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HIV and Unintended Fertility in Sub-Saharan Africa: Multilevel Predictors of Mistimed and Unwanted Fertility Among HIV-Positive Women

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Abstract

Sub-Saharan Africa (SSA) has a disproportionate burden of both unintended fertility and HIV infection, but the relationship between these two reproductive health risks is not well understood. This paper investigates the association between HIV status and unintended (mistimed and unwanted) fertility and examines multilevel predictors and national variations of unintended fertility among HIV-positive women across countries in SSA. Multilevel multinomial logistic regression models are applied to Demographic and Health Surveys data collected during 2006–2014 from 25 countries of SSA. Overall findings reveal that across countries of SSA, pregnancies of HIV-positive women are, on average, less likely to be mistimed (RR = 0.90, p < 0.05) but more likely to be unwanted (RR = 1.18, p < 0.05), rather than wanted, compared to pregnancies among HIV-negative counterparts with similar characteristics. Besides, knowledge of HIV status is associated with lower unintended fertility among HIV-negative, but not HIV-positive women. At country level, higher HIV prevalence and testing coverage are associated with higher mistimed and unwanted, rather than wanted fertility. Interaction effects suggest different effect sizes between HIV-positive and HIV-negative women: pregnancies among HIV-positive women are more likely than those among HIV-negative women to be unwanted rather than wanted among those who know their HIV status, are of older age, are married, have higher parity or reside in rural areas. The results further reveal notable country effects on unintended fertility, depicting regional variations that mirror HIV prevalence—being highest in Southern Africa and lowest in Western/Central Africa.

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Notes

  1. For example, it is estimated that in Eastern and Southern Africa, 68% of pregnant women living with HIV received ART in 2009, and a number of countries had set targets for near universal coverage by 2015 (UNICEF 2012—Factsheets on the status of national PMTCT responses in the most affected countries).

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    Monica A. Magadi

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Appendices

Annex 1

See Table 7.

Table 7 A summary description of variables included in the study
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Annex 2

See Table 8.

Table 8 Comparison of percent distribution of unintended fertility among HIV-positive and HIV-negative women between study sample and current pregnancy by background characteristics
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Annex 3

See Table 9.

Table 9 Bivariate correlation of mistimed, unwanted and overall unintended pregnancy (based on current pregnancies) by country-level characteristics (n = 25 countries)
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Annex 4

See Table 10.

Table 10 The predictors of unintended fertility among HIV-negative women in SSA: Average Relative Risks (RR) of mistimed and unwanted (versus wanted) births (n = 83,838)
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Annex 5

See Fig. 2a, b.

Fig. 2
figure 2

a Simultaneous confidence intervals for country effects for mistimed fertility among HIV-negative women—variance components model (Model 0) and final model. b Simultaneous confidence intervals for country effects for unwanted fertility among HIV-negative women—variance components model (Model 0) and final model

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Magadi, M.A. HIV and Unintended Fertility in Sub-Saharan Africa: Multilevel Predictors of Mistimed and Unwanted Fertility Among HIV-Positive Women. Popul Res Policy Rev 40, 987–1024 (2021). https://doi.org/10.1007/s11113-020-09620-9

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