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Background: Women living with HIV continues to encounter unintended pregnancies with a concomitant risk of mother-to-child transmission of HIV infection. Preventing unintended pregnancy among HIV-infected women is one of the strategies in the prevention of new HIV infections among children. The aim of this analysis was to assess the practice of family planning (FP) among HIV-infected women and the influence of women’s awareness of HIV positive status in the practice of FP. Methods: The analysis was made in the Malawi Demographic and Health Survey (DHS) data among 489 non-pregnant, sexually active, fecund women living with HIV. Multiple logistic regression analysis was performed using SPSS software to identify the factors associated with FP use. Adjusted odds ratios (AOR) with 95 % confidence intervals were computed to assess the association of different factors with the practice of family planning. Result: Of the 489 confirmed HIV positive women, 184 (37.6 %) reported that they knew that they were HIV positive. The number of women who reported that they were currently using FP method(s) were 251 (51.2 %). The number of women who reported unmet need for FP method(s) were 107 (21.9 %). In the multiple logistic regression analysis, women’s knowledge of HIV positive status [AOR: 2.32(1.54, 3.50)], secondary and above education [AOR: 2.36(1.16, 4.78)], presence of 3-4 alive children [AOR: 2.60(1.08, 6.28)] and more than 4 alive children [AOR: 3.03(1.18, 7.82)] were significantly associated with current use of FP. Conclusion: Women’s knowledge of their HIV-positive status was found to be a significant predictor of their FP practice. Health managers and clinicians need to improve HIV counselling and testing coverage among women of child-bearing age and address the FP needs of HIV-infected women.
Malawi is divided into three regions namely the Northern, Central, and Southern Region. There are 28 districts in the country. The Malawi DHS was implemented by the National Statistical Office (NSO) with a nationally representative sample of more than 27,000 households. Individual interviews were made with all eligible women aged 15–49 in these households and all eligible men aged 15–54 in a subsample of one-third of the households. HIV testing was conducted among eligible women aged 15–49 and eligible men aged 15–54 in a selected subsample of one-third of the households. Data for this analysis were drawn from the Malawi DHS of 2010 which was designed to provide population and health indicator estimates at the national, regional, and district levels [3]. Standard household questionnaire, women’s questionnaire and men’s questionnaire were used. The questionnaires were adapted to reflect the population and health issues relevant to Malawi. In addition to English, the questionnaires were translated into two major languages: Chichewa and Tumbuka. The questionnaires were pre-tested and data collectors were trained on the questionnaires, interviewing techniques and field procedures. Data were collected by thirty-seven interview teams. One supervisor (team leader), one field editor, four female interviewers, two male interviewers, and one driver constituted a team. Staff members from NSO and ICF Macro coordinated and supervised fieldwork activities. Data collection took place over six-month period: June-November 2010 [3]. In 2010, the Malawi DHS recorded data relating to fertility levels, nuptiality, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of mothers and young children, early childhood mortality, maternal mortality, maternal and child health, malaria, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections, and HIV prevalence. This analysis is based on 489 non-pregnant, HIV confirmed fecund women who were sexually active in the 12 months preceding the survey [3]. Eligible women and men were asked to voluntarily provide five drops of blood for HIV testing. Participants were provided with information on the procedure, confidentiality of the data, and the fact that the test results would not be made available. After securing consent for the HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a bar code label unique to the respondent was affixed. Information brochure on HIV/AIDS was provided to each household irrespective of their consent to give blood for HIV testing. The details of the testing protocol and handling of blood samples are described in Malawi DHS report [3]. The study protocol and the procedures for the blood specimen collection and the testing for HIV was reviewed and approved by the Malawi Health Sciences Research Committee, the Institutional Review Board of ICF Macro, and the Centres for Disease Control and Prevention (CDC) in Atlanta. All consent procedures in DHS are verbal consent. All three ethics committees/IRBs mentioned above approved this consent procedure. The identities of the respondents remained anonymous and the signatures of the respondents were not collected. An alternate procedure of obtaining consent was used: the interviewer read the consent statement to the respondent and the respondent was free to consent or not to consent. The interviewer signed his or her signature confirming that he or she read the consent statement to the respondent, and records the respondent’s reply (“yes voluntarily consents” or “no does not consent”). Consent to individual interviews and HIV testing of adults was made by the respondents themselves and the interviewer signed his/her own name testifying that he/she read the informed consent statement to the respondents. Minors eligible for participating in the survey are those age 15–17. Informed consent for individual interviews and blood collection from the minors was obtained from the parents or guardians of the minors and from the minors themselves. When a minor consented, the interviewer went on to obtain voluntary consent from the parent or guardian. Consent from parents/guardians and minors for the individual interviews and blood collection was recorded by the interviewer signing his or her own name testifying that he/she read the consent statement to the guardian/minor. When consent was given, the interviewer signed his/her own name testifying that the informed consent statement was read and the respondent’s consent accurately recorded (“yes voluntarily consents” or “no does not consent”). The protocol allowed for the merging of the HIV test results with the socio-demographic data collected in the individual questionnaires, provided that identifier information of an individual was destroyed before data linking takes place [3]. Women were asked whether they or their partners were using a method of FP at the time of the survey. Women who reported current use of either modern or traditional contraceptive methods were considered as current users of FP method. The potential predictors of current FP practice were grouped into four categories: socio-demographic, access to FP information, reproductive and awareness of HIV positive status. The details of the potential predictors are as follows:- Women who indicated that they either wanted no more children (limiters) or wanted to wait for two or more years before having another child (spacers), but were not using contraception, were identified as having an unmet need for FP [3]. This analysis was performed on data from a selected group of sexually-active women in their reproductive age with HIV positive test results in the DHS. All women fulfilling the criteria in the three regions were included. Percentages and means were used to describe the characteristics of study participants. Bivariate analysis (Chi-square test) was used to assess the effect of each independent variable on current practice of FP. Multivariable logistic regression analysis was used to explore the effect of the different exposure variables on the outcome variable. Multiple logistic regression analysis was performed to control for possible confounding factors. The logistic regression analysis was made in three steps: first model using socio-demographic variables; second model included socio-demographic, access to health information and reproductive variables; the final model included women’s awareness of HIV positive status in addition to all the variables in the second model. Multiple logistic regression analysis (enter method) was used. Odds ratios with 95 % confidence interval (95 % CI) were computed for the association between risk factors and FP practice. Statistical significance was considered at p-value less than 0.05. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp was used in the analysis of the data. Detailed information on the study area, study population, organization of the survey, sample design, questionnaires, data collection, data quality, data processing and ethical issue is published in the Malawi DHS 2010 report [3]. The lead author communicated with MEASURE DHS/ICF International and permission was granted to download and use the data for this project.
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