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Unplanned pregnancy in the 2011 Botswana Antenatal Clinic Sentinel Surveillance

Unplanned pregnancy in the 2011 Botswana Antenatal Clinic Sentinel Surveillance A.C. Voetsch, M.G. Anderson, E. Machakaire, S. Bodika, W. Jimbo, B.P. Yadav, M. Schann, T. Madidimalo, R. Lebelonyane. Outline. Background Reproductive health in Botswana Botswana PMTCT program

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Unplanned pregnancy in the 2011 Botswana Antenatal Clinic Sentinel Surveillance

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  1. Unplanned pregnancy in the 2011 Botswana Antenatal Clinic Sentinel Surveillance A.C. Voetsch, M.G. Anderson, E. Machakaire, S. Bodika, W. Jimbo, B.P. Yadav, M. Schann, T. Madidimalo, R. Lebelonyane

  2. Outline • Background • Reproductive health in Botswana • Botswana PMTCT program • 2011 Botswana Antenatal Clinic Survey • Unplanned pregnancy question analysis • Recommendations/Next steps

  3. Background Population = 2.1 million Middle income country Per capita GDP = $16,300 Adult HIV prevalence = 25% 300,000 PLWH

  4. Reproductive health in Botswana • Fertility rate 3.2 • Annual birth rate 22 births/1,000 • Antenatal care visits 95% • Skilled antenatal clinic provider 94% • Delivery in a health care facility 94% • Skilled provider at delivery 95% • Outcomes • Maternal mortality 190/100,000 live births • Infant mortality 57/1,000 live births

  5. Botswana PMTCT program 2011 • Pregnant women 43,828 • Tested for HIV and knew result 97% • Tested HIV positive 30.6% • Received ARVs to prevent MTCT 93% • HIV-exposed infants • Tested for HIV 91% • Tested positive for HIV <4%

  6. Four prong approach 1. Primary prevention 2. Prevent unintended pregnancies 3. Prevent vertical transmission 4. Link to care, treatment, follow-up

  7. Knowledge and current use of contraceptives

  8. ANC Sentinel Surveillance • August 1 through October 28, 2011 • 262 selected antenatal clinics • All 24 health districts • Pregnant women aged 15–49 years • First presentation • One-page surveillance form • Demographic information • Gravidity • HIV testing history • Planned pregnancy (“Was this pregnancy planned?”)

  9. Results • 7209 eligible women • 6745 (94%) women surveyed and tested • Adjusted national HIV prevalence = 30.4% • Prevalence varied by district and age

  10. Age-specific HIV prevalence Age group (years)

  11. HIV prevalence by district

  12. Results • 6667 (99%) answered planned pregnancy question • 3383 (51%) current pregnancy was unplanned • Highest among women • 15-19 years (68%) and 40-49 years (67%) • 4 or more pregnancies (67%) • Divorced, widowed, separated (60%) • Primary school education (61%) • HIV-positive (56%)

  13. Unplanned pregnancy by age and HIV status

  14. Multivariable model • Logistic regression model adjusted for linear and quadratic effects of age and for health district

  15. Conclusions • Gap between contraceptive knowledge and use • Half of women in ANC survey reported unplanned pregnancy • Both HIV-positive and HIV-negative women • Younger/older, less educated, unmarried

  16. Recommendations • Strengthen HIV/Sexual Reproductive Health linkages • Dual protection • Guidance for women who want to become pregnant • Target family planning services • Improve supply chain for contraceptives

  17. Next steps • European Union grant • UNFPA national coordinator • Pilot co-location in 3 districts • PEPFAR • Education materials/flip charts • Male/youth friendly services • Supply chain

  18. Acknowledgments • Staff from the 262 clinics who collected the data • 6745 pregnant women in the 2011 ANC survey • This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention under the terms of grant number 5U62PS025095-05.  

  19. Ke a leboga (Thank you) The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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