'They haven’t asked me. I haven’t told them either': fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

Autor: Deborah Loxton, Melissa L. Harris, Tesfaye Regassa Feyissa
Rok vydání: 2020
Předmět:
Adult
Counseling
medicine.medical_specialty
Adolescent
Anti-HIV Agents
Health Personnel
media_common.quotation_subject
education
Staffing
Reproductive medicine
HIV Infections
Fertility
Intention
lcsh:Gynecology and obstetrics
03 medical and health sciences
0302 clinical medicine
Pregnancy
Antiretroviral Therapy
Highly Active
Health care
medicine
Humans
Women
Safer conception
030212 general & internal medicine
Human resources
lcsh:RG1-991
media_common
Physician-Patient Relations
030219 obstetrics & reproductive medicine
business.industry
Research
Communication
Public health
HIV
Obstetrics and Gynecology
Infectious Disease Transmission
Vertical
Contraception
Reproductive Medicine
Family planning
Family medicine
Counselling
Female
Reproductive Health Services
Ethiopia
Thematic analysis
business
Psychology
Risk Reduction Behavior
Zdroj: Reproductive Health
Reproductive Health, Vol 17, Iss 1, Pp 1-16 (2020)
ISSN: 1742-4755
DOI: 10.1186/s12978-020-00971-2
Popis: Background Despite the importance of women living with HIV (WLHIV) engaging in fertility plan discussions with their healthcare providers (HCPs), little research exists. This study explored perceptions surrounding fertility plan discussions between WLHIV and their HCPs in western Ethiopia, from the perspectives of both women and providers. Methods Thirty-one interviews (27 with WLHIV and 4 with HCPs) were conducted at four healthcare facilities in western Ethiopia in 2018. Data were transcribed verbatim and translated into English. Codes and themes were identified using inductive thematic analysis. Results There was a discordance between HCPs and WLHIV’s perception regarding the delivery of fertility plan discussions. Only nine of the 27 WLHIV reported they had discussed their personal fertility plans with their HCPs. When discussions did occur, safer conception and contraceptive use were the primary focus. Referrals to mother support groups, adherence counsellors as well as family planning clinics (where they can access reproductive counselling) facilitated fertility discussions. However, lack of initiating discussions by either HCPs or women, high client load and insufficient staffing, and a poor referral system were barriers to discussing fertility plans. Where discussions did occur, barriers to good quality interactions were: (a) lack of recognizing women’s fertility needs; (b) a lack of time and being overworked; (c) mismatched fertility desire among couples; (d) non-disclosure of HIV-positive status to a partner; (e) poor partner involvement; (f) fear of repercussions of disclosing fertility desires to a HCP; and (g) HCPs fear of seroconversion. Conclusions Our findings highlight the need for policies and guidelines to support fertility plan discussions. Training of HCPs, provision of non-judgmental and client-centered fertility counselling, improving integration of services along with increased human resources are crucial to counselling provision. Enhancing partner involvement, and supporting and training mother support groups and adherence counsellors in providing fertility plan discussions are crucial to improving safer conception and effective contraceptive use, which helps in having healthy babies and reducing HIV transmission.
Databáze: OpenAIRE
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