The desire for more children and pregnancy rates are influenced by many relationship dynamics and HIV serostatus of couples.
Rakai Community Cohort Study in Uganda.
Couple data were retrospectively linked from survey rounds between 2007 and 2015 to assess drivers of fertility desire and pregnancy incidence by HIV status (M−F−; M+F+; M−F+; and M+F−). Multivariable modified Poisson regression was used to estimate prevalence ratios of fertility desire, whereas multivariable Poisson regression was used to estimate incidence rate ratios of pregnancy associated with couple characteristics.
Six thousand six hundred forty-seven couples contributed to 7656 person-years. Approximately 40% of couples (where at least 1 HIV+) desired more children. Unmet need for family planning was evident; couples of medium or low Socioeconomic status and with coresident children had lower fertility desires but higher pregnancy rates. Older age, being in a polygamous union, and having a HIV+ spouse in care were associated with lower fertility desire while having an older male partner was associated with higher fertility desire. Pregnancy incidence was lower with older age, among women using hormonal contraception and condoms, HIV+ concordant couples and couples where the HIV+ spouse was in care while pregnancy incidence were higher among women who desired more children, and serodiscordant couples (M−F+).
There are many drivers of fertility desires and pregnancy rates, and HIV does not diminish the desire for more children. Unmet need for family planning was evident and highlighted the need to understand and meet the contraceptive needs of couples.
aDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
bJohns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Heath and the Perinatal HIV Research Unit (PHRU), Johannesburg, South Africa
cDepartment of Population, Family and Reproductive Health, Columbia University, School of Public Health, New York, NY;
dRakai Health Science Program, Rakai, Uganda; and
eMakerere University, School of Public Health, Kampala, Uganda.
Correspondence to: Heena Brahmbhatt, MPH, PhD, Department of Population, Family and Reproductive Health, 615 North Wolfe Street, Baltimore, MD 21205 (e-mail: firstname.lastname@example.org).
Supported by NIH and BMGF.
Presented at The International Family Planning Conference; November 2018; Kigali, Rwanda.
The authors have no funding or conflicts of interest to disclose.
Received July 12, 2018
Accepted October 29, 2018