The plight of women living with HIV/AIDS and family planning uptake
My story is premised on a dialogue I chanced on. HIV positive mothers were sharing challenges regarding their barriers, beliefs and motivation for using or not using family planning. This happened sometime early this year when I paid a visit to a colleague who was admitted in the maternity ward at a hospital in Western Uganda.
Seated in proximity to two pregnant HIV positive women, they seemed to know each other, at least going by their conversation. Their tÃªte-Ã -tÃªte was so touching to me and I found it worth sharing. I heard one of them say: â€œFor me this is going to be my sixth childâ€¦I tell you since I knew my HIV status, I have produced now three children.â€ Similarly, the other lamented: â€œMy husband is against me from using family planning (FP). He cautioned me that the moment he realizes that I am using any family planning method that will be the end of our marriage.â€
The accounts of these mothers aroused my interest to understand factors associated with utilization and uptake of family planning methods among these HIV positive women. There are a number of challenges that HIV positive mothers go through in regards to family planning usage. UNICEF estimates that Uganda has 2.5 million orphans of which 1.2 million are orphaned by HIV/AIDS, High maternal, Infant and child mortality (UNICEF 2014). The poverty level for such families is high in which close to half of the population are surviving on less than a dollar per day for a living. These are some of the challenges being experienced due to low uptake of modern family planning services especially amongst women living with HIV/ AIDS.
Like any other Ugandan, HIV positive mothers have the right to sexual and reproductive health. However, there is still a contentious issue regarding the sexual and reproductive right of these people. The foretaste of the converstion of these young positive mothers is just a tip of the iceberg of what is happening in our country.
To this, a couple of questions came to my mind: why is there low uptake among HIV positive women; who is to be held accountable; what has not gone well with the current strategy being employed by the concerned stakeholders and what has to be put right anyway. A lot more questions could be asked. In a recently conducted unpublished study at TASO Mbarara branch, utilization of family planning among HIV positive women was found to be low at 65% (Kanakunda 2016). Factors that were found to influence utilization among these mothers included communication among spouses, consistency and adherence to FP method usage (condoms) and enabling health system environment (privacy, confidentiality and positive attitude during counseling).
As a way forward, I would suggest strategies such as intensifying sensitization on changing the community attitudes and having an integrated services like offering Prevention of Mother to Child Transmission services with family planning. Where they exist, they should be strengthened. Evidence tells us that this can avert the cost of each new HIV infection by half from US$ 1300 to US$ 660. (Stover et al, 2003).
Finally I must say that the informal conversation by these HIV positive mothers must be a lesson for all stakeholders to critically take up their roles in order to increase utilization of family planning which will help accrue numerous benefits, key among which will contribute to the reduction of maternal and child mortality in Uganda.
*Blog by Ms Felicia Kanakunda who is currently a Masters of Health Services Research student at MakSPH and one of our 2016 research grant awardees.