The need to better meet the Family Planning needs of women living with HIV in Kenya and Swaziland

Women living with HIV in Swaziland and Kenya want to manage the number and spacing of their children, but many experience unintended or mistimed pregnancies. New research suggests there needs to be a specific focus on improving access to long-acting contraception and dual protection for women living with HIV. 

Family Planning and HIVUnintended pregnancies and potential mother to child transmission of HIV are some of the challenges faced by women living with HIV. New research from the Integra Initiative examines contraceptive use and fertility intentions among women living with HIV in Kenya and Swaziland

In sub-Saharan Africa, major efforts to expand access to anti-retroviral therapy (ART) mean that many people are living longer with HIV and leading productive and sexually active lives. Therefore, understanding the fertility preferences and reproductive decisions of women living with HIV is vital for informing policy and programmatic efforts to enable them to achieve these desires effectively and safely.

We are using condoms and I still use that pill, because condoms prevent germs to enter into me and to him, but this pill is for family planning to prevent getting pregnant if the condom bursts .

–FP client, Kenya

The research, which is part of an initiative to better understand the benefits and costs of integrated SRH and HIV services, concluded that – compared to HIV-negative women – more women living with HIV had experienced an unintended pregnancy and many have a high desire to cease childbearing. However, this desire to avoid unplanned pregnancies was not matched by appropriate family planning use.

The project also found a heavy reliance on condoms for to prevent pregnancy, and that women in the study were using short term methods rather than long-action methods prior to their most recent (unintended) pregnancy.

The research indicates that women living with HIV who are not planning on having any more children need better access to long-acting contraception.  There should also be greater use of dual protection – e.g. condoms as well as another contraceptive method. There is also a need to increase psychosocial support for women living with HIV, particularly around pregnancy intentions, and to decrease stigma in the community, especially around fears related to breastfeeding.

The study concludes that facilities and providers should do more to promote and offer a wider choice of family planning methods and improve information and access to long-term methods for women living with HIV who do not wish to have any more children.

For more information and research on family planning, stigma, and the benefits of the integration of sexual reproductive health and HIV services, visit the Integra research findings library or SRH and HIV Linkages Resource Pack.