Policy Brief: Maternal Health and PMTCT Thematic Group, National Research Advisory Council of RMNCAH-N, Federal Democratic Republic of Ethiopia, Ministry of Health, Maternal and Child Health Directorate

A systematic review of 17 studies involving 6010 HIV-positive individuals found that the level of fertility desire ranged from 18% in South Wollo zone of Amhara region in 2010 to 48% in Addis Ababa in 2015. The studies were conducted in Oromia region, Amhara region, and Addis Ababa city administration. Socio-demographic characteristics such as age, marital status, and number of living children were found to be important factors affecting fertility desire among people living with HIV. Younger age groups, married individuals, and those with fewer living children were more likely to desire more children. Community variables such as partner's desire, pressure from family and community to have children, also had a significant impact on raising fertility desire. Knowledge on Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV status disclosure, CD4 count, and ART use were also found to be associated with fertility desire. Individuals who knew their HIV status, had a higher CD4 count, and were on ART were more likely to desire fertility. The studies documented that fertility desire was inversely associated with the number of living children among people with HIV/AIDS. Additionally, people living with HIV who felt pressured by the community for having children, had higher odds of fertility desire when compared to those who did not feel pressured. The systematic review highlights the need for quality counseling that ensures people living with HIV are aware of the eligibility/safety margin for pregnancy or from the perspective of MTCT of HIV, and relatively safer conception strategies for PLHIV. Providers should be aware that HIV status disclosure, levels of CD4 count, and ART use are important determinants of fertility desire. To strengthen the PMTCT and ART service delivery, special emphasis should be placed on the younger age groups. Community awareness on the importance of male involvement in informed decision-making about fertility should also be enhanced. Integration of PMTCT/ART and family planning services should be strengthened to facilitate fertility decisions of people living with HIV. Large-scale community-based longitudinal studies are recommended to determine the effect of PMTCT and ART programs on the fertility desire of people living with HIV, particularly among rural populations. Qualitative studies that explore community norms and behaviors on fertility intentions/desires of people living with HIV are also recommended.