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Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa
Background: Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission (PMTCT). However, we have little understanding of how HIV status and antiretroviral therapy (ART) may influence pregnancy planning. There are few data on pregnancy planning in HIV-infecte...
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| Format: | Thesis |
| Language: | English |
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Institute of Infectious Disease and Molecular Medicine
2017
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| _version_ | 1867613177055805440 |
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| access_status_str | Open Access |
| author | Iyun, Victoria |
| author2 | Myer, Landon |
| author_browse | Iyun, Victoria Myer, Landon |
| author_facet | Myer, Landon Iyun, Victoria |
| author_sort | Iyun, Victoria |
| collection | Thesis |
| description | Background: Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission (PMTCT). However, we have little understanding of how HIV status and antiretroviral therapy (ART) may influence pregnancy planning. There are few data on pregnancy planning in HIV-infected South African women, and no comparative data with HIV-uninfected women. Methods: We conducted a cross-sectional study of 2105 pregnant women (1512 HIV-infected; 593 HIV-uninfected) ages 18-44 making their first antenatal clinic visit at a primary-level health care facility in Gugulethu, Cape Town. All women completed structured questionnaires including the London Measure of Unplanned Pregnancy (LMUP), a 6-item scale that categorizes pregnancies into planned, ambivalent and unplanned. Analyses examined LMUP results across 4 groups of participants: HIV-infected established on ART; known HIV-infected but not currently on ART; newly diagnosed HIV-infected; and HIV-uninfected. Results: Overall, the mean age was 29 years (SD: 5.63), 43% of women were married or cohabiting and 20% were nulliparous. The LMUP performed well across all groups (Cronbach's α=0.84). Levels of unplanned pregnancy were higher in HIV-infected versus HIV-uninfected women (50% vs. 33%, p<0.001); and highest in women not on ART. Overall, 69% of women reported contraceptive use in the year before pregnancy; this was strongly associated with unplanned pregnancy (p<0.001). Compared to HIV-uninfected women, HIV-infected women had significantly higher odds of unplanned pregnancy, even after adjusting for age, parity and cohabiting status. The odds were greatest among women newly-diagnosed with HIV and previously diagnosed but not on ART (OR: 1.43; 95% CI: 1.05-1.94 and OR: 1.56; 95% CI: 1.13-2.15, respectively). Increased parity and age <24 years were also associated with unplanned pregnancy (OR 1.83; 95% CI: 1.24-2.74 and OR 1.42; 95% CI: 1.25- 1.60 respectively). Conclusions: These data indicate high levels of unplanned pregnancy in a high HIV prevalence setting, highlighting missed opportunities for family planning and counselling services for HIVpositive women. Possible explanations for the high level of unplanned pregnancy observed include contraceptive failure and/or misuse thereof. Therefore, women living with HIV require additional support to avoid unplanned, particularly those who are younger and have one or more children. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/23710 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:58.458Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Institute of Infectious Disease and Molecular Medicine |
| publisherStr | Institute of Infectious Disease and Molecular Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/23710 Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa Iyun, Victoria Myer, Landon Epidemiology and Biostatistics Pregnancy intentions Unplanned pregnancy PMTCT HIV Background: Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission (PMTCT). However, we have little understanding of how HIV status and antiretroviral therapy (ART) may influence pregnancy planning. There are few data on pregnancy planning in HIV-infected South African women, and no comparative data with HIV-uninfected women. Methods: We conducted a cross-sectional study of 2105 pregnant women (1512 HIV-infected; 593 HIV-uninfected) ages 18-44 making their first antenatal clinic visit at a primary-level health care facility in Gugulethu, Cape Town. All women completed structured questionnaires including the London Measure of Unplanned Pregnancy (LMUP), a 6-item scale that categorizes pregnancies into planned, ambivalent and unplanned. Analyses examined LMUP results across 4 groups of participants: HIV-infected established on ART; known HIV-infected but not currently on ART; newly diagnosed HIV-infected; and HIV-uninfected. Results: Overall, the mean age was 29 years (SD: 5.63), 43% of women were married or cohabiting and 20% were nulliparous. The LMUP performed well across all groups (Cronbach's α=0.84). Levels of unplanned pregnancy were higher in HIV-infected versus HIV-uninfected women (50% vs. 33%, p<0.001); and highest in women not on ART. Overall, 69% of women reported contraceptive use in the year before pregnancy; this was strongly associated with unplanned pregnancy (p<0.001). Compared to HIV-uninfected women, HIV-infected women had significantly higher odds of unplanned pregnancy, even after adjusting for age, parity and cohabiting status. The odds were greatest among women newly-diagnosed with HIV and previously diagnosed but not on ART (OR: 1.43; 95% CI: 1.05-1.94 and OR: 1.56; 95% CI: 1.13-2.15, respectively). Increased parity and age <24 years were also associated with unplanned pregnancy (OR 1.83; 95% CI: 1.24-2.74 and OR 1.42; 95% CI: 1.25- 1.60 respectively). Conclusions: These data indicate high levels of unplanned pregnancy in a high HIV prevalence setting, highlighting missed opportunities for family planning and counselling services for HIVpositive women. Possible explanations for the high level of unplanned pregnancy observed include contraceptive failure and/or misuse thereof. Therefore, women living with HIV require additional support to avoid unplanned, particularly those who are younger and have one or more children. 2017-01-30T10:28:17Z 2017-01-30T10:28:17Z 2016 Master Thesis Masters MPH http://hdl.handle.net/11427/23710 eng application/pdf Institute of Infectious Disease and Molecular Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Epidemiology and Biostatistics Pregnancy intentions Unplanned pregnancy PMTCT HIV Iyun, Victoria Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| thesis_degree_str | Master's |
| title | Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| title_full | Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| title_fullStr | Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| title_full_unstemmed | Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| title_short | Prevalence and determinants of unplanned pregnancy in HIV-infected and uninfected pregnant women seeking antenatal care in Cape Town, South Africa |
| title_sort | prevalence and determinants of unplanned pregnancy in hiv infected and uninfected pregnant women seeking antenatal care in cape town south africa |
| topic | Epidemiology and Biostatistics Pregnancy intentions Unplanned pregnancy PMTCT HIV |
| url | http://hdl.handle.net/11427/23710 |
| work_keys_str_mv | AT iyunvictoria prevalenceanddeterminantsofunplannedpregnancyinhivinfectedanduninfectedpregnantwomenseekingantenatalcareincapetownsouthafrica |