Fertility Desires and Family Planning Among HIV-affected Couples in Nyanza Province, Kenya

Sara Newmann, MD, MPH

Men, Masculinities and Family Planning in Africa

October 14, 2010

October 14, 2010October 14, 2010

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

3

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

HIV care providers, Nyanza

“In our community, the Luos, most…use Depo because…they know their husbands will not realize very fast.”

“We do manipulate their decisions, that is why when you go to our records Depo is on the highest side.”

“We can improve [family planning] by including the males. She tries to hide, but if they come [together] the husband knows that my wife is on family planning..it’s safer than the mother just coming alone.”

Newmann, APHA, 2008

High unmet need for family planning

Future fertility preferences:HIV-infected men and women, Nyanza

77

83

1

195

3610

58

76

19

189

12

1

3

Sooner than 2 years

2 years+

Infertile

Prefers no more children

Undecided/not sure when

Wait until marriage

Other

Women (n=358)

Newmann, Reproductive Health 2010

Men (n=402)

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Study Aim

• To assess the feasibility of recruiting and separately and simultaneously interviewing partners of heterosexual couples in Nyanza Province

• To perform qualitative, hypothesis-generating research to explore couple decision-making and relationship power around fertility and family planning among HIV-affected couples in Nyanza Province

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Study Population• Clinic-based couples:

• Reproductive-age, heterosexual couples, at least one partner is HIV-infected and a patient at a FACES-supported HIV clinic

• Community-based couples: • Reproductive-age men and women in heterosexual

couple relationships in Nyanza Province communities

• Community leaders• Village chiefs, assistant chiefs, community group

leaders, village elders, religious leaders, leaders of community committees

Study LocationMigori, Rongo, Nyatike, districts in Nyanza Province

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Specific Objectives

To explore:

• fertility desires

• gender dynamics in decision-making around fertility and family planning

• perceptions of contraceptive methods

• impact of unintended pregnancy

…and the influence of HIV infection on the above

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Study Design• In-depth, semi-structured interviews:

– 15-20 clinic-based couples– 15-20 community-based couples– 15-20 Key informants/Community leaders

• Separate, simultaneous interviews• Same-sex interviewers in Dhluo• Purposive and chain referral sampling• Transcription/Translation• Data analysis: Atlas.ti 5.6• Qualitative, grounded theory methods

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Study Progress

• All Interviews completed (includes pilots):

• 21 clinic-based couples

• 21 community-based couples

• 26 community leaders

• Interviews translated/transcribed:

• 1 clinic-based couple

• 2 community-based couples

• 2 community leaders

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Community Couple Case StudyDemographics

Response to question about male involvement in family planning

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

12

Loss of lineage

• Religion

• Traditional Luo culture

• Political pressure

• Land ownership/security– Importance of male children

• Impact of HIV

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Community Couple Case Study

Response to question about male involvement in family planning

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Need for facilitation of FP discussion

Family planning stigma

Myths/misperceptions

Side effects

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Community Couple Case Study

Demographics

Response to question about male involvement in family planning

Response to question about clandestine use of family planning

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

16

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

Final thoughts

• Need discourse about family planning in male spaces and with male leaders

• Emphasize reversibility of methods

Encouragement, the only way to encourage people is through talks…Then they hear okay,… so and so only had two children and they are just alive. Then later those children went to school very well, and the kind of assistance they get at home is much easier than one who has a heavy burden.

17

Department of Obstetrics, Gynecology & Reproductive

Sciences

School of Medicine

18

Thank you

Maricianah Onono

Rachel Steinfeld

Zachary Kwena

Elizabeth Harrington

Salome Ogola

Alphonce Omondi

Steve Ajuoga

Daniel Grossman

Elizabeth Bukusi

Craig Cohen

Shari Dworkin

Lynae Darbes

Megan Comfort

Nicolas Sheon

19

Thank you

Maricianah Onono

Rachel Steinfeld

Zachary Kwena

Elizabeth Harrington

Salome Ogola

Alphonce Omondi

Steve Ajuoga

Daniel Grossman

Elizabeth Bukusi

Craig Cohen

Shari Dworkin

Lynae Darbes

Megan Comfort

Nicolas Sheon