Fertility Desires and Intentions among HIV-Positive Women during the Post-natal period in Uganda

Sarah A. Gutin, Fatuma Namusoke, Starley B. Shade, Florence Mirembe


This study describes the fertility intentions and discusses the potential reproductive health needs of post-natal HIV-infected Ugandan women. HIV-infected mothers attending post-natal services in Kampala, Uganda participated in this cross-sectional study using structured interviewer administered questionnaires. Descriptive statistics and logistic regression models were used to identify predictors of desire for more children. Among 403 participants, 35% desired more children. Of these, 25% wanted another child within 2 years and 75% within 3 years or more. In multivariable analyses, believing that one’s partners wanted more children (OR=2.44; 95% CI = 1.30, 4.59) was associated with the desire for future children while having more living children was negatively associated with the desire for future children (OR=0.08; 95% CI = 0.02, 0.39). A minority of women desired future pregnancies, and most wanted to delay pregnancy for 3 years. These women are in need of family planning (FP) methods to meet stated desires to delay or end future pregnancies. Perceived partner desire for children also impacts on women’s fertility intentions, highlighting the importance of engaging men during the post-natal period. (Afr J Reprod Health 2014; 18[3]: 67-77)


Keywords: fertility intentions; desire for children; Post-natal women; HIV; reproductive health; contraception.



Cette étude décrit les intentions de la fécondité et examine les besoins potentiels de la reproduction chez les femmes ougandaises post-natales infectées par le VIH. Des mères séropositives qui fréquentent les services de post-natal à Kampala, en Ouganda, ont participé à cette étude transversale en utilisant des questionnaires  structurés et administrés par les intervieweurs. Les statistiques descriptives et des modèles de la régression logistique ont été utilisés pour identifier les indices de l’envie d’avoir plus d’enfants. Parmi 403 participants, 35% désire avoir plus d'enfants. Parmi celles-ci, 25% voulaient avoir un autre enfant dans  2 ans et 75% dans  3 ans ou plus. Dans les analyses multivariées, estimant que ses partenaires voulaient plus d'enfants (OR = 2,44; IC à 95% = 1,30, 4,59) a été associée à la volonté de leurs futurs enfants tout en ayant plus d'enfants alors que d’avoir plus d’enfants vivant a été négativement associés au désir d'avoir des enfants dans l’avenir (OR = 0,08 IC à 95% = 0,02, 0,39). Une minorité de femmes ont désiré des grossesses futures, et la plupart voulaient  reporter la grossesse pendant 3 ans. Ces femmes ont besoin des méthodes de la planification familiale (PF)  pour satisfaire aux  désirs exprimés pour retarder ou pour  mettre fin à des grossesses futures. Le désir perçu du partenaire  des enfants a également un impact sur les intentions de la fécondité chez les femmes, soulignant ainsi l'importance de la participation des hommes au cours de la période post-natale. (Afr J Reprod Health 2014; 18[3]: 67-77)


Mots-clés: intentions de fécondité; Désir d'enfants;  femmes post-natales;  VIH; santé de la reproduction; contraception.  

Full Text:



Nakayiwa S, Abang B, Packel L, et al. Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS and behavior. Jul 2006;10(4 Suppl):S95-104.

Uganda Ministry of Health, ORC Macro,

MEASURE/DHS+, Centers for Disease Control and Prevention. Uganda HIV/AIDS sero-behavioural survey : 2004-05. Uganda; Calverton, MD: Ministry of Health; ORC Macro; 2006.

Uganda Bureau of Statistics (UBOS), ICF International Inc. Uganda demographic and health survey, 2011. Kampala, Uganda; Calverton, MD: Uganda Bureau of Statistics; 2012.

Cooper D, Harries J, Myer L, Orner P, Bracken H, Zweigenthal V. "Life is still going on": Reproductive intentions among HIV-positive women and men in South Africa. Social science & medicine. Nov 2007;65(10):2186.

Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS and behavior. Jun 2009;13 Suppl 1:38-46.

Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A. My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC public health. 2010;10:247.

Elul B, Delvaux T, Munyana E, et al. Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda. AIDS. Nov 2009;23 Suppl 1:S19-26.

Kaida A, Laher F, Strathdee SA, et al. Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hyperendemic setting.

American journal of public health. Feb


Hoffman IF, Martinson FE, Powers KA, et al. The yearlong effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. Journal of acquired immune deficiency syndromes. Apr 1 2008;47(4):477483.

Taulo F, Berry M, Tsui A, et al. Fertility Intentions of HIV-1 Infected and Uninfected Women in Malawi: A Longitudinal Study. AIDS and behavior. Jun 2009;13:S20-S27.

Chama C, Morrupa J, Gashau W. Sex and reproduction among HIV-infected people in Maiduguri, Nigeria. Journal of Obstetrics and Gynaecology. Nov 2007;27(8):812-815.

Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O. Fertility desires and intentions of HIV-positive patients at a suburban specialist center. Journal of the National Medical Association. Dec 2005;97(12):16721681.

Kaida A, Lima VD, Andia I, et al. The WHOMEN's scale (Women's HAART Optimism Monitoring and EvaluatioN Scale v.1) and the association with fertility intentions and sexual behaviours among HIVpositive women in Uganda. AIDS and behavior. Jun 2009;13 Suppl 1:72-81.

Maier M, Andia I, Emenyonu N, et al. Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV plus Women in an Early HIV Treatment Program in Rural Uganda. AIDS and behavior. Jun 2009;13:S28-S37.

Makumbi FE, Nakigozi G, Reynolds SJ, et al. Associations between HIV Antiretroviral Therapy and the Prevalence and Incidence of Pregnancy in Rakai, Uganda. AIDS research and treatment.


Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, Abrams EJ. Impact of antiretroviral therapy on incidence of Africa: a cohort study. PLoS Med. Feb 2010;7(2):e1000229.

Homsy J, Bunnell R, Moore D, et al. Reproductive Intentions and Outcomes among Women on Antiretroviral Therapy in Rural Uganda: A

Prospective Cohort Study. Plos One. Jan 8 2009;4(1).

Ditekemena J, Koole O, Engmann C, et al. Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review. Reprod Health. 2012;9:32.

Pool R, Nyanzi S, Whitworth JA. Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda. Ann Trop Paediatr. Jun 2001;21(2):119-125.

Paiva V, Santos N, Franca-Junior I, Filipe E, Ayres JR, Segurado A. Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil. AIDS Patient Care STDS. Apr 2007;21(4):268-277.

Becker S, Mlay R, Schwandt HM, Lyamuya E. Comparing couples' and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: a randomized trial. AIDS and behavior. Jun 2010;14(3):558-566.

Medley A, Baggaley R, Bachanas P, Cohen M, Shaffer N, Lo YR. Maximizing the impact of HIV prevention efforts: Interventions for couples. AIDS care. May 8 2013.

Dorenbaum A, Cunningham CK, Gelber RD, et al. Twodose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission: a randomized trial. JAMA : the journal of the American Medical Association. Jul 10 2002;288(2):189-198.

Chen JL, Philips KA, Kanouse DE, Collins RL, Miu A. Fertility desires and intentions of HIV-positive men and women. Family planning perspectives. Jul-Aug 2001;33(4):144-152, 165.

Borda M, Winfrey W. Postpartum Fertility and Contraception: An Analysis of Findings from 17 Countries. 2010. http://www.k4health.org/sites/ default/files/Winfrey_Borda_17countryanalysis.pdf

Keogh SC, Urassa M, Roura M, et al. The impact of antenatal HIV diagnosis on postpartum childbearing desires in northern Tanzania: a mixed methods study.

Reproductive health matters. Dec 2012;20(39 Suppl):39-49.

WHO. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. Geneva: WHO; 2006.

Ministry of Health of the Republic of Uganda. National

Policy Guidelines and Service Standards for

Reproductive Health Services. Kampala: Reproductive Health Division, Community Health Department, Ministry of Health; May 2001.

Peltzer K, Chao LW, Dana P. Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS and behavior. Oct 2009;13(5):973-979.

Wanyenze RK, Tumwesigye NM, Kindyomunda R, et al. Uptake of family planning methods and unplanned pregnancies among HIV-infected individuals: a crosssectional survey among clients at HIV clinics in Uganda. Journal of the International Aids Society. 2011;14:35.

Myer L, Morroni C, Rebe K. Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS patient care and STDs. Apr 2007;21(4):278-285.

Nobrega AA, Oliveira FA, Galvao MT, et al. Desire for a child among women living with HIV/AIDS in northeast Brazil. AIDS patient care and STDs. Apr 2007;21(4):261-267.

Mbatia R AG, Pals S, Bachanas P, Carpenter D, DeLuca N, Muhenje O, Sheriff M, Arthur G, Elul B, and the 'HIV Prevention for PLHA: Evaluation of an Intervention Toolkit for HIV Care and Treatment Settings' Study Team. Unmet need for family planning and low rates of dual method protection among men and women attending HIV care and treatment services in Kenya, Namibia and Tanzania. Sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Vol abstract TUPDC0102. Rome; 2011.

Bunnell R, Ekwaru JP, Solberg P, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. Jan 2 2006;20(1):85-92.

Kimuna SR, Adamchak DJ. Gender relations: husbandwife fertility and family planning decisions in Kenya. J Biosoc Sci. Jan 2001;33(1):13-23.

Ntshebe O. Contraceptive decisions and HIV/AIDS concerns among married couples in Malawi. J Biosoc Sci. May 2011;43(3):329-343.

Shattuck D, Kerner B, Gilles K, Hartmann M, Ng'ombe T, Guest G. Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project. Am J Public Health. Jun 2011;101(6):1089-1095.

Newmann SJ, Grossman D, Blat C, et al. Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV-infected individuals in Nyanza Province, Kenya. Int J Gynaecol Obstet. Nov 2013;123 Suppl 1:e16-23.

39. Grossman D, Onono M, Newmann SJ, et al. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS. Oct 2013;27 Suppl 1:S77-85.


  • There are currently no refbacks.