Theme | Adolescents | Adult men and women |
---|---|---|
Preferred contraceptive methods | · Largely condoms: easy to use, accessible and do not affect their fertility | · Condoms most preferred: easy to use, cheap and easy to access; limited side effects; prevent pregnancy and HIV transmission (men who fear to disclose their HIV status can use them under the pretext of FP) |
· Some preferred to abstain | · Some women liked injectables, implants: no challenges with remembering to take pills daily, do not like to use or cannot tell partners to use condoms (limit sexual pleasure); can use without telling their partners or asking their permission | |
· Fear pills, injectables and other long-term methods because they can prevent them from having children in future |  | |
Challenges/experiences with contraceptives | · Education on FP is limited; providers focusing more on adults | · Intrauterine devices and implants were not easily accessible and were expensive |
· Challenges with accessing FP information; not aware of options and side-effects | · Injectables available but expensive | |
· Fear to ask providers for information if providers do not initiate discussion | · Limited education on some methods (e.g. Intrauterine devices; implants) | |
 | · Pills: concerns about pill burden and remembering to take them | |
· Side effects with pills and injectables noted by both men and women: abdominal complications, prolonged periods, infertility and child abnormalities; weight problems, high blood pressure, heart palpitations, and sleeplessness | ||
· Mixed feelings about vasectomy among men | ||
· Men felt providers focused more on women | ||
· Providers focused more on PLHIV who had initiated ART | ||
Challenges with accessing contraceptives at the clinics and other facilities | · Cost of the contraceptives high | · Mulago: busy clinic and long waiting time (separate desk/provider for FP) |
· NHC: some of the PLHIV do not go to the facilities where they are referred for contraceptives; challenges disclosing their HIV status to another set of providers; ‘Moon beads’/rhythm method that is talked about at the clinic unreliable | ||
Decisions to have children | · All want to have children; at least one/feared dying without children | · All want to have children; feel it is not good to have one child/unfair to the child |
· Considerations: have few children or none/cultural expectations to have large families; have only boys or only girls; male child to have an heir; getting into a new sexual relationship/to strengthen relationship; pressures from family members and community (to be accepted); HIV status of the sexual partner; ability to care for more children | ||
Decision not to have children | · Health status (transient issue) | · Sero-discordance/concerns about infecting sexual partner |
· Already have several children | ||
· Health status (transient issue) | ||
Information and support given by providers on childbearing: client perspectives | · Same issues as adults | · Focusing more on contraceptives |
· Not enough attention to child spacing and number of children they want to have | ||
· Not addressing fertility decisions and support for those who want to have children | ||
Attitude and support from HCWs in relation to childbearing: Client perspectives | · Desired to have more guidance on childbearing | · Providers talk about PMTCT services |
· Counselors were supportive and asked them to be open up about their plans to marry and have children | · Health status: providers emphasized need to have high CD4 count; adherent to ART | |
 | · Noted gaps in information for those who want to have children/told to use condoms all the time and not clear how they can conceive | |
· Mulago: all participants felt providers were supportive | ||
· NHC: divided about support from providers (some felt providers had negative attitude towards childbearing among PLHIV) | ||
Health workers’ voices |  | · Need to expand SRH services to include cervical cancer screening |
· Support for PLHIV who want to have children not comprehensive enough and needs improvement | ||
· NHC providers noted gap with not providing FP supplies: suggested formal referral mechanism since their policy does not allow contraceptives on site | ||
· All felt PLHIV had a right to have children and needed support: need to be clinically stable and have a high CD4 count; should be on ART; should use PMTCT services | ||
· More sympathetic to those who have no children (e.g. adolescents); those who have children should not get more |