Desire for Children and Unmet Need for Contraception among HIV-Positive Women in Lesotho

In Lesotho, where the HIV prevalence rate for women is 26.4%, there is high risk for mother-to-child transmission (MTCT) of HIV. Efforts to prevent MTCT can focus on reducing the fertility level of HIV-positive women. This paper examines the desire for children and unmet need for contraception to limit or space births among HIV-positive women age 15-49 years, using data from the 2004 Lesotho Demographic and Health Survey. Multivariate analysis of HIV-positive women, 83% of whom have never learned their HIV status, shows that the desire for children in the future does not differ by socioeconomic status. Unmet need for contraception is highest among women in the poorest households. Although these women have lower HIV prevalence, they have higher potential for MTCT. The multivariate results are similar for both HIV-positive and HIVnegative women because of low self-awareness of HIV status. Efforts to reduce the level of MTCT require improved access to family planning services for all women, especially the poorest, and an increase in HIV testing and counseling. Background The southern African country of Lesotho has one of the highest national HIV prevalence rates in the world. According to the 2004 Lesotho Demographic and Health Survey (LDHS), 26.4% of women age 15-49 years are HIV positive (MOHSW et al., 2005). A Total Fertility Rate (TFR) of 3.5 births per woman in Lesotho has caused mother-to-child transmission (MTCT) of HIV to be of major concern (MOHSW et al., 2005). It is estimated that the current under-five mortality rate in Lesotho of 123 deaths per 1,000 births would be 71 if there was no AIDS (Population Reference Bureau, 2006). HIV testing of pregnant women and the distribution of antiretroviral drugs during delivery and following birth are two primary approaches currently used to prevent MTCT (PMTCT). Efforts to decrease the level of MTCT can also focus on reducing fertility among HIVpositive women. Two causes of the level of fertility are the desire for children and unmet need for contraception to limit or space births. Therefore, this paper utilizes the 2004 LDHS to analyze the factors associated with these two causes among HIV-positive women, to help identify strategies to reduce their fertility levels and the extent of MTCT in Lesotho. Worldwide, 1,800 children under the age of 15 become infected with HIV each day, the vast majority of whom are in Africa (UNAIDS, 2006). The risk of mother-to-child transmission occurs during pregnancy, delivery, and breastfeeding. During pregnancy and labor the risk of transmission is 15% to 30%. Breastfeeding through 18 to 24 months increases the overall risk to 30% to 45% (De Cock et al., 2000). There are a number of PMTCT services. HIV testing of pregnant women can identify women who require antiretroviral therapy and counseling. Antiretroviral therapy for the mother and child consists of one dose of the drug nevirapine to the mother at delivery and one dose to the child soon after birth. Counseling on risk reduction of transmission through breastfeeding may also reduce the risk of mother-to-child transmission; if there are no appropriate substitute feeds, however, this method may not be feasible. Despite the risk of MTCT in 1 Promoting voluntary HIV testing and counseling of women that are not pregnant can contribute to preventing HIV-positive women from becoming pregnant. 2 A report on a study in Malawi indicates that the reduction of mortality among children of HIV-positive women due to breastfeeding more than offsets the risks of mother-to-child transmission (Taha et al., 2006).