Fertility Desires and Family Planning Among HIV-affected Couples in Nyanza Province, Kenya

Fertility Desires and Family Planning Among HIV-affected Couples in Nyanza Province, Kenya Sara Newmann, MD, MPH Men, Masculinities and Family Planning in Africa October 14, 2010 October 14, 2010October 14, 2010

HIV care providers, Nyanza “In our community, the Luos, most…use Depo because…they know their husbands will not realize very fast.” “We do manipulate their decisions, that is why when you go to our records Depo is on the highest side.” “We can improve [family planning] by including the males. She tries to hide, but if they come [together] the husband knows that my wife is on family planning..it’s safer than the mother just coming alone.” Newmann, APHA, 2008

High unmet need for family planningFuture fertility preferences:HIV-infected men and women, Nyanza Men (n=402) Newmann, Reproductive Health 2010

Study Aim • To assess the feasibility of recruiting and separately and simultaneously interviewing partners of heterosexual couples in Nyanza Province • To perform qualitative, hypothesis-generating research to explore couple decision-making and relationship power around fertility and family planning among HIV-affected couples in Nyanza Province

Study Population • Clinic-based couples: • Reproductive-age, heterosexual couples, at least one partner is HIV-infected and a patient at a FACES-supported HIV clinic • Community-based couples: • Reproductive-age men and women in heterosexual couple relationships in Nyanza Province communities • Community leaders • Village chiefs, assistant chiefs, community group leaders, village elders, religious leaders, leaders of community committees Study Location Migori, Rongo, Nyatike, districts in Nyanza Province

Specific Objectives To explore: • fertility desires • gender dynamics in decision-making around fertility and family planning • perceptions of contraceptive methods • impact of unintended pregnancy …and the influence of HIV infection on the above

Study Design • In-depth, semi-structured interviews: • 15-20 clinic-based couples • 15-20 community-based couples • 15-20 Key informants/Community leaders • Separate, simultaneous interviews • Same-sex interviewers in Dhluo • Purposive and chain referral sampling • Transcription/Translation • Data analysis: Atlas.ti5.6 • Qualitative, grounded theory methods

Study Progress • All Interviews completed (includes pilots): • 21 clinic-based couples • 21 community-based couples • 26 community leaders • Interviews translated/transcribed: • 1 clinic-based couple • 2 community-based couples • 2 community leaders

Community Couple Case Study Demographics Response to question about male involvement in family planning

Loss of lineage • Religion • Traditional Luo culture • Political pressure • Land ownership/security • Importance of male children • Impact of HIV

Community Couple Case Study Response to question about male involvement in family planning

Need for facilitation of FP discussion Family planning stigma Myths/misperceptions Side effects

Community Couple Case Study Demographics Response to question about male involvement in family planning Response to question about clandestine use of family planning

Final thoughts • Need discourse about family planning in male spaces and with male leaders • Emphasize reversibility of methods Encouragement, the only way to encourage people is through talks…Then they hear okay,… so and so only had two children and they are just alive. Then later those children went to school very well, and the kind of assistance they get at home is much easier than one who has a heavy burden.

Maricianah Onono Rachel Steinfeld Zachary Kwena Elizabeth Harrington Salome Ogola Alphonce Omondi Steve Ajuoga Daniel Grossman Elizabeth Bukusi Craig Cohen Shari Dworkin Lynae Darbes Megan Comfort Nicolas Sheon Thank you

Fertility Desires and Family Planning Among HIV-affected Couples in Nyanza Province, Kenya