Factors Influencing Use of Family Planning Services among HIV-positive Women in the PMTCT Program at Clínica de Familia La Romana in the Dominican Republic

Reducing unmet family planning need to zero is an integral part of UNAIDS’ Global Plan to virtually eliminate infant HIV infection by 2015. This study aims to understand the beliefs and attitudes that influence family planning use among HIV-positive women in the prevention of mother-to-child transmission (PMTCT) program at Clínica de Familia La Romana, Dominican Republic, and to determine which barriers to use are most important in this population and prioritize them as targets for intervention. Data were collected from one focus group and 21 single investigator-administered semistructured interviews with women in the PMTCT program at Clínica de Familia La Romana, Dominican Republic. The majority of women stated that their last pregnancy was undesired, although they were not using family planning at the time of the pregnancy. Knowledge about the methods, social influences (family, friends), and logistics were not significant barriers within this population. The two barriers that were most frequently reported as reasons for not using, or stopping use of, a family planning method were the attitudes and beliefs of the partner and menstrual changes ranging from irregular bleeding to amenorrhea. This study suggests two main categories of interventions to reduce unmet family planning need in this PMTCT population. First, further research is needed to probe family planning attitudes and beliefs among the partners of HIV-positive women. Only by exploring both partners’ beliefs and expectations can culturally sensitive interventions be developed to increase family planning acceptability among the partners, and thus potentially increase use among women. Second, specific counseling is needed to ask for and address concerns of the women. Importantly, women need to understand that menstrual change is normal with certain methods and does not indicate a decline in their health status. Involving partners in family planning education and improving women’s understanding of how methods work and side effects to expect may improve uptake of contraception in this population.