Abstract
Prevention of unintended pregnancy amongst HIV-positive women is a critical intervention to reduce maternal mortality and prevent HIV infection of infants. In this qualitative study carried out in Soweto, South Africa, HIV-positive mothers of HIV-negative or HIV-positive infants were interviewed shortly after the birth of their babies in order to explore their perceptions, understandings and experiences on a range of issues. The interviews were subjected to thematic analysis to identify themes significant to the women themselves, as well as those relevant to healthcare provision. This report focuses on findings regarding fertility desires, intentions and practise. The findings are discussed in relation to other research findings. Some implications for healthcare provision are highlighted.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
The term, family planning, is used rather than the alternative, reproductive choices, since the former is the term in general use in many guidelines and, in South Africa, amongst women themselves and healthcare workers.
- 2.
Although the focus in this chapter is on prevention of unintended pregnancy, linkages/integration of HIV/AIDS and SRH services are also intended to offer more effective services to support maternal health during pregnancy and delivery and offer PLWHA who wish to have children appropriate counselling related to child spacing and ways to limit risks of transmission to partners during conception and from mother to child.
- 3.
Ethical approval for the study was obtained from the Ethics Committee of the University of the Witwatersrand, Johannesburg, South Africa.
- 4.
- 5.
Written informed consent to participate in tape-recorded interviews was obtained before the interviews. Confidentiality was assured by recording all data under anonymous codes, removing any identifying information during interview transcription and destroying interview tape recordings on completion of the study.
- 6.
Not her real name – pseudonyms are used throughout to protect the identity of participants. Number in brackets – participant number (numbers less than 30, mothers of HIV-negative babies; numbers 30 and above, mothers of HIV-positive babies).
References
Beyeza-Kashesya J, Kaharuza F, Mirembe F, Neema S, Ekstrom AM, Kulane A (2009) The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda. Afr Health Sci 9(1):2–12
Boerma J, Urassa M (2000) Associations between female infertility, HIV and sexual behaviour in rural Tanzania. In: Boerma J, Mgalla Z (eds) Women and infertility in Sub-Saharan Africa: a multidisciplinary perspective. KIT Publishers, Amsterdam, pp 175–187
Cooper D, Harries J, Myer L, Orner P, Bracken H (2007) ‘Life is still going on’: reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med 65:274–283
Cooper D, Moodley J, Zweigenthal V, Bekker L, Shah I, Myer L (2009) Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for Integrating reproductive health and HIV care services. AIDS Behav 13:S38–S46
Dinh TH, Goga A, Jackson D, Lombard C, Woldesenbet S, Puren A et al (2012) Impact of the South Africa’s PMTCT programs on perinatal HIV transmission: results of the 1st year implementing the 2010 WHO recommended guidelines. Presentation. 4th international workshop on HIV paediatrics, Washington, DC
Elul B, Delvaux T, Munyana E, Lahuerta M, Horowitz D, Ndagije F et al (2009) Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda. AIDS 23(Suppl 1):S19–S26
Family Health International (FHI) (2010a) Family planning and HIV integration: approaching a tipping point. In: The case for integrating family planning and HIV/AIDS services: evidence, policy support and programmatic experience, Research Triangle Park, NC, USA
Family Health International (FHI) (2010b) Policy support for strengthening family planning and HIV/AIDS linkages. In: The case for integrating family planning and HIV/AIDS services: evidence, policy support and programmatic experience, Research Triangle Park, NC, USA
Feldman R, Maposhere C (2003) Safer sex and reproductive choice: findings from ‘positive women: voices and choices’ in Zimbabwe. Reprod Health Matter 11(22):162–173
Gender Links/Medical Research Council (MRC) (2010) The war @ home: preliminary findings of the Gauteng Gender Violence Prevalence Study. Retrieved 7 Dec 2010 from:http://www.genderlinks.org.za/article/gauteng-gender-violence-prevalence-study-2010-11-22
Goga AE, Dinh TH, Jackson DJ, for the SAPMTCTE Study Group (2012) Evaluation of the effectiveness of the national prevention of mother-to-child transmission (PMTCT) programme measured at six weeks postpartum in South Africa, 2010. South African Medical Research Council, National Department of Health of South Africa & PEPFAR/US Centers for Disease Control and Prevention, Pretoria, SA
Gray RH, Wawer MJ, Serwadda D, Sewankambo N, Li C, Wabwire-Mangen F et al (1998) Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet 351:98–103
Gray GE, Van Niekerk R, Struthers H, Violari A, Martinson N, McIntyre J, Naidu V (2006) The effects of adult morbidity and mortality on household welfare and the wellbeing of children in Soweto. Vulnerable Child Youth Stud 1(1):17–30
Greeff M (2013) Chapter 5: Disclosure and stigma: a cultural perspective. In: Liamputtong P (ed) Stigma, discrimination and HIV/AIDS: a cross-cultural perspective. Springer, Dordrecht
Gruskin S, Ferguson L, O’Malley J (2007) Ensuring sexual and reproductive health for people living with HIV: an overview of key human rights, policy and health system issues. Reprod Health Matter 15(Suppl 29):4–26
Harries J, Cooper D, Myer L, Bracken H, Zweigenthal V, Orner P (2007) Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa. BMC Publ Health 7:282–288
Harries J, Stinson K, Orner P (2009) Health care providers’ attitudes towards termination of pregnancy: a qualitative study in South Africa. BMC Publ Health 9:296–307
Hunter SC, Isingo R, Boerma JT, Urassa M, Mwaluko GM, Zaba B (2003) The association between HIV and fertility in a cohort study in rural Tanzania. J Biosoc Sci 35:189–199
Kaida A, Lima VD, Andia I, Kabakyenga J, Mbabazi P, Emenyonu N et al (2009) The WHOMEN’s Scale (Women’s HAART Optimism Monitoring and EvaluatioN Scale v.1) and the association with fertility intentions and sexual behaviours among HIV-positive women in Uganda. AIDS Behav 13:S72–S81
Kakaire O, Osinde MO, Kaye DK (2010) Factors that predict fertility desires for people living with HIV infection at a support and treatment centre in Kabale, Uganda. Reprod Heal 7:27
Kanniappan S, Jeyapaul MJ, Kalyanwala S (2008) Desire for motherhood: exploring HIV-positive women’s desires, intentions and decision-making in attaining motherhood. AIDS Care 20(6):625–630
Laher F, Todd CS, Stibich MA, Phofa R, Behane X, Mohapi L, Gray G (2009) A qualitative assessment of decisions affecting contraceptive utilization and fertility intentions among HIV-positive women in Soweto, South Africa. AIDS Behav 13:S47–S54
Lazarus R, Struthers H, Violari A (2009) Hopes, fears, knowledge and misunderstandings: responses of HIV-positive mothers to early knowledge of the status of their baby. AIDS Care 21(3):329–334
Lazarus R, Struthers H, Violari A (2010) Starting HIV-positive babies on antiretroviral treatment: perspectives of mothers in Soweto, South Africa. J Pediatr Health Care 24(3):176–183
London L, Orner PJ, Myer L (2008) ‛Even if you’re positive, you still have rights because you are a person’: human rights and the reproductive choice of HIV-positive persons. Dev World Bioeth 8(1):11–22
Long C (2009) Contradicting maternity: HIV-positive motherhood in South Africa. Wits University Press, Johannesburg
Maier M, Andia I, Emenyonu N, Guzman D, Kaida A, Pepper L, Hogg R, Bangsberg D (2009) Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV + women in an early HIV treatment program in rural Uganda. AIDS Behav 13:28–37
Mphatswe W, Blankenberg N, Tudor-Williams G, Prendergast A, Thobakgale C, Mkhwanazi N et al (2007) High frequency of rapid immunological progression in African infants infected in the era of perinatal HIV prophylaxis. AIDS 21:1253–1261
Myer L, Morroni C, Rebe K (2007) Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS 21(4):278–285
Nakayiwa S, Abang B, Packel L, Lifshay J, Purcell DW, King R et al (2006) Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav 10:95–104
National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) (2008) Saving mothers 2005–2007: fourth report on confidential enquiries into maternal deaths in South Africa. NDOH, Pretoria. Retrieved 21 Dec 2010 from: http://www.doh.gov.za/docs/reports/2007/savingmothers.pdf
National Department of Health, South Africa (NDOH) (2010) National antenatal sentinel HIV and syphilis prevalence survey in South Africa, 2009. NDOH, Pretoria. Retrieved 23 Dec 2010 from: www.doh.gov.za/docs/index.html
National Department of Health, South Africa/South African National AIDS Council (NDOH/SANAC) (2010) Clinical guidelines: PMTCT (Prevention of mother-to-child transmission). NDOH, Pretoria
Nattabi B, Jianghong L, Thompson SC, Orach CG, Earnest J (2009) A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 13:949–968
Ndlovu V (2009) Considering childbearing in the age of highly active antiretroviral therapy (HAART): views of HIV-positive couples. J Soc Aspects HIV/AIDS 6(2):58–68
Nduna M, Farlane L (2009) Women living with HIV in South Africa and their concerns about fertility. AIDS Behav 13:S62–S65
Nóbrega AA, Oliveira FA, Galvão MT, Mota RS, Barbosa RM, Dourado I et al (2007) Desire for a child among women living with HIV/AIDS in Northeast Brazil. AIDS Patient Care STDS 21(4):261–267
Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O (2005) Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc 97(12):1672–1681
Panozzo L, Battegay M, Friedl A, Vernazza PL (2003) High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner—two challenging issues. Swiss Med Wkly 133:124–127
Peltzer K, Chao L-W, Dana P (2009) Family-planning among HIV-positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS Behav 13:973–979
Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG (eds) Analysing qualitative data. Routledge, London, pp 173–194
Rutenberg N, Baek C (2005) Addressing the family-planning needs of HIV-positive PMTCT clients: baseline findings from an operations research study. Horizons Research Update, Washington, DC
Smith DJ, Mbakwem BC (2007) Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria. AIDS 21:S37–S41
Struthers H, Violari A, Myeni Z, McIntyre J (2006) PMTCT in Soweto: a large scale intervention. PEPFAR HIV/AIDS Implementers’ Meeting, Durban, 12–15 June
Tavrow P (2010) Promote or discourage: how providers can influence service use. In: Maalarchar S (ed) Social determinants of sexual and reproductive health: informing future research and programme implementation. World Health Organisation, Geneva, pp 17–36
Ujiji OA, Ekstrom AM, Ilako F, Indalo D, Rubenson B (2010) ‘I will not let my HIV status stand in the way.’ Decisions on motherhood among women on ART in a slum in Kenya – a qualitative study. BMC Women’s Health 10:13–22
UNAIDS (Joint United Nations Programme on HIV/AIDS) (2010) Global report: UNAIDS report on the global AIDS epidemic 2010. UNAIDS, Geneva
UNAIDS (2012) Global report: UNAIDS report on the global AIDS epidemic 2012, UNAIDS, Geneva
UNICEF/UNAIDS/WHO/UNPF (2010) Children and AIDS: 5th stocktaking report. UNICEF/UNAIDS/WHO/UNPF, Geneva
Violari A, Cotton M, Gibb D, Babiker A, Steyn J, Jean-Philippe P, et al (2007) Antiretroviral therapy initiated before 12 weeks of age reduces early mortality in young HIV-infected infant: Evidence from the children with HIV Early Antiretroviral Therapy (CHER) Study. In: Fourth IAS conference on HIV Pathogenesis and Treatment, Sydney, Australia
Wilcher R, Cates W (2010) Reaching the underserved: family planning for women with HIV. Stud Fam Plann 41:125–128
World Health Organisation (WHO) (2010) PMTCT strategic vision 2010–2015: preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. World Health Organisation, Geneva
Acknowledgments
The work reported in this chapter was undertaken at the Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. The Unit is based at Chris Hani Baragwanath Hospital, Soweto. We would like to thank the women who participated in the study; fieldworkers Boitumelo Rakosa for conducting and, together with Thomas Mogale, transcribing interviews; and Janet Jobson for assisting with the literature review.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Lazarus, R., Struthers, H., Violari, A. (2013). Growing Confidence? Family Planning by HIV-Positive Mothers in a South African Urban Setting. In: Liamputtong, P. (eds) Women, Motherhood and Living with HIV/AIDS. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5887-2_2
Download citation
DOI: https://doi.org/10.1007/978-94-007-5887-2_2
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-5886-5
Online ISBN: 978-94-007-5887-2
eBook Packages: Humanities, Social Sciences and LawSocial Sciences (R0)