Reproductive Decision-Making in the Context of HIV and AIDS: A Qualitative Study in Ndola, Zambia

Context: As the AIDS epidemic continues to spread in Sub-Saharan Africa, increasing numbers of women of childbearing age and their partners have become infected with HIV. Family planning programs potentially can reduce perinatal and heterosexual transmission, but effective programmatic strategies depend on how HIV and AIDS influence reproductive decision-making. Methods: In 1997, eight focus groups and 23 in-depth interviews were conducted among women and men in Ndola, Zambia, an area with a high prevalence of HIV and AIDS. Coded transcripts and summary matrices permitted substantive themes to be analyzed by gender of study participants. Results: In the absence of signs or symptoms of illness, HIV's impact on women's and men's childbearing and contraceptive use decisions is generally weak. One important exception is the study participants' observation of the burden of caring for children whose parents have died of AIDS. However, when signs or symptoms of the illness are present, both women and men are overwhelmingly against continued childbearing and support the use of condoms to prevent transmission of the disease to a spouse. Many women said they would fear getting pregnant if they suspected they were HIV positive because pregnancy would "bring out" the disease, and some women said that before having another child they would consider taking an HIV test. Conclusions: Family planning programs could help clients ascertain their own risk of infection and thus reduce perinatal transmission of HIV by frankly discussing risk factors, offering HIV testing and assisting couples affected by HIV make better choices about contraceptive methods.