Factors Accounting for Differences of Fertility Desires and Intentions Among HIV-Infected and Uninfected Women of Reproductive Age at Six Hospitals in Two Regions of Kenya
International Journal of HIV/AIDS Prevention, Education and Behavioural Science
Volume 4, Issue 1, June 2018, Pages: 11-19
Received: Jun. 23, 2018;
Accepted: Jul. 9, 2018;
Published: Aug. 1, 2018
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Simba Milker Atieno, Faculty of Health Sciences, Jomo Kenyatta University of Agriculture and Technology Nairobi, Kenya
Linus Gitonga, Department of Biological Sciences, Karatina University, Nairobi, Kenya
Zipporah Ng’ang’a, Department of Medical Laboratory Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
Patrick Orege, Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
Previous studies indicate that parenthood is a central life goal in most societies. Child bearing among HIV infected women poses danger of vertical HIV transmission. The study sought to investigate factors accounting for the differences in levels of fertility desires and intentions for HIV-infected and uninfected women of reproductive age from six hospitals in Nyanza and Central regions of Kenya. Intention connotes commitment to a course which usually leads to instrumental behaviors whereas desires are, however, wishes, which may be based more on emotions than on reality. A combination of quantitative and qualitative methods was used. Both HIV-infected and uninfected women desired and intended to have a median of three children. Women from Nyanza were 10.1 times more likely to desire more children than those from Central region (p<0.001). There was significant greater intention to have children among women aged 40-44 years or older with lower levels of education and living in rural areas. Cultural factors were found to influence fertility desires and intentions among women. To eliminate mother-to-child transmission of HIV, reproductive health interventions should take into consideration the special needs of HIV-infected women to avoid unintended pregnancies, and eliminate the risk of vertical transmission. Additional tailored sexual and reproductive care and counselling support should be provided to HIV- infected women; couples and men to assist them make decisions on issues such as number, spacing and timing of pregnancy and use of contraceptives. Fertility and family planning education should be part of each clinic visit for both female and male HIV- infected clients. More effort should be put on educating male HIV infected clients since male partners have greater influence on fertility intentions in the family in Kenyan society.
Simba Milker Atieno,
Factors Accounting for Differences of Fertility Desires and Intentions Among HIV-Infected and Uninfected Women of Reproductive Age at Six Hospitals in Two Regions of Kenya, International Journal of HIV/AIDS Prevention, Education and Behavioural Science.
Vol. 4, No. 1,
2018, pp. 11-19.
Kenya HIV County Profile, (2016). Accessed on 28/4/2018 (http://nacc.or.ke/wp-content/uploads/2016/12/Kenya-HIV-County-Profiles-2016.pdf?)
National AIDS and STI Control Program (NASCOP) and National AIDS Control council (NACC). (2016). Kenya HIV Estimates Report, 2015. Nairobi: Ministry of Health. (http://nacc.or.ke/wp-content/uploads/2016/12/Kenya-HIV-Estimates-2015.pdf)
UNAIDS, (2016) Country Fact sheet (http://www.unaids.org/en/regionscountries/countries/kenya
National Bureau of statistics and ICF International, (2015). 2014 KDHS Key findings. Rockville, Maryland USA: KNBS and ICF International (https://www.dhsprogram.com/pubs/pdf/sr227/sr227.pdf)
NACC. Kenya AIDS Response Progress Report, 2016. Nairobi: Ministry of Health, (http://nacc.or.ke/wp-content/uploads/2016/11/Kenya-AIDS-Progress-Report_web.pdf)
Kyomuhendo S. and Kiwanuka, J. (2008). Access to care, treatment and sexual and reproductive health rights and needs of HIV positive women in Masindi and Busia districts, Uganda. International Community of Women Living with HIV/AIDS Eastern Africa Region.
Mwau M. Bwana P. Kithinji L. et al (2017). Mother- to- Child transmission of HIV in Kenya: A cross-sectional analysis of national data base over 9 years, PLOS ONE; 12(8): doi 10. 1371/journal.pone. 0183860.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. (2015). Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS One; 10(2):e0116144. pmid:25695494
Oladapo OT, Olusoji JD, Odusoga OL et al. (2005). Fertility desires and intentions of HIV-infected patients at a suburban specialist centre. Journal of the National Medical Association. 12: 1672-1682. 7.
Withers M, Dworkin S, Harrington E, et al. (2014). Fertility intentions among HIV-infected, sero-concordant Kenyan Couples in Nyanza province, Kenya. Journal of Culture Health Sexuality. 15(10): 10. 1080/13691058. 2013. 811289.
Becker G and Nacthigall RD. (1994). Born to be a mother: the cultural construction of risk in infertility treatment in the US. Social Science Medicine. 39: 507-518.
Guthrie Bl, deBruyn G and Farquhar C. (2007). HIV-1-discordant couples in sub-Saharan Africa: explanations and implications for high rates of discordancy. Current HIV Research. 4: 416-429.
Ujiji OA, Ekstrom AM, Ilako F. et al. (2010). I will not let my HIV-status stand in the way: decisions on motherhood among women on ART in a slum in Kenya. BMC Women’s Health. 133.
Ayieko J, Ti A, Hagey J, Akama E, Bukusi EA, Cohen GR and Patel RC. (2016). HIV status and Treatment Influence on Fertility desires among Women newly becoming eligible for Antiretroviral Therapy in Western Kenya: Insights from a Qualitative study. BMC Reproductive Health.
Kebogile M & Yenealem RB (2017) Fertility intention and use of contraception among women living with the human immunodeficiency virus in Oromia Region, Ethiopia, South African Family Practice, 59:1, 46-51, DOI: 10. 1080/20786190. 2016. 1254931.
Ashimi A O, Amole T G, Abubakar M Y, Ugwa E A. Fertility desire and utilization of family planning methods among HIV-positive women attending a tertiary hospital in a suburban setting in Northern Nigeria. Trop J Obstet Gynaecol [serial online] 2017 [cited 2018 Jul 4]; 34: 54-60. Available from: http://www.tjogonline.com/text.asp?2017/34/1/54/207095
Mayhew SH, Colombini M, Kimani JK, et al (2017). Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study BMC Public Health. 2017; 17: 626. doi: 10. 1186/s12889-017-4514-2.
Kimani J, Warren C, Abuya T Mutemwa R et al. (2015). Family planning use and fertility desires among women living with HIV in Kenya. BMC Public Health; 15: 909. doi: 10. 1186/s12889-015-2218-z.
Ngugi EW, Kim AA, Nyoka R, N’gan’ga L, et al. (2014). Contraceptive Practices and Fertility Desires Among HIV-Infected and Uninfected Women in Kenya: Results from a Nationally Representative Study. Journal of Acquired Immune Deficiency Syndrome. Volume 66, supplement 1.
Gutin SA, Namusoke F, Shade SB, & Mirembe F. (2014). Fertility Desires and Intentions among HIV –positive Women during Post-natal period in Uganda. African Journal of Reproductive Health; 18(3): 67.
Wekesa & Coast E. (2015). Contraceptive Need and Use among Individuals with HIV/AIDS Living in the slums of Nairobi Kenya. Journal of Gynecology and Obstetrics 130, E31-E36.
Oyebode T, Sagay A, Musa J, Ekwempu C, Agaba P, Idoko J, Okonkwo P, Kanki P. Unmet need for contraception among human immunodeficiency virus-positive women in Jos, Nigeria: A call to integrate family planning and human immunodeficiency virus services. J HIV Hum Reprod 2016;4:13-9
Abeje G. & MotbaynorA. (2016). Demand for family planning among HIV positive women on ART: the case of South Gondar and North Wollo Zones Amhara region, BMC Res Notes 2016; 9:43. Doi: 10. 1186/s13104-016-1850-8.
Ajzen I. (2005). Attitudes, personality, and behavior. 2nd ed. Maidenhead, Berkshire, England: Open University Press.
Ajzen I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes. 50: 179-211.
Ivy, AK, David R. J. & Johson, BC. (2010), Examining the predictive value of fertility preferences among Ghanaian women. Demographic Research. 2010; 22: 965–984. doi: 10. 4054/DemRes. 22. 30.
KNBS, Kenya. Kenya Demographic and Health Survey 2008-09. (, 2009). Preliminary Report, Calverton, Maryland: KNBS, NACC, NASCOP, NPHLS, KEMRI, NCAPD, ICF Macro. (https://dhsprogram.com/pubs/pdf/fr229/fr229.pdf)
Cochran WG. (1963.). Sampling Techniques. 2nd ed. New York: John Wiley and Sons,
StataCorp. 2013. Statistical Software: Release 13. College Station, TX: StataCorp LP
Jones DL Cook R. Potter JE Shatz MT et al (2016). Fertility Desires among Women Living with HIV. PLoS One. 2016; 11(9): e0160190. doi: 10. 1371/journal. pone. 0160190
Tan PC, & Tey NP. (1994). Do Fertility Intentions Predict Subsequent Behaviour? Evidence from Peninsular Malaysia: Studies on Family Planning.
Mekonnen H, Enquselassie F (2017) Effect of antiretroviral therapy on changes in the fertility intentions of human immunodeficiency virus-positive women in Addis Ababa, Ethiopia: a prospective follow-up study. Journal of Epidemiology and Health; 39: e2017028. DOI: https://doi.org/10.4178/epih.e2017028
Rutaremwa G, & Kabagenyi A. (2016). Utilization of Integrated HIV and Sexual and Reprodictive Health Services among Women in Uganda. BMC Health Services Research. https://doi.org/10.1186/s12913-016-1761-3
UNFPA. (2004). The Glion Call to Action on Family Planning and HIV/AIDS in Women and children. New York. Available at http://www.who.int/hiv/pub/advocacymaterials/glionconsultationsummary-DF pdf
Caldwell JC and Caldwell P. (1987). The cultural context of high fertility in sub-Saharan Africa. Population and Development Review. 13: 409-437.
Fapohunda BM, & Poukouta P. V. (1997). Trends and Differentials in Desired Family Size in Kenya. African Population Studies: 12 (1)
Kalule-Sabiti (1992) Socio-economic factors affecting fertility in Kenya, South African Journal of Sociology, 23:2, 46-52, DOI: 10. 1080/02580144. 1992. 10429816
"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. (2016). Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10. 17226/21857.
Lerch M. (2017). Urban and Rural Fertility Transitions in developing World: A cohort perspective. Max Planck Institute for Demographic Research; MPIDR Working Paper.
Bodkin C, Klopper H and Langley G. (2006). A comparison of HIV positive and negative pregnant women at a public sector hospital in South Africa. Journal of Clinical Nursing; 6: 735-741.
Gonzalez R, Ruperez M, Sevene E, Vala A, Maculuves S, Bulo H et al. (2017). Effects of HIV infection on maternal and neonatal health in Sourthern Mozambique: A prospective cohort study after a decade of antiretroviral drugs roll out. PLOS ONE.
Barber JS. (2011). Theory of Planned Behaviour: Considering Drives, Proximity and Dynamics. Vienna Yearbook of Population Research, 9, 31-35. Doi: 10. 1553/population yearbook 2011s31
Wagner G J. and Wanyenze R. (2013). Fertility Desires and Intentions and the Relationship to Consistent Condom Use and Provider Communication regarding Childbearing among HIV Clients in Uganda. Infectious Diseases. Volume 2013, Article ID 478192, 7 pages. http://dx.doi.org/10.5402/2013/478192
Chen JL, Philips KA Kanouse DE et al. (2001). Fertility desires and intentions of HIV-infected men and women. Family Planning Perspectives; 13: 144-152.