Family planning need of people living with HIV/AIDS in antiretroviral therapy clinics of Horro Guduru Wollega zone, Ethiopia
Tsegaye BMC Res Notes
Family planning need of people living with HIV/AIDS in antiretroviral therapy clinics of Horro Guduru Wollega zone, Ethiopia
Reta Tsegaye 0
0 Department of Nursing and Midwifery, College of Health Sciences, Wollega University , P.O. Box 395, Nekemte , Ethiopia
Objective: The purpose of this study was to identify factors associated with family planning needs among people living with human immunodeficiency virus (HIV) in Ethiopia. Results: Three hundred twenty-one participants provided information on family planning methods and associated factors. Forty-six-point four percent of respondents reported using at least one form of family planning method; injectables (50.3%) and condoms (70.2%) were the most commonly used type of family planning method before and after HIV diagnosis, respectively. Age, the desire to have children, and the desire to have more than two children were significantly associated with the use of family planning methods.
Family planning; People living with HIV (PLWH); Horro Guduru Wollega; Mother to child transmission
By the end of 2015, the number of people living with HIV
had reached an estimated 33.3 million. Women account
for half of the estimated adults living with HIV and AIDS
worldwide, the majority of whom are in their
reproductive years [
]. With increased access to treatment for
PLHIV, there has been a consequent decrease in
mortality among PLHIV and subsequent increase in normal
functioning including sexual activity .
Many women are at risk for unintended pregnancy
and HIV infection at the same time. In a number of
African countries the rate of unintended pregnancy among
women living with HIV range from 51 to 84% [
Family planning has a major impact on improving the overall
health of a woman as well as that of her children by
delaying first births, reducing the total number of children
born to a woman, and preventing unintended
pregnancies. Nearly one-third of maternal deaths could be
prevented by meeting unmet need for family planning [
Despite these benefits, in sub Saharan Africa, family
planning among PLWH is not widely used [
]. A national
survey conducted in Malawi among HIV positive women
revealed that 51.2% of the respondents were using family
planning methods and unmet need of FP methods were
]. According to a cross-sectional survey
conducted in Tigray region, Ethiopia, 44.3% of the
respondents were using contraceptive methods at time of survey
]. A cross sectional study conducted in West Shewa
zone, Ethiopia also revealed that less than half (43.1%) of
study participants were using family planning during the
study period [
Factors associated with low utilization of family
planning among PLWH vary across the countries and study
sites. In the study area there is no available evidence on
the use of family planning methods among PLWH. Thus,
this study was done to explore factors associated with
family planning needs among PLWH in Horro Guduru
Wollega zone, Ethiopia.
The study was conducted in Horro Guduru Wollega
(HGW) Zone, Oromia National Regional State. HGW is
one of twenty zones of the region which has ten districts
with different climatic conditions. This zone has a total
population of 570,040 (285,515 male and 284,525 female)
of which 11.36% of the population were urban
]. Shambu is the capital town of the zone and
found 310 km from country’s capital, Addis Ababa.
Study population and design
The study involved cross sectional institution based study
among randomly selected PLWHA who were in
reproductive age and had taken at least one visit at
antiretroviral therapy (ART) care from the selected ART care unit
from March 31 to April 30, 2012. There were ten health
care institutions (one hospital and nine health centers)
providing ART services in HGW Zone. Among these,
one hospital and two health centers were randomly
selected. The source population was all PLWH (men and
women) following ART care unit in selected HGW zone
ART care units during the study period. Study
populations were randomly selected who were in reproductive
age and had taken at least one visit at ART care from the
selected ART care unit during the study period. Those
who were critically ill and could not provide informed
consent were excluded from the study.
Sample size determination and sampling technique
The sample size was determined using single
population proportion formula taking the proportion of HIV
positive individuals who received ART treatment and
had the desire to have children is 40% from study done
in Addis Ababa [
], 5% marginal error, 95% confidence
interval. A total of 1050 eligible participants were
identified. Since the total number of people living with HIV/
AIDS who were following ART clinics in HGW zone in
ten ART clinics was < 10,000, correction formula was
used. To compensate the non-response rate, 10% of
the determined sample was added up on the calculated
sample size and the final sample size was 323. Then the
study participants were selected by systematic random
sampling of every 3rd person from three study sites
proportional their size. The dependent variable was family
planning need, and the independent variables were
sociodemography, fertility desire, and number of children
Data collection methods and tools
Data was collected using structured questionnaire with
closed and open ended questions. The questionnaire
was adapted from different literatures [
(Additional file 1). The questionnaires were prepared in
English, translated into Afan Oromo (working language of
Oromia region), and then retranslated back to English by
people who are proficient in both languages to maintain
the consistency of the questionnaires. The questionnaire
contained questions on socio-demographic
characteristics, information about family planning use, choice and
demand, and sexual behavior and condom use. Six data
collectors were selected from the study site. Training was
given for 2 days about the objective and relevance of the
study, confidentiality of information, respondents’ rights,
informed consent and techniques of interview. Three
supervisors were also selected from each site and closely
followed the data collection process with principal
investigator. Field questionnaires were reviewed each night
and any issues encountered during data collection
procedures were addressed accordingly.
Data processing and analysis
The data cleaning was done, entered into a computer by
using EPI Info version 6.5. The data were then exported
to SPSS windows version 20.0 for further analysis. The
descriptive analyses such as proportions, percentages,
frequency distribution and measures of central tendency
were conducted. Bivariate analysis of demographic
variables and family planning need was described. Odds
ratio was used to check significant association between
dependent and independent variables. Then all variables
found to be significant at bivariate level (p value < 0.05)
were entered into multivariate analysis using the
logistic regression model to test the significance of the
Socio demographic characteristics of study participants
Three hundred twenty-one respondents participated in
the study among 323 eligible clients in the selected ARV
care units, giving a response rate of 99.4%. The
majority 156 (48.6%) of the respondents were between 30 and
39 years of age. The mean age (SD) of females and males
were 31.4 (± 5.8) and 35.6 (± 7.9) respectively. The age
range of the respondents was from 19 to 58 years. The
majority more than half of the respondents were
orthodox (51.4%) in religion. Nearly one-third (29.65) of the
study participants can’t read and write (see Table 1).
Family planning need, choice and use
One hundred forty-nine (46.4%) were using different
types of family planning methods during the survey
period. Among these 120 (80.5%) and 50 (33.6%) were
using condom and injectables respectively. Out of those
who were not using family planning method at the time
(34.7%) did not use. Out of those who reported condom
use, the majority 115 (89.8%) used it regularly. The most
common reason for condom use was advice from health
professionals 57 (44.5%) while wanting to have child 39
(57.3%) was the most common reason for non condom
Factors associated with family planning need
From multivariate analysis, those ages group 18–29 were
more likely want to use family planning methods than
those above thirties (AOR: 2.5, 95% CI 1.18–5.46). Study
subjects who desired children were more likely to want to
use family planning in the future than those who did not
desire children (adjusted OR: 2.8, 95% CI 1.2–6.6). On
the other hand those who desired to have less than two
children were less likely to use any family planning in the
future than their counter parts (adjusted OR: 0.26, 95%
CI 0.1–0.8) (Table 3).
The current study was undertaken to describe
family planning need among people living with HIV/AIDS
in Horro Guduru Wollega zone, Ethiopia. In this study
about 44.5% of the respondents had used at least one
method of family planning methods before HIV diagnosis
and this number was increased to 57.6% after HIV
diagnosis. This finding was similar with a study conducted
among HIV positive women in South Gondar and North
Wollo zone, Ethiopia and South Africa [
reason for increased utilization of family planning may
be attributed to the counseling services they got from
their ART providers to prevent unintended pregnancies
and prevention of HIV re-infection from their partners.
Among those who were not currently using, only 33.7%
did want to use family planning in the future; indicating
that counseling for family planning for these people still
needs to be addressed.
Sixty-one point one percent of the study participants
were sexually active 6 months preceding the survey. This
finding was higher than study conducted in Bahir Dar
city (50.4%) of Ethiopia but lower compared to study
conducted among serodiscordants in Henan, China (83.6%)
]. The increase in sexual activity among PLWH
could be attributed to improved quality of life because
of antiretroviral therapy, opportunistic infection
prophylaxis and other health care packages . With increased
access to ART made possible by global and national
initiatives, more HIV positive people are increasingly
becoming healthier and more sexually active [
Of those who were sexually active, the majority 128
(65.3%) reported using condom while 68 (34.7%) never
used at all and among who reported using condoms,
over 10% inconsistently used them. These findings were
of survey period, only 58 (33.7%) of them have intended
to use family planning methods in the future (Table 2).
Sexual behavior and condom use
One hundred ninety-six (61.1%) of the study participants
were sexually active within the past 6 months. Among
these 128 (65.3%) reported using condoms while 68
Contraceptive use n (%)
a Among current contraceptive non users (n = 172)
b Among current contraceptive users (n = 149) and more than one FP methods were reported use
c Among those who want to use contraceptive in the future (n = 58) and more than one FP methods were reported need in the future
similar to study conducted in Malawi (65.8%) and Nepal
(65.8%) reported condom use but lower compared to
study conducted in Uganda (77.6%) [
]. The results
appear to indicate significant proportions of PLWH were
increasingly practicing risky sexual behavior which has
a greater risk of horizontal HIV transmission. So
counseling regarding the importance of condom usage in
conjunction with more effective modern contraceptive
methods must continue to be reinforced over the course
of ongoing ART treatment to prevent both infection and
pregnancy. Oral pre-exposure prophylaxis (PrEP) for
heterosexual HIV discordant couples has proven feasible to
reduce HIV transmission and this may be considered as
possible additional intervention for the uninfected
This study identified many factors like age; desire to
have children and number of children desired as
important factors associated with future family planning need.
Those who were age group between 18 and 29 were more
likely to use family planning than those above thirties
Future need to use n (%)a
which was similar to study conducted in Uganda and
Tigray region [
]. This may be attributed to the possible
need of these populations to prevent unintended
pregnancy, and delay to have children as their age is
comparably younger than their counter parts. However, according
to study conducted in Addis Ababa, age has no
significant association with future family planning need.
The other factor associated with future family planning
use was future desire for children. Those who desired
children were three times more likely to use future
family planning than those who did not desire children.
Similarly study conducted in Addis Ababa, North Shewa
(unpublished) and West Shewa zones of Ethiopia
identified that those who desired children were more likely to
use family planning in the future than their counter parts
]. This may be again the possible need of these
populations to limit and space the number of children. But
according to study conducted in Kenyan health facility,
those expressed fertility desire were less likely to use
family planning in the future .
Number of children desired was another factor for
future family planning need identified in this study; those
who desired two and above children were more likely to
use family planning methods than those who desired one.
This may be again due to the possible desire of these
populations to limit and space births as their desired number
of children increases. This finding was comparable with
the study conducted in slums of Nairobi, Tigray region
and Debre Markos of Ethiopia [
8, 24, 25
] as respondents
who have one or more living children were more likely to
use contraceptive compared with those with no child.
Limitation of the study
• The cross-sectional nature of the data could not allow
the causal effect relationships of dependent and
• In this study, sexually active refers to sexual
relationship between male and female only. Men sex with
men (MSM) was not included as it is culturally
inappropriate in the study area.
• Even though data collectors were trained on
respondent’s confidentiality, respondents may still provide
desired answers by data collectors especially on
sexual behaviors. Thus, social desirability bias may not
be totally avoidable.
• Despite these limitations, the data being gathered
possess a better description of family planning need
of PLWH in the study area.
Additional file 1. Questionnaire. Information sheets, Consent form and
questionnaire used during the study.
AIDS: acquired immune deficiency syndrome; ART: antiretroviral therapy;
HGW: Horro Guduru Wollega; HIV: human immunodeficiency virus; PLWH:
people living with HIV; SPSS: Statistical Packages for the Social Sciences.
I am grateful to acknowledge Addis Ababa University for funding this project.
I would also like to acknowledge supervisors, data collectors, and study
The author declare that he has no competing interests.
Availability of data and materials
All relevant data are within the manuscript.
Consent for publication
Ethics approval and consent to participate
Ethical clearance was obtained from the Addis Ababa University Ethical
Review Committee (Protocol No: 26/12/NURS). Permission was also obtained
from Shambu Hospital, Wayu Health Center and Fincha Health Center by
formal letter. Written informed consent was obtained from the study participants
after telling purpose of the study and importance of their participation. The
anonymity of the participants was respected by the use of codes rather than
the name of the participants. The names of the participants were not reported
in the findings of the study to ensure confidentiality.
This research was funded by Addis Ababa University.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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