Repeat Pregnancy in HIV Positive Indian Women

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Repeat Pregnancy in HIV Positive Indian Women

• Nishi Suryavanshi1 Ashwini Erande1, Hemlata
  Pisal1, Anita V. Shankar2, Robert C. Bollinger3,
  Mrudula Phadke4, Jayagowri Sastry1 MIT study
  staff1
• 1 Ed Search, Pune, India 2Johns Hopkins
  University, School of Public Health, Baltimore,
  United States 3 Johns Hopkins University,
  School of Medicine, Baltimore, United States 4
  Maharashtra University Of Health Sciences ,
  Nasik, India.
• Abstract No WEAX0303

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Background
Developed Setting
Developing Setting

• Sowell (2002)
• Intent to get pregnant to traditional gender
  roles

• Ganatra (2002)
• Greater reproductive decision making role. Older
  women proved their fertility
• Better economic means and mobility

• Wilson (1999)
• contraceptive use HIV positive women

• Local norms about fertility control
• Acceptability of contraception

Barge et al (2003) Difference of opinion, it is
usually the wishes of the husband that prevail.
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Background

• Social norms and familial obligations influence
  reproductive choices of married HIV positive
  women
• Reproductive decision making is a challenging
  gender issue in India. Having HIV adds critical
  component to these challenges.
• Understanding these factors will guide
  interventions and counseling strategies to better
  inform and support HIV positive women.

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Research Questions and Hypothesis

• RESEARCH QUESTIONS
• What are the socio-cultural factors associated
  with repeat pregnancies among HIV positive and
  HIV negative women?
• 2. For HIV-positive women, what socio-cultural
  characteristics are different between women who
  become pregnant and those who are currently not
  pregnant?

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Research Questions and Hypothesis

• HYPOTHESES
• Majority of repeat pregnancies among HIV positive
  women are unplanned
• 2. Family pressure, child death, disclosure of
  positive HIV status to no one, contraceptive
  usage etc. are some of the characteristics that
  may lead to repeat pregnancies.

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METHODS

• PARTICIPANTS Sub sample of women
  participated/participating in a clinical trial.
• HIV positive pregnant (n63).
• HIV positive women non pregnant within 9 to 12
  months of their most recent pregnancy (n63).
• HIV negative pregnant (n63).
• DEFINITION OF REPEAT PREGNANCY For the purpose
  of this study, we define a repeat pregnancy as
  one in which a woman who has been previously
  screened for HIV, has completed at least one
  pregnancy and is pregnant again with in 2 years
  of the last pregnancy
• DATA COLLECTION PERIOD Sept. 2004 to March
  2006
• DATA COLLECTION TOOL Semi structured interviews.
• ANALYSIS Data were entered and analysed in SPSS
  computer software.Chi square was done to compare
  demographic variables and simple logistic
  regression, was done to compare socio cultural
  variables among HIV positive pregnant, HIV
  negative pregnant and HIV positive non- pregnant
  women.

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ResultsSocio-demographic characteristics of HIV
positive and HIV negative women
p0.02
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ResultsKnowledge PracticeContraception
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Narratives (unplanned pregnancies)

• I can not help as my husband does not know about
  my HIV status and he wants baby. Even the
  financial condition at my natal home is very
  poor. I have no support from anyone. He wants
  this child so I had to accept and continue
  (pregnancy).(21 years old housewife)
• I have 2 kids so I came for FP operation and I
  had taken date for operation but my mother in law
  did not allow. She does not know my HIV status. I
  have two daughters and she wants male child She
  said I have one son so you should also have one
  to support when you get older" Anyway her son
  does not look after her but who is going to tell
  her. (27years.housewife)

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Results Fig. 1Socio-cultural factors associated
with repeat pregnancies among HIV positive and
HIV negative women
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Results Fig. 1Socio-cultural factors associated
with repeat pregnancies among HIV positive and
HIV negative women
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Results Fig 2 Socio cultural factors affecting
reproductive decision making among Pregnant and
non pregnant HIV positive women.
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Conclusion

• These data appear to indicate that desire of
  family, having lost a child affect reproductive
  decision of HIV positive women irrespective of
  their positive status.
• Face greater challenges and are more likely not
  to have planned their most recent pregnancy.
• Despite being pregnant they are concerned about
  their pregnancy (mostly because of the risk of
  HIV transmission)

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Implications

• Appropriate counseling techniques for HIV
  positive pregnant women need to include
  reproductive counseling.
• If possible, with womans consent involve husband
  and other key family members who influence
  reproductive choices of couple.
• Life skill interventions will be important in
  reducing Number of unplanned high risk
  pregnancies.

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Implications

• Need to understand gender dynamics along with
  social and cultural norms while counseling about
  reproductive choices in the context of HIV/AIDS
  epidemic.
• The determinants of contraceptive use, barriers
  to contraceptive use, and factors that contribute
  to effective contraceptive use in this population
  must be understood to reduce the risk of
  unplanned pregnancies.
• It is also important to know how health care
  providers address the issues related to
  unintended pregnancies among HIV positive women.

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Acknowledgement

• This study is supported by a grant from National
  Institutes of Health (NIH, NIAID) (R01 AI45 462)
  and This presentation has been supported, in
  part, by a fellowship/grant from the Fogarty
  International Center/USNIH Grant 2 D 43
  TW000010-18-AITRP
• The authors would like to thank the participants,
  as well as all BJ Medical College-Johns Hopkins
  University-MTCT project staff (Pune) for their
  help with this study.