Factors associated with the utilization of family planning by women of reproductive age living with HIV in the integrated family planning and art clinics of Mpigi district

Abstract

Background: To reduce the unmet need for family planning (FP) among sexually active women of reproductive age (15-49 years) living with HIV requires understanding the utilization of FP services. In 2011, the Uganda Ministry of Health with funding support from PEPFAR, started providing FP services within the ART clinics in order to improve utilization. However, there is scarce data regarding utilization and factors that influence women to utilize FP services in the integrated FP and Anti-Retroviral Therapy (ART) clinics in Mpigi District. This study set out to determine the proportion of women utilizing FP services, identify individual and health system factors associated with the utilization of FP in ART clinics in Mpigi district. Methods: A convergent parallel cross-sectional mixed methods study design was used to collect data between January and March 2019 at Mpigi HCIV and ten other HCIIIs. Descriptive summary statistics, chi-square tests, and logistic regression were used to describe participants and identify factors associated with family planning utilization. An inductive thematic analysis was used to analyze the qualitative data. Results: Of the 335 women enrolled into the study, the median age was 32 (IQR:26-38) years, majority (83.6%) were living together with their sexual partners and (51.3%) had attained a secondary level of education. Seventy six percent (253/335) of women reported receiving FP services in the integrated clinics of whom,62.8% (159/253) were using hormonal contraceptives. Factors significantly associated with FP utilization were; women taking a lot of time to get FP and ART at the clinic (AOR=0.447; 95% CI=0.247 - 0.811; p<0.008), Receiving counseling on FP choices from healthcare providers at the facility (AOR=0.419; 95% CI=0.279 - 0.629; p<0.00), Receiving inadequate counseling services among fellow women in community groups (AOR=4.43; 95% CI=1.689 - 11.658; p<0.003), Side effects or reactions to any FP method during use (AOR=0.204; 95% CI=0.089 to 0.467; p=0.00), and perceptions of future reactions to FP after utilization (AOR=0.136; 95% CI=0.050 to 0.369; p=0.00). Conclusion: The study revealed that majority of the women living with HIV were using FP in the integrated FP and ART clinics. Besides that, drivers to FP utilization need to be strengthened through improved health education among women and capacity building of health workers to offer timely and quality FP services in the integrated FP and ART clinics.