What Works for Women and Girls

A study in Côte d’Ivoire with 546 HIV-positive women and 393 HIV-negative womenwho were tested for HIV prenatally and followed up for two years following delivery andwere provided contraception as desired at each postpartum visit, resulting in high ratesof contraception use after delivery and low pregnancy incidence. HIV-positive womenhad fewer unwanted pregnancies than HIV-negative women. At each postpartum visit,women received family planning counseling and free contraception. Between 6 and24 months, proportion of women using modern contraception varied from 52 to 65%among HIV-positive women. Among HIV-positive women, pregnancy incidence for100 women years at risk was 5.70 and unwanted pregnancy incidence was 1.07 (Brou etal., 2009). (Gray III) (pregnancy, contraception, Côte d’Ivoire)A pre-post test design with 356 postpartum women and 53 health care workers thatinstituted a one week post-delivery postpartum visit along with provider training inSwaziland from 2006 to 2007 found that the proportion of HIV-positive postpartumwomen not wanting another child increased from 77% to 83%. Provider trainingincreased the woman being asked about her preferred contraceptive method, from 32%to 82% and receiving her preferred method, from 28% to 70%. Male partners whotested for HIV increased from 28% to 56% (Warren et al., 2008). (Gray III) (contraception,HIV testing, Swaziland)A study of 319 HIV-positive pregnant women who were followed postpartum for oneyear in a perinatal HIV transmission study in Kenya and were referred to local clinics forcontraceptive counseling and management resulted in high rates of contraceptive useand dual method use, with 72% initiating hormonal contraceptive use and 61% of 231hormonal contraceptive users reporting condom use in additional to hormonal contraceptives.Prior to this project, which had linked antenatal care with family planning, only50% of the currently using 231 hormonal contraceptive users had a history of previoushormonal contraceptive use. Prior to this project, only 6 or 3% had used condoms. Ofthose using contraception, 44% used DMPA, 31% used oral contraception and 25%switching methods at follow up. Women were counseled antenatally to initiate contraceptionpostpartum and dual contraception was encouraged. No particular method ofcontraception was given priority. Hormonal methods were the most popular contraceptivemethod, possibly because they are female controlled and available. Women whoopted of formula feed their infants were counseled to initiate contraception four weeksafter delivery, whereas those who opted to breastfeed were counseled to initiate contraceptionsix weeks after delivery. Breastfeeding women who wanted oral contraceptionreceived progesterone only pills and non-breastfeeding women received combined oralcontraceptive pills. DPMA was available for both breastfeeding and non-breastfeedingwomen. Median time to initiation of sexual activity was two months following delivery,ranging between one and 11 months, with 77% of women resuming sexual activity withinthree months of delivery. Partner notification and condom use were similar betweenthose using and not using other forms of contraception besides condoms. (Balkus etal., 2007). Other studies that did not provide contraceptive counseling in antenatal careWHAT WORKS FOR WOMEN AND GIRLS259