Paper:Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011
Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011
BMC Public Health201313:935
© O’Reilly et al.; licensee BioMed Central Ltd. 2013
- Received: 2 August 2012
- Accepted: 30 September 2013
- Published: 8 October 2013
Abstract
Background
Family planning is an important public health intervention with numerous potential health benefits for all women. One of those key benefits is the prevention of mother-to-child transmission of HIV, through the prevention of unintended pregnancies among women living with HIV.
Methods
We conducted a systematic review of the effectiveness of family planning counseling interventions for HIV infected women in low- and middle-income countries.
Results
We found nine articles which met the inclusion criteria for this review, all from Africa. Though these studies varied in the specifics of the interventions provided, research designs and measures of outcomes, key features were discernible. Providing concerted information and support for family planning use, coupled with ready access to a wide range of contraceptive methods, seemed most effective in increasing use. Effects on pregnancy overall were difficult to measure, however: no studies assessed the effect on unintended pregnancy.
Conclusions
Though these results are far from definitive, they do highlight the need for strengthened efforts to integrate family planning counseling and access to services into HIV prevention, and for greater consistency of effort over time. Studies which specifically investigate fertility intentions and desires of women living with HIV, contraception use following interventions to increase knowledge, awareness, motivation and access to the means to act on those intentions and unintended pregnancies would be valuable to help clinic personnel, programme planners and policy makers guide the development of the integrated services they offer.
Conclusions
The right of reproductive choice for women living with HIV has long been established [40, 41], though significant gaps remain between the commitment to choice and the delivery of health services [14]. The evidence reviewed here indicates that this right is increasingly being recognized in the services that are being made available to women living with HIV, while simultaneously raising the question if these services are widely available. It also suggests a recognition that as circumstances and desires for more children change over the course of a woman’s life, more comprehensive interventions of longer duration are needed.
Despite increased recognition of the need for greater integration of sexual and reproductive health services and services for HIV prevention, care and treatment [6, 42], most of the studies included in this review were based on secondary analyses of data collected for other primary purposes. As the need to integrate services for sexual and reproductive health with services for HIV prevention becomes more empirically supported [43], and especially as the need for greater attention to preventing unintended pregnancies in women living with HIV increases, it will become more important that the provision of integrated services is well understood and that evaluations of their effectiveness are well designed and implemented [44]. Studies of interventions that are informed by the reproductive desires and perspectives of women on living with HIV, the barriers and challenges they face and their need for long term support will be valuable. Studies that measure not only contraception use at one point in time but over time, that address not only pregnancy incidence but the incidence of unintended pregnancy and that can measure or detect the effects of treatment availability and use on women’s perspectives and understandings of mother to child transmission are essential as well. Attempting to reach the goal of elimination of HIV infections in infants will surely benefit from using the full range of interventions available, including an intensified focus on the reduction of unintended pregnancies in women living with HIV. Family planning counselling is but one intervention needed to meet that goal, but it is an important one and it is insufficiently studied and understood.
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