Post-partum family planning choices and decision-making among women living with HIV in Kigali, Rwanda. Open Access
Green, Marche (Spring 2026)
Abstract
Background: Postpartum family planning (PPFP) prevents unintended pregnancy and improves maternal, newborn, and family health. However, how to meet the needs of women living with HIV (WLWH) remains understudied. This study describes PPFP choices and decision-making among Rwandan WLWH.
Methods: The Center for Family Health Research implemented PPFP services in 14 Kigali public health facilities (2022-2024). PPFP informed-choice educational counseling was provided to women and partners beginning in antenatal care, with methods provided in labor and delivery, postpartum, and infant vaccination wards. Mixed-method follow-up surveys administered about one year after PPFP uptake assessed decision-making processes.
Results: Among 38,226 pregnant women given PPFP educational counseling, 22,126 (58%) chose a PPFP method, including 310 (1.4%) WLWH. WLWH vs HIV-negative women were more likely (p<0.05) to choose sterilization (7% vs 3%) and the copper intrauterine device (38% vs 24%), independent of age and parity (adjusted odds ratio=1.99; 95% confidence interval=1.58-2.51). Follow-up surveys among 56 WLWH and 221 HIV-negative women found WLWH were more likely (p= 0.001) to be single (11% vs 5%) and want no more children (70% vs 45%). PPFP decision-making among WLWH was more frequently driven by preferences for non-hormonal (21% vs 10%), fertility goals (41% vs 27%), and positive HIV status (16% vs 0%). WLWH were also more likely to have continued their PPFP method at months follow-up (87% vs 78%) and report making independent PPFP-decisions (96% vs 77%). Among those married/cohabiting, WLWH were less likely to discuss PPFP with partners (27% vs 11%). WLWH were also more likely to recommend peer labor and delivery (77% vs 49%) PPFP educational counselling and expressed a desire for HIV-tailored counselling, including discussions of antiretroviral treatment-contraception interactions.
Conclusions: WLWH were more likely to choose highly effective, non-hormonal methods and report independent PPFP decision-making, without outside influence. Tailored HIV-specific educational messaging, delivered in traditional and non-traditional settings, may enhance informed choice. These findings inform the refinement of services to improve the impact and inclusivity of PPFP programs in Rwanda.
Table of Contents
Table of Contents
Introduction. 5
Methods. 7
Results. 10
Discussion. 12
Conclusion. 18
References. 19
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