Barriers to uptake of long term and permanent family planning methods among HIV infected postpartum mothers in Kenyatta national hospital

Abstract

Introduction Family planning is a key component of prevention of mother to child transmission of HIV and reduction of maternal morbidity and mortality. While most health facilities in Kenya provide long term and permanent methods of family planning, the long term and permanent family planning prevalence is still low and especially among the HIV positive patients. Post-partum visit at sixth week provides an opportunity to counsel and provide LTCM to the mothers. This study was therefore conducted to assess both client and facility factors that contribute to missed opportunities for LTCM uptake among HIV infected post-partum women at sixth week visit in order to inform policy and design interventions that can improve uptake. Objective of the study The objective of the study is to determine factors that hinder uptake of LTCM by HIV infected postpartum women attending PNC at the KNH. Methods A facility based descriptive cross sectional study was conducted at the HIV postpartum clinic at KNH using quantitative method of data collection from March 2013 to July 2013. An exit questionnaire was used for interviews after the mothers had been attended to by the clinician. A total of 103 HIV infected postpartum mothers were interviewed. The mothers were interviewed on family planning information, counseling during pregnancy, child birth, post natal period and their socioeconomic and clinical characteristics. Quantitative data was analyzed using SPSS version 17.0. Odd’s ratios, 95% confidence intervals and p value set at 0.05 were used to determine statistical significance of the associations between independent variable s and preference for LTCM. Qualitative data was coded and analyzed using content thematic analysis. Results The postpartum uptake of LTCM by HIV infected postpartum mothers attending postpartum clinic at sixth week visit was only 0.97%. However 41.7% of the mothers had preference for long term contraceptive methods. Older age (pvalue =0.05) and knowledge of the HIV status of the spouse(pvalue= 0.002, OR 3.8 (1.6 - 8.9) were significantly associated with preference for uptake of LTCM. Barriers to LTCM use included low rate of counseling amongst mothers attending the postpartum clinic as only 7.8% of the mothers were counseled by the clinician during the sixth postpartum visit. Other barriers included failure to provide LTCM services in the same setting as the postpartum clinic and 58.3% of the mothers’ preference for barrier methods. Conclusion The low rate of family planning counseling by clinicians, patient preference for barrier methods especially condoms, and lack of integration of FP services with HIV postpartum clinic services at the HIV postpartum clinic lead to missed opportunities for long term and permanent family planning methods uptake. One on one clinician counseling with HIV infected postpartum mothers on LTCM could enhance accurate information on FP. This would reduce the perceptions on LTCM hence improve their uptake. Recommendations There is need to integrate family planning services and maternity services at KNH. Measures should be put in place to use flip charts for patient education on long term family planning methods. Also, there is need to introduce a check list on what the patients are to be advised on in the HIV postpartum clinic to minimize missed opportunities for LTCM use by clinicians. Nevertheless, health education to patients is required to remove the perception that when one is using barrier methods especially condoms, one does not require a LTCM. Finally, disclosure of HIV status to the partner should be encouraged