Child Bearing Decisions among Women Enrolled In PMTCT Programme: A Comparative Study of the Rural and Semi-Urban Setting of Malawi Chiradzulu District

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DOI: 10.21522/TIJPH.2013.05.04.Art040

Authors : Olive Jean Makuwira


Background: HIV and AIDS have caused untold harm and human suffering globally. Over 90% of people infected with this deadly virus live in sub-Saharan Africa including Malawi. In Malawi HIV disproportionally affects women in comparison with men. According to Demographic and Health Survey (2015-2016) key indicators, HIV prevalence among women aged 15-64 was 12.8% compared to men 8.2% public health. As per 2010 Malawi demographic and health survey, HIV prevalence in the southern region was twice as high as prevalence in the other regions (Southern 14.5%, Central 7.6% and northern region (6. 6%).Women and children are more affected than the rest of the general population. HIV infection in children below 15 years is largely due to mother-to-child transmission (MTCT). Worldwide, over two million children have been infected through MTCT.

Type of Research Study: The study adopted a qualitative research design using the inductive research technique or grounded theory research in which the steps occur simultaneously, observing, collecting data and forming theory from the data at the same time.

Problem Statement: HIV prevalence in Southern Region of Malawi is twice as high as Northern and Central regions, at 14.5% where fertility rate at 5.7% are also high. A combination of high fertility rate and high HIV prevalence have contributed to the undermining of an effective PMTCT continuum of prevention, care and treatment programme towards achieving virtual elimination of mother to child HIV transmission and keeping the mothers alive. Therefore, there is need to examine how and through what pathways learning about one’s HIV positive status could alter one’s childbearing decisions.

Objectives: This study explored the decision-making process on pregnancy decisions among PMTCT participants and their family support systems; Examined factors that influence decision making process among PMTCT participants and their immediate family networks; Determined the gaps in the PMTCT service delivery; Explored the knowledge and attitudes of health providers PMTCT mothers; and analysed the gap between the PMTCT policy guidelines and their implementation

This study revealed factors that influence fertility decisions among pregnant women with HIV attending ANC and ART clinic at Chiradzulu District Hospital. Some of participants became pregnant because they desired to have another child and others because their partners wanted a child. A proper understanding of factors associated with pregnancies among these women is essential to guide interventions and counselling strategies to better inform and support them. Religious doctrines, beliefs about having a healthy baby, personal desire and familial desires to have a baby, combined with the social stigma that accompanies HIV, puts women who are HIV-positive in a difficult situation. HIV-positive women must be appropriately counselled about the risks of childbearing rather than focusing only on issues related to mother-to-child transmission of HIV.


[1].     Therapy at a Health Centre in Balaka, Malawi: A Descriptive Qualitative Study1. Balaka: Not Published.

[2].     Burns, N. Et. al. (2009). The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence (6th Ed). St Louis: Saunders Elsevier.

[3].     Chi Kim Bui, Et. al. (2011). Pregnancy Decision-Making among HIV Positive Women in Northern Vietnam: Reconsidering Reproductive Choice. Antropology and Medicine.

[4].     Cooper, D. Et. al. (2009, June 13). Fertility Intentions and Reproductive Health Care Needs of People Living with HIV in Cape Town, South Africa: Implications for Intergrating Reproductive Health and HIV Care Services. pp. 38-46.

[5].     Creswell, J. Et. al (2011). Designing and Conduction Mixed Methods Research. SAGE Publications.

[6].     Crookes, P. Et. al (2004). Research into Practice: Essential Skills for Reading and Applying Research in Nursing and Health Care (2nd Ed). Edinburgh: Bbailliere Tindall.

[7].   (Ed), D. Y. (n.d.). Skills for Reading and Research in Nursing and Health are. In Handbook of Qualitative Research (2nd Ed) (pp. 105-117). Califonia: Thousand Oaks.

[8].     Gerrish, K. Et. al (2010). The Research Process in Nursing. (6th Ed). West 8: Sussex Wiley-Backwell.

[9].     Gerrish, K. Et. al (2010). The Research Process in Nursing.(6th Ed). West 8: Sussex Wiley-Backwell.

[10].  Gombachika, B. Et. al (2013). Reproductive Decision of Couples Living with HIV in Malawi: What Can We Lean for Future Policy and Research Study? Malawi Medical Journal, 65-71.

[11].  Gombachika, B. Et. al. (2013). Source of Information on HIV and Sexual and Reproductive Health for Couples Living with HIV in Rural Southern Malawi. AIDS Research and Treatment, 11.

[12].  Guba, E. G. (1994). Competing Paradigms in Qualitative Research. New Delhi: Sage Publications.

[13].  Guba, E. G. (2010). The Paradigm Dialog. SAGE Publications.

[14].  International Community of Women Lliviny with HIV/AIDS (2015). Positive Women: Voices and Choices Zimbabwe Report. Harare: ICW.

[15].  Iwelunmor, J. E. (n.d.). Socio-Cultural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in Nigeria: A Synthesis of The Literature. Lagos: Not Published.

[16].  Kaida, A. Et. al. (2011). Childbearing Intentions of HIV-Positive Women of Reproductive Age in Soweto, South Africa: The Influence of Expanding Access to HAART in an HIV Hyper Endemic Setting. Not Published.

[17].  Kannaippan, S. Et. al. (2012). Desire for Motherhood: Exploring HIV-Positive Women's Desire, Intentions and Decision-Making in Attaining Motherhood. AIDS CARE.

[18].  Kasenga, F. (2010). Making it Happen: Prevention of Mother to Child Transmission of HIV in Rural Malawi. Retrieved from Global Health Action:

[19].  Kawale, P. Et. al. (2015). Providers Attitudes about Childbearing and Knowledge of Safer Conception at Two HIV Clinics in Malawi. Not Published.

[20].  King, Et. al. (1995). A Family Planning Intervention to Reduce Vertical Transmission of HIV in Rwanda. BMC Public Health, 45-51.

[21].  Leedy, P. D. (2010). Practical Research: Planning and Design. (9th ED). Boston: Pearson.

[22].  Maier, M. Et. al. (2008). Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, Among HIV+ Women in an Early HIV Treatment Program in Rural Uuganda. Kampala: Epub. Ministry of Health (2011). Clinical Management of HIV in Children and Adults: Malawi Intergrated Guidelines for Providing HIV Services.

[23].  Ministry of Health (2014). Clinical Management of HIV in Children and Adults. Lilongwe: Ministry of Health.

[24].  Newman, W. L. (1994). Social Research Methods. London: Boston Allyn and Bacon.

[25].  Njunga J. Et. al. (2010). The Divorce Program: Gendered Experiences on HIV Positive Mothers Enrolled in PMTCT Programs: The Case of Rural Malawi.

[26].  Nyasulu, J. Et. al. (2011). Decision Making for Women to Access Prevention of Mother to Child Transmission Services in Blantyre and Balaka Malawi. Journal of rural and Tropical Public Health. vol. 10, 95-100.

[27].  Patton, M. Q. (1990). Qualitative E valuation and Research Methods. (2nd Ed). California: Sage Publications.

[28].  Polit, D. F. (2010). Nursing Research: Appraising Evidence for Nursing Practice. (8th Ed). Philadelphia: Lippicott Williams & Wilkins.

[29].  Rutenberg, N. Et. al. (2000). Reproductive Decision-Making in the Context of HIV and AIDS: A Qualitative Study in Ndola, Zambia. Ndola: International Family Planning.

[30].  Strauss, A. &. (1998). Basic of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (2nd Ed). London: Thousand Oaks.

[31].  WHO. (2011). HIV and Infant Feeding: Guidelines for Decision Makers. Geneva: WHO.

[32].  Wolcott, H. F. (1980). Ethnographic Research in Education. Washington DC: American Educational Research Association.