Achieving Fertility Aspirations in High HIV Settings: Using Anomalous Case Analysis in Zambia

Ann M. Moore, Guttmacher Institute
Megan L. Kavanaugh, Guttmacher Institute
Sarah C. Keogh, University College London
Chishimba Mulambia, University of Zambia
Isaac Adewole, University of Ibadan
Adesina Oladokun, University of Ibadan
Namuunda Mutombo, University of Zambia
Oyedunni S. Arulogun, University of Ibadan
Maximillian M. Bewupe, Ministry of Health, Zambia
Akinrinola Bankole, Guttmacher Institute

Achieving one’s fertility desires in high HIV settings requires simultaneously navigating HIV risk while attempting to get pregnant. The HIV prevalence rate in Zambia is 14.3%. We conducted follow-up in-depth interviews with a subset of quantitative survey respondents (half of whom were HIV-positive) who were outliers in their fertility aspirations to improve our understanding of factors that influence fertility desires. Preliminary analyses found that fertility desires decreased after HIV diagnosis only for some even though people who were HIV-positive said that their families stopped encouraging them to have more children. Drug interactions between ARVs and contraceptives limited couples’ contraceptive options and exposed women to unintended pregnancy. Abortion was just as stigmatized for the HIV-positive women as for anyone else since there was a great deal of confidence in ARVs allowing women to have a healthy pregnancy. Examining outliers provides insight into different factors which influence childbearing desires in Zambia.