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Half of HIV-Positive Women in Ontario Survey Have Unintended Pregnancies
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1st International Workshop on HIV and Women, January 10-11, 2011, Washington, DC
Mark Mascolini
Slightly more than half of HIV-positive women surveyed across Ontario had an unintended pregnancy, according to results of a 400-woman cross-sectional study [1]. Women who had an unintended pregnancy were more likely never to be married and to have delivered one or more children.
Although there is much speculation about rates of unintended pregnancy among HIV-positive women, the Ontario investigators observed, little research has addressed this issue. Determining the frequency and correlates of unintended pregnancy is crucial to integrating family planning into HIV care.
The World Health Organization regards averting unintended pregnancies by HIV-positive women as a key strategy in preventing mother-to-child transmission of HIV in low- and middle-income countries [2], and a review analyzes data on unintended pregnancy in these countries [3]. The new study [1] confirms that unintended pregnancy is also problem among HIV-positive women in high-income countries.
This study involved 490 HIV-positive women of reproductive age who completed a 189-item self-administered questionnaire between October 2007 and April 2009 at 38 sites across the province of Ontario. The questionnaire aimed to define the pregnancy desires and intentions of 18- to 52-year-old HIV-positive women. This substudy of unintended pregnancy involved 416 women (85%) who had at least one pregnancy before the survey.
Median age of the study group was 38 (interquartile range 33 to 44). The analysis included 245 women (59%) born outside Canada; there were 187 women of African ethnicity(47%), 39 Caribbean (10%), 37 aboriginal (9%), and the rest of European or French Canadian descent. About half of the women (211, 51%) lived in Toronto, and 308 (74%) were taking antiretrovirals. Ninety-seven women (25%) never married, 183 (47%) were married or had common-law partners, and 108 (28%) were divorced or widowed.
Of the 416 women who had at least one pregnancy, 233 (56%, 95% confidence interval 51% to 61%) said their last pregnancy was unintended. Similar proportions said their last pregnancy was unintended before they had HIV (57%) and after they had HIV (54%). Of 233 with unintended pregnancies, 179 (77%) gave birth to one or more children in their lifetime, compared with 176 of 183 women (96%) who did not have an unintended pregnancy (P < 0.001).
Multivariate analysis identified three other factors associated with ever having an unintended pregnancy, at the following odds ratios (OR) (and 95% confidence intervals):
Lowered chance of unintended pregnancy:
-- Married or living with a partner (versus never married): OR 0.31 (0.17 to 0.56), P < 0.0001
-- Divorced or widowed (versus never married): OR 0.29 (0.15 to 0.56), P < 0.001
Raised chance of unintended pregnancy:
-- More years in Canada if born elsewhere: OR 1.04 (1.00 to 1.07), P = 0.03
Neither ethnicity nor age affected risk of unintended pregnancy.
Women were significantly less happy about unintended pregnancies than intended pregnancies (P < 0.01), and ethnicity did not affect the level of happiness.
The investigators stress the importance of pregnancy planning "to decrease fetal and maternal complications and to reduce vertical and horizontal transmission." They see an urgent need for data-driven programs to increase pregnancy planning among women with HIV.
References
1. Loutfy M, Raboud J, Wong J, et al. High prevalence of unintended pregnancies in HIV-positive women of reproductive age in Ontario, Canada. 1st International Workshop on HIV and Women. January 10-11, 2011. Washington, DC. Abstract P_36.
2. World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infant: towards universal access. Recommendations for a public health approach. Geneva: World Health Organization. 2006.
3. Morrison CS, Cates W Jr. Preventing unintended pregnancy and HIV transmission: dual protection or dual dilemma? Sex Transm Dis. 2007;34:873-875.
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