Open Access Highly Accessed Research article

Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011

Kevin R O’Reilly1*, Caitlin E Kennedy2, Virginia A Fonner2 and Michael D Sweat3

Author Affiliations

1 Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

3 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA

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BMC Public Health 2013, 13:935  doi:10.1186/1471-2458-13-935

Published: 8 October 2013

Abstract

Background

Family planning is an important public health intervention with numerous potential health benefits for all women. One of those key benefits is the prevention of mother-to-child transmission of HIV, through the prevention of unintended pregnancies among women living with HIV.

Methods

We conducted a systematic review of the effectiveness of family planning counseling interventions for HIV infected women in low- and middle-income countries.

Results

We found nine articles which met the inclusion criteria for this review, all from Africa. Though these studies varied in the specifics of the interventions provided, research designs and measures of outcomes, key features were discernible. Providing concerted information and support for family planning use, coupled with ready access to a wide range of contraceptive methods, seemed most effective in increasing use. Effects on pregnancy overall were difficult to measure, however: no studies assessed the effect on unintended pregnancy.

Conclusions

Though these results are far from definitive, they do highlight the need for strengthened efforts to integrate family planning counseling and access to services into HIV prevention, and for greater consistency of effort over time. Studies which specifically investigate fertility intentions and desires of women living with HIV, contraception use following interventions to increase knowledge, awareness, motivation and access to the means to act on those intentions and unintended pregnancies would be valuable to help clinic personnel, programme planners and policy makers guide the development of the integrated services they offer.

Keywords:
HIV; Family planning; Counseling; Systematic review