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Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study.

Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study.
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Mayhew SH, Colombini M, Kimani JK, Tomlin K, Warren CE, , Mutemwa R,


Mayhew SH, Colombini M, Kimani JK, Tomlin K, Warren CE, , Mutemwa R, (click to view)

Mayhew SH, Colombini M, Kimani JK, Tomlin K, Warren CE, , Mutemwa R,

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BMC public health 2017 07 0517(1) 626 doi 10.1186/s12889-017-4514-2

Abstract
BACKGROUND
Preventing unwanted pregnancies in Women Living with HIV (WLHIV) is a recognised HIV-prevention strategy. This study explores the fertility intentions and contraceptive practices of WLHIV using services in Kenya.

METHODS
Two hundred forty women self-identifying as WLHIV who attended reproductive health services in Kenya were interviewed with a structured questionnaire in 2011; 48 were also interviewed in-depth. STATA SE/13.1, Nvivo 8 and thematic analysis were used.

RESULTS
Seventy one percent participants did not want another child; this was associated with having at least two living children and being the bread-winner. FP use was high (92%) but so were unintended pregnancies (40%) while living with HIV. 56 women reported becoming pregnant "while using FP": all were using condoms or short-term methods. Only 16% participants used effective long-acting reversible contraceptives or permanent methods (LARC-PM). Being older than 25 years and separated, widowed or divorced were significant predictors of long-term method use. Qualitative data revealed strong motivation among WLHIV to plan or prevent pregnancies to avoid negative health consequences. Few participants received good information about contraceptive choices.

CONCLUSIONS
WLHIV need better access to FP advice and a wider range of contraceptives including LARC to enable informed choices that will protect their fertility intentions, ensure planned pregnancies and promote safe child-bearing.

TRIAL REGISTRATION
Integra is a non-randomised pre-post intervention trial registered with Current Controlled Trials ID: NCT01694862 .

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