Reproductive aspirations and intentions of young women living with HIV, in two South African townships.

Abstract

South Africa has an estimated population of approximately 47. 9 million of which almost (51%) are female; according to the 2007 mid-year report of Statistics South Africa (Stats-SA, 2007). The availability of Antiretroviral (ARVs) that delay HIV progression and improve quality of life of HIV infected individuals and the roll-out of prevention of mother to child transmission (PMTCT) have brought renewed hope among many couples and individuals in South Africa. The four pillars of the Prevention of Mother to Child Transmission (PMTCT) programme include prevention of HIV infection among young women, prevention of un-intended pregnancies among HIV infected women, prevention of HIV infection to the child and provision of care and support services. HIV-positive young women live by socially and medically constructed values that expect them to avoid becoming pregnant, but at the same time they are expected to marry and bear children. A more in-depth understanding of the reproductive decision making experiences of women below the age of 35 is needed because they are at reproductive age and most at risk of HIV infection in South Africa. The impact of a positive HIV diagnosis may be best understood when viewed within a social constructivist framework. A few studies in South Africa (Cooper et al, 2005; Harries et al, 2007; Myer, Morroni, and Rebe, 2007; Orner et al, 2007; Stevens, 2008) have been conducted on fertility desires of HIV positive individuals and couples although not specifically exploring young women who are mostly vulnerable to HIV infection. Recognizing the gap in the desired public health care objectives, such as preventing mother to child transmission of HIV and the lived experiences of young women living with HIV, this qualitative exploratory research was conducted in two South African Townships. The purpose was to explore the reproductive aspirations and intentions of the women below the age of 35, in the light of the higher HIV prevalence in this population, compared to other groups. The research explored two theories of human behaviour; the theory of planned behaviour and Erick Erikson’s human developmental theory. Eleven semi-structured in-depth interviews and two focus group discussions were conducted through support groups at clinics in Soweto and Attridgeville. Ethical approval was obtained from the University of KwaZulu-Natal and all participants signed consent to participate in the research. Findings showed that women younger than 30 who did not have a child, desired and intended to have biological children. Health concerns such as CD4 count, concerns about HIV progression, early death and orphan-hood, previous loss of a child due to HIV and financial concerns were often cited. Tied to this were health workers’ attitudes towards pregnancy among women who knew their HIV status. Women said that a child brought joy, strength and courage to the mother and was seen as an image, when the mother dies, due to HIV. Almost all the women were in support groups that openly discouraged pregnancy among HIV positive women, especially those who already have a child or children. This research indicates that in practice, counselling and information around reproductive health and choices, is often offered in a quest to dissuade HIV-infected women from considering pregnancy. Health services, families and partners, as well as past experiences of motherhood, all play a role in decision making (Cooper et al, 2005). Sometimes policy guidelines alone are not enough to ensure that reproductive rights of women living with HIV are respected at the different levels. This research points out the population of women who have specific needs and who should not be treated as a homogenous group with all women. This recognition should go beyond policy recommendations into implementation and monitoring.