Family planning methods and fertility preferences according to HIV status among women in Cameroon

Allison Ruark, Kathleen Nulah, Simon Manga, Mbebwo Babila, Edith Welty, Mona Bormet, Thomas Welty


We investigated whether HIV-positive women differ from HIV-negative women in their fertility, fertility intentions, and use of family planning (FP) among 16,202 women who received services through the Cameroon Baptist Convention Health Services’ Women’s Health Program from 2015 to 2017. The 13% of women who were HIV-positive had similar rates of modern FP usage and unmet need compared to HIV-negative women (26% versus 29% for modern FP usage, and 20% versus 21% for unmet need). However, HIV-positive women were more likely to be satisfied with their FP method (aOR = 1.70, p < .001). There were no significant differences in usage by HIV status for most FP methods, but HIV-positive women were more likely to use condoms (aOR = 1.85, p < .01) and less likely to use IUDs (aOR = 0.77, p < .05). HIV-positive women had fewer living children and also desired fewer children (both associations significant at p < .001 in multivariate linear regression). These findings highlight low FP usage and high unmet need among all women, and the need for integrated HIV and FP services for HIV-positive women, particularly aimed at increasing use of more reliable FP methods in addition to condoms. (Afr J Reprod Health 2021; 25[5]: 25-36).

Full Text:



O'Shea MS, Rosenberg NE, Tang JH, Mukuzunga C,

Kaliti S, Mwale M and Hosseinipour MC. Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women. AIDS Care 2015; 27(4): 489-498. doi:10.1080/09540121.2014.972323.

Feyissa TR, Harris ML, Melka AS and Loxton D.

Unintended pregnancy in women living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. AIDS Behav 2019; 23(6): 1431-1451. doi:10.1007/s10461-018-2346-4.

Agadjanian V and Hayford SR. HIV status, fertility

intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique. Glob Public Health 2016; 13(5): 582-596. doi:10.1080/17441692.2016.1268188.

Grossman D, Onono M, Newmann SJ, Blat C, Bukusi EA,

Shade SB, Steinfeld RL and Cohen CR. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS 2013; 27(Suppl 1): S77-S85.

Cahill N, Sonneveldt E, Stover J, Weinberger M,

Williamson J, Wei C, Brown W and Alkema L. Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool. Lancet 2018; 391: 870-882. doi:10.1016/S0140-6736(17)33104-5.

National Institute of Statistics (Cameroon), ICF. Enquête

Démographique Et De Santé Du Cameroun 2018. Indicateurs Clés [Cameroon Demographic and Health Survey 2018: Key Indicators Report]. Yaoundé, Cameroon and Rockville, Maryland, USA: INS and ICF; 2019.

Ajong AB, Njotang PN, Yakum MN, Essi MJ, Essiben F,

Eko FE, Kenfack B and Mbu ER. Determinants of unmet need for family planning among women in Urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, Yaoundé. BMC Women's Health 2016; 16: 4. doi:10.1186/s12905-016-0283-9.

Edietah EE, Njotang PN, Ajong AB, Essi MJ, Yakum MN

and Mbu ER. Contraceptive use and determinants of unmet need for family planning; a cross sectional survey in the North West Region, Cameroon. BMC Women's Health 2018; 18: 171. doi:10.1186/s12905-018-0660-7.

Family Planning 2020. Cameroon 2020 Core Indicator

Summary Sheet: 2017-2018 Annual Progress Report.

Yangsi TT, Florent FY, Ngole ME and Nelson F. Modern contraceptive choice among patients seen at the “Cameroon National Planning Association for Family Welfare” Clinic Yaoundé. Clin Med Insights Reprod Health 2017; 11: 1-6.

Nansseu JRN, Nchinda EC, Katte J-C, Nchagnouot FM

and Nguetsa GD. Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon. Reprod Health 2015; 12 (92). doi:10.1186/s12978-015-0085-9.

DeGregorio G, Manga S, Kiyang E, Manjuh F, Bradford

L, Cholli P, Wamai R, Ogembo R, Sando Z, Liu Y, Sheldon LK, Nulah K, Welty T, Welty E and Ogembo JG. Implementing a fee-for-service cervical cancer screening and treatment program in Cameroon: challenges and opportunities. Oncologist 2017; 22(7): 850-859.

Budhwani H, Hearld KR, Dionne-Odom J, Manga S,

Nulah K, Khan M, Welty T, Welty E and Tita AT. HIV status and contraceptive utilization among women in Cameroon. J Int Assoc Provid AIDS Care 2019; 18(4): 232595821982659–7. doi:10.1177/2325958219826596.

Bradley SEK, Croft TN, Fishel JD and Westhoff CF.

Revising unmet need for family planning. Calverton, MD: ICF International; 2012.[12June2012].pdf

Moreau C, Shankar M, Helleringer S, and Becker S.

Measuring unmet need for contraception as a point prevalence. BMJ Global Health. 2019;4(4):e001581.

Hancock NL, Chibwesha CJ, Bosomprah S, Newman J,

Mubiana-Mbewe M, Sitali ES, Bolton-Moore C, Mbwili-Muleya C and Chi BH. Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: a cross-sectional survey. BMC Public Health 2016; 16: 392. doi:10.1186/s12889-016-3070-5.

Cholli P, Bradford L, Manga S, Nulah K, Kiyang E,

Manjuh F, DeGregorio G, Ogembo RK, Orock E, Liu Y, Wamai RG, Sheldon LK, Gona PN, Sando Z, Welty T, Welty E and Ogembo JG. Screening for cervical cancer among HIV-positive and HIV-negative women in Cameroon using simultaneous co-testing with careHPV DNA testing and visual inspection enhanced by digital cervicography: findings of initial screening and one-year follow-up. Gynecol Oncol 2018; 148(1): 118-125. di:10.1016/j.ygyno.2017.11.002.

Patel RC, Morroni C, Scarsi KK, Sripipatana T, Kiarie J,

and Cohen CR. Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines. J Int AIDS Soc. 2017; 20(1): 21396-21396.


  • There are currently no refbacks.