Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa.
Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa.
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DOI：
10.1016/j.socscimed.2021.114555
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Pellowski J
中科院分区：
文献类型：
--
作者：
McTigue G;Swartz A;Brittain K;Rini Z;Colvin CJ;Harrison A;Myer L;Pellowski J
支持感染艾滋病毒的妇女（WLWH）避免产后意外怀孕的能力，减少了新的儿科艾滋病毒感染的数量，降低了与怀孕有关的发病率和死亡率，是消除母婴传播的一项具有成本效益的战略。然而，目前对感染艾滋病毒的母亲从怀孕过渡到产后期间重新开始计划生育的避孕意图和经验知之甚少。目的：（1）了解南非开普敦艾滋病毒感染妇女在怀孕期间和产后的避孕轨迹，（2）确定产后期间形成不同避孕轨迹的因素。30名怀孕的WLWH在怀孕的第8个月接受了采访，并在产后6-8周和9-12个月完成了随访采访（共81次采访）。访谈主题包括产后避孕意愿、避孕药具使用情况和获得计划生育服务的经验。避孕意愿的轨迹分析后，初步主题编码。虽然在怀孕期间接受采访的妇女中有近一半表示打算在分娩后使用非注射避孕方法（如植入、宫内节育器、绝育、口服避孕药），但所有接受采访的妇女在产后一年时都至少接受过一次注射。确定了三种主要的避孕轨迹。(1)产后避孕意愿的实现;（2）产后避孕意愿未实现;（3）避孕意愿随时间的变化。提供者的影响，服务的协调，以及低避孕库存被确定为参与研究的参与者的避孕轨迹形成的潜在因素。WLWH在怀孕期间阐述的避孕方法意图和产后获得的方法之间的差异表明，对注射避孕不满意的妇女仍然存在重大障碍。未能向感染艾滋病毒的产后母亲提供计划生育方法，会破坏预防意外怀孕的努力，而意外怀孕是消除母婴传播的一个关键支柱。
Supporting the ability of women living with HIV (WLWH) to avoid unintended pregnancy during the postpartum period decreases the number of new pediatric HIV infections, reduces pregnancy-related morbidity and mortality, and is a cost-effective strategy for the elimination of mother-to-child transmission. However, little is currently known about the contraceptive intentions and experiences of reinitiating family planning use among mothers living with HIV as they transition from pregnancy into postpartum. To (1) understand the contraceptive trajectories of women living with HIV during pregnancy and postpartum in Cape Town, South Africa, and (2) identify factors shaping differing contraceptive trajectories during the postpartum period. Thirty pregnant WLWH were interviewed during their eighth month of pregnancy and completed follow-up interviews at 6–8 weeks and 9–12 months postpartum (n=81 total interviews). Interview topics included postpartum contraception intentions, contraceptive use, and experiences accessing family planning services. Trajectory analysis of contraceptive intentions was applied after initial thematic coding. While nearly half of women interviewed during pregnancy expressed an intention to utilize a non-injectable contraceptive option after childbirth (e.g. implant, IUD, sterilization, oral contraceptive pills), all women interviewed at one year postpartum had received at least one injection. Three main contraceptive trajectories were identified. (1) realization of contraceptive intentions postpartum; (2) unrealized contraceptive intentions postpartum; and (3) change in contraceptive intention over time. Provider influence, coordination of services, and low contraceptive inventory were identified as potential factors shaping the contraceptive trajectories of participants enrolled in the study. Disparities between contraceptive method intentions articulated by WLWH during pregnancy and methods attained postpartum suggest that significant barriers remain for women who are unsatisfied with injectable contraception. Failing to provide postpartum mothers living with HIV their intended family planning method undermines efforts to prevent unintended pregnancy, a key pillar of elimination of mother-to-child transmission.
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3.4
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通讯作者：
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