterilisation or oral contraceptives at first ANC visit are using IC after birth. Women commonly report receiving an IC shortly after birth, including those who had previously chosen to use another method or no method. Among WLWH, injectables dominated the contraceptive method mix. Despite a human rights-grounded policy and attempts to introduce new methods, contraceptive services in South Africa remain largely unchanged over time. Women are frequently unable to make autonomous contraceptive choices. Despite low desires for future pregnancy, we observed high rates of contraceptive discontinuation, resulting in heightened risk of unintended pregnancy.

Details

Language :
English
ISSN :
26410397
Volume :
27
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Sexual and Reproductive Health Matters
Publication Type :
Academic Journal
Accession number :
edsdoj.b146efc1b8f94bee9f8ceef37741e0cc
Document Type :
article
Full Text :
https://doi.org/10.1080/26410397.2019.1628593