Adesina OA*, Awolude O, Oladokun A, Roberts A, Adewole IF, Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan. *Corresponding author

Background  The prevention of unintended pregnancies has important consequences for women and their families; it serves to  lengthen birth intervals and to  reduce infant and maternal morbidity and mortality.

Background  Additional benefits for the HIV positive women includes reduction in  the number of HIV infected infants;  the number of orphans.  Family planning is an important component of HIV programs to inform the reproductive decisions and decrease HIV transmission.

Background  The WHO Medical Eligibility Criteria for contraceptives use ( WHO MEC) do not place restrictions on the use of contraceptives  hormonal methods ( COC, DMPA etc)- special consideration needed for women taking ARVs.  IUDs are considered safe for HIV- infected women and women with AIDS on ART.  Condoms are recommended to reduce risk of HIV transmission and STI acquisition or transmission.

Background  In a bid to tackle the burden of mother-to-child transmission of HIV  The Government of Nigeria, has facilitated the provision of ARV,  In addition, need to pay attention to the prevention of unintended pregnancies among HIV-positive women.

Background  The reproductive health situation in Nigeria is poor.  Maternal Mortality Ratio ( MMR) of 398/ 100, 000 live births  The contraceptive prevalence rate is low at 15%  11% modern methods, 4% traditional.  Infant mortality rate of 75/ 1000 live births.

Objectives  To describe the pattern of contraceptive use by HIV positive women at the University College Hospital, Ibadan, (UCH) following delivery and  To identify factors associated with uptake of a mode of contraception.  The outcome measure was the mode of contraception being utilized at 6 months postpartum.

Methods  The study was conducted in the PMTCT unit of the ARV clinic of the University College Hospital, Ibadan, Nigeria.  This clinic is supported by funds from the HARVARD-PEPFAR/ APIN Plus.   Starting from June 2009, it involved HIV- positive pregnant women presenting for care over a 6-month period.

Methods  The clinic sessions include a health talk  ARV, disclosure, delivery/ infant feeding options  counseling on reproductive issues such as family planning, pap smear etc  In addition, IEC materials were given out.  They were asked at gestational age weeks if they desired an effective form of contraception after delivery and what method they desired.

Methods  Over an eighteen month period they were followed up.  Other points of encouraging uptake of contraception included at delivery, at the 6 weeks postnatal visit and at 3 months postpartum.

Methods  Family planning services are available in another clinic about 400 meters away within the hospital premises.  COC, IUCDs, DMPA, Implants, male condoms, sterilization, LNG-IUS.  They were again interviewed 6 months postpartum as to what method they were using.

Results  Most of the women  had between 6-10 years of education (98%),  were married (77%) and  were para 0-2 (83.0%).

Socio-demographic characteristics VariableFrequencyPercentage Marital statusSingle Married Sep/ Dvcd Widowed % 77.0% 8.0% 3.2% HAART Experience HAART-Exp. HAART Non-E % 44.6% Parity2 and below 3 and above % 15.5% Mode of delivery Vag. /Delivery Cs/ Del % 35.3%

Antenatal Desire to use Contraception  Of the 200 women, 151 (75.5%) declared a desire to use an effective form of contraception postpartum.

Contraceptive method desired antenatally CONTR ACEPTIVE METHOD FREQUENCY ( 117) PERCENTAGE COC76.0 % INJECTABLES % IMPLANTS4538.5% IUCD % BARRIER METHODS %

Results  Six months after delivery, 112 of the women were available for follow-up.

Contraception 6 months Ppartum VARIABLEFREQUENCY ( 112) PERCENTAGE Yes, on a method of contraception % No, not on a method of contraception %

Contraceptive method 6 months postpartum CONTR ACEPTIVE METHOD FREQUENCY ( 78) PERCENTAGE COC45.1% INJECTABLES67. 7% IMPLANTS33. 8% IUCD67. 7% BARRIER METHODS % STERILIZATION11.3%

contraception desired antenatally contraception practiced Ppartum

Results postpartum desire to use contraception  Of the 34 not on any contraception 61.8% expressed a desire to use an effective form of contraception.

Likely use of contraception VariableOn a method ( 78) Not on a method ( 34)P value Mean age of women ( years) ,0.78 Parity2 and below (100) 70 ( 70.0%)30 ( 30.0%) and above ( 12) 8 ( 66.6%)4 ( 33.3%) Antenatal desire to use contraceptin Yes ( 92)65 ( 70.7%)27 ( 29.3%) No ( 14)7 ( 50.0 %) Not sure ( 6)6 ( %)0

Likely use of contraception VariableOn a method ( 78) Not on a method ( 34)P value HAART experience Yes ( 63)40 ( 63.5% )23 ( %) No ( 49)38 ( 77.6%)11 ( 22.5%) Mode of delivery Vaginal ( 41)27 ( 65.9%)14 ( 34.1%) Cesarean ( 28)22 ( 78.6%)6 ( 21.4%)

Conclusions  Contrary to the antenatal desire of most of these women and the dual method encouraged for HIV positive individuals most women utilized only condoms and maybe at increased risk for repeat pregnancies.

Conclusions  In addition, about 1/3 of these women were not on any form of contraception, including condoms, and are at risk of pregnancies and transmitting the virus to others or acquiring other infections.

Conclusions  Use of contraception was noted more among the women  who expressed an antenatal desire to do so.  Who were HAART inexperienced  Who delivered by cesarean

Conclusions  Range of factors associated with contraceptive choice in literature include:  Method effectiveness  Childbearing goals,  Relationship characteristics,  method related  attitudes of service providers and  service access and provision  There is a need to explore further the role of these factors in the contraceptive choices made by these women.

Conclusions  Possible measures suggested to improve contraceptive uptake among HIV positive women include:  The integration of reproductive (including family planning services) with HIV services  Provision of free family planning services  Male involvement in reproductive health issues.

Conclusions  The study was limited by the observational nature of the data.

Acknowledgment  The women who participated in this study.  The staff of the PMTCT counseling unit of the ARV clinic UCH, Ibadan.  The secretarial staff.  The HARVARD- PEPFAR/ APIN Plus leadership of the ARV clinic of UCH, Ibadan.  Organizers ICASA 2011

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