Understanding Childbearing Decision Making within the Context of Sexual and Reproductive Health Care Needs of Women Living With HIV/AIDS in Southwest Nigeria

Open Access
Sofolahan, Yewande A
Graduate Program:
Biobehavioral Health
Doctor of Philosophy
Document Type:
Date of Defense:
February 21, 2013
Committee Members:
  • Collins O Airhihenbuwa, Dissertation Advisor
  • Collins O Airhihenbuwa, Committee Chair
  • Gary King, Committee Member
  • Rhonda Belue, Committee Member
  • Edward A Smith, Committee Member
  • Edgar Paul Yoder, Special Member
  • Nigeria
  • women
  • pregnancy
  • childbearing
  • healthcare
  • support
  • men
  • partners
In sub-Saharan Africa, women continue to be disproportionately affected by HIV/AIDS. In 2009, of the 22.4 million persons living with HIV and AIDS (PLWHA), 13.4 million were women (UNAIDS, 2009). Women in sub-Saharan Africa between the ages of 15 and 24 years constitute 76% of those at risk for contracting HIV, and the risk of infection for this age group is three times that of the general population (UNAIDS, 2008). As the epidemic enters its third decade, the reproductive choices available to women living with HIV/AIDS (WLHA) are constantly evolving. This is in part due to the availability of antiretroviral drugs (ARVs) and prevention of mother-to-child transmission (PMTCT) services which have contributed significantly to sustaining the reproductive intentions of many WLHA. The purpose of this study is to examine the sexual and reproductive healthcare (SRH) needs of WLHA in a clinical setting in southwestern Nigeria, and the factors that influence their childbearing (CB) decisions. In this dissertation, I answer three primary questions: (a) How do the perceptions of WLHA SRH needs influence and/or affect their CB decisions? (b) How are the CB decisions of WLHA influenced by their partners’ desires for children? and (c) How does a supportive healthcare system influence the CB decisions of WLHA? In the first three chapters, I describe HIV infection in Lagos and in Nigeria, distinguish between fertility desires and intentions, and describe motivations for childbearing, the theoretical frameworks employed, and the methods used to conduct the study. Paper 1 (Chapter 4) is based on the first phase of data collection and is grounded in the PEN-3 cultural model. I describe the factors responsible for the CB decisions of WLHA in Lagos, Nigeria by identifying: (a) WLHA perceptions that may promote or hinder healthy behaviors when factored into CB decisions; (b) enablers, such as healthcare support services, that may influence healthy behaviors and practices; and (c) nurturers, such as partners and family members who may support or discourage childbearing among WLHA. Paper 2 (Chapter 5) is based on the second phase of data collection and is grounded in the PEN-3 cultural model and the Ottawa Decision Support Framework (ODSF). In this paper, I examine WLHA perceptions of male partner support in the CB decision-making process after disclosure, pre-partum, and post-partum. In particular, I determine whether male partners were supportive, and how this support was shown to their female partners living with HIV. The results reveal that all of the male partners were supportive except one, and the level of support provided remained consistent. In Paper 3 (Chapter 6), I describe how WLHA interactions with the healthcare system shape their CB decisions. Specifically, I address how WLHA perceive the support and recommendations of healthcare workers (HCWs) related to their CB decisions pre- and post-partum, and what contextual factors within the healthcare system promote or hinder WLHA acceptance of healthcare recommendations. The results reveal that the role of faith was more significant to WLHA pre-partum, while the role of HCWs and access to available healthcare services were important for favorable CB outcomes post-partum. All three studies provide evidence that CB decision-making is a process that may change over time based on different factors. If the UNAIDS/ WHO goal of eliminating new pediatric HIV infections by 2015 is to be achieved, closer attention must be paid to multiple contextual factors such as cultural expectations and spirituality that may influence CB decisions of WLHA. Furthermore, HIV and other SRH service personnel in resource-limited settings should consider WLHA perceptions of their partners and the healthcare system when designing interventions in order to help them make informed reproductive decisions.