Fertility Desire and Associated Factors among Reproductive Age Women Receiving Antiretroviral Therapy at a Tertiary Hospital in Eastern Ethiopia

Abstract

Background: Fertility desire among women living with human immunodeficiency virus (WLHIV) is a pressing worldwide health challenge. Pregnancy in this group carries risks of HIV transmission and poses serious challenges in settings with high HIV prevalence and poorly functioning healthcare systems. Despite these risks, many WLHIV continue to express strong fertility intentions, with considerable variations across countries and regions due to cultural norms, social pressures, stigma, availability of treatment, and reproduction-related services, resulting in a reproductive dilemma and service disparities. However, limited information is available regarding the prevalence of fertility desire and related factors in the present in Eastern Ethiopia. The purpose of this study was to examine the level and determi­nants of fertility desire among women receiving antiretroviral therapy (ART) at the Hiwot Fana Referral Hospital in Eastern Ethiopia.

Methods: Hospital-based cross-sectional survey involving 412 women living with HIV was carried out from August 1, 2021, to March 10, 2022. Trained data collectors conducted face-to-face interviews using a standardized, pretested instrument.  The data were entered and analyzed using EpiData version 3.1 and STATA version 14. Logistic regression analysis was applied to identify factors independently associated with fertility desire, and statistical significance was declared at p < 0.05.

Results: Nearly half of the participants, 44.2% (95% CI: 39.62, 48.92), expressed fertility desire. Factors like age of 25–34 years (AOR:  2.10, 95% CI: 1.32, 4.35), married (AOR: 2.23, 95% CI: 1.40, 3.55) having a sexual partner (AOR:  1.55, 95%CI: 1.01, 2.40), not using family planning (AOR:  7.80, 95% CI: 4.70,12.95), years of living with HIV (AOR:  5.10, 95% CI: 2.70, 9.80), HIV status disclosure(AOR: 0.08, 95% CI: 0.04, 0.15), living children (AOR:  0.18, 95%CI: 0.11,0.28) and history of abortion (AOR: 0.20, 95% CI: 0.12, 0.33) were significantly associated with fertility desire.

Conclusion: Nearly half of HIV-positive women in the study setting expressed fertility desire. Women aged 25-34 years who were married or cohabiting, had a regular sexual partner, and didn't disclose having HIV indicated signif­icantly increased fertility desire. Conversely, disclosing HIV serostatus, having a living child/children, and having a history of abortion were associated with reduced reproductive desire. These findings highlight the importance of integrating both fertility history and demographic factors into fertility-related counseling for HIV-positive women.