Family Planning Support and Its Impact on Pregnancy Desires and Contraceptive Use Among Recently Postpartum HIV Positive Women Delivering at Mbarara Regional Referral Hospital

HIV status and availability of ART have been found to widely influence the desirability and expectations to have children among childbearing women living with HIV (Nieves et al., 2015; Kaida et al., 2011). Up to 85% of the pregnancies within 3 years following ART are often unwanted, often leading to illegal abortions and maternal deaths (Desgrees-Du-Lou et al., 2002).

Uganda's HIV epidemic has declined over time to about a sero prevalence of 7.2% and this decline has been attributed in part to improved prevention behavior like condom use, reduction in multiple concurrent partnerships and other strategies to prevent unwanted pregnancies. Specifically, HIV prevalence is estimated at 7% among women attending antenatal clinics in Uganda (UN, 2010). Whereas ART availability has improved general health outcomes through viral load suppression and immune reconstitution, there is still a high unmet need for family planning among HIV positive women in Uganda (Snow et al., 2011), where modern contraceptive prevalence is at 33% in the general population despite the widespread promotional messages across the country. This continues to expose HIV positive women to increased risks of unwanted/unplanned pregnancies, perinatal HIV transmission, pregnancy complications, and increased economic burden of care for self and others among others.

The high average fertility rate of 5.9 children per woman in Uganda may further complicate the immunity and wellbeing of the already burdened HIV positive women and their families even amongst those already accessing HIV care (Muyindike et al., 2012; Homsy et al., 2009).

Supporting HIV positive women to delay or prevent an unwanted pregnancy may improve women's health through family planning choices, regular health reviews, and support. A cohort study that was done in Mbarara amongst HIV-infected women documented 50% of the enrolled women having no desire for a (another) child during the 4 years since ART initiation, 51% had a serodiscordant partner, with only 45% using effective contraceptive method. Key predictors of contraceptive use were family planning goals within the DYAD. One of the key predictors of effective contraceptive use was male partner involvement and CD4 count. The WHO recommends dual contraception (use of condoms and a hormonal or permanent method) to prevent both HIV transmission and unwanted pregnancies (WHO,2014).This prospective intervention study aims at providing information on whether continuous family planning accessibility and support has a measurable impact on pregnancy intentions and contraceptive usage among postpartum HIV positive mothers delivering at MRRH, SW Uganda.

General objective To test the effect of a family planning availability and support intervention on pregnancy intentions and use of effective contraception among recently postpartum women living with HIV who delivered at MRRH.