Table 1 shows the socio-demographic characteristics of the 2,760 women who were included in the analysis. Nearly half (46%, n=1,284) were aged 30-39 years, with the Eastern region having slightly more than half of the women (52.1%) aged 30-39 years. More than half of the respondents (58%, n=1,600) were married, with the highest proportion of married HIV-positive women reported in the Eastern region (66.7%) followed by the Western region (63.1%) and Kampala region (58%) in that order. About a quarter of the women (24.3%, n=670) were in a relationship but not married, with the highest proportion reported in the Central region (36.4%), Kampala region (32%) and the Northern region (27.3%) in that order. More than half of the women (57.4%, n=1,585) had primary education while 24% (n=656) had secondary education with the Western region (65.1%), the Central region (60.4%) and the Northern region (59%) having the highest proportion of women with primary education. It is important to note that nearly a quarter (24.6%) of women in the Northern region had no education.
About 43% (n=1,180) of women were in the lowest or second lowest wealth quintile with women in the Northern region (65%), those in the Eastern region (51.4%) and those in the Western region of Uganda (46.5%) more likely to be in the lowest or second lowest wealth quintile than women in other regions. More than half of women in Kampala region (53.3%) were in the highest wealth quintile while only a small proportion of women in the other regions (5.4-16.9%) were in this category.
Forty-one per cent (n=1,122) of the respondents lived within less than 4km to a health facility in all the regions with Kampala having more than half of the respondents living within this distance to a health facility. Majority (97%, n=2,667) of the respondents were on antiretroviral therapy (ART) with slightly more than two-thirds (66.8%) having been on ART for more than two years. The Central region (100%), Eastern region (98.3%) and the Northern region (96.9%) recorded the highest proportion of HIV-positive women on ART. Only 15.6% (n=426) of HIV-positive women reported that they disclosed their HIV sero-positive status to their sexual partners, and this trend was observed across all the other regions. Forty-three per cent (n=1,181) of women had four or more (4+) biological children, with the proportion of those reporting 4+ biological children recorded in the Eastern (53.3%) and the Northern regions (52.4%) while Kampala region (27.4%) had the lowest proportion of women with 4+ biological children.
Receipt of FP Counselling
Table 2 shows the percentage of women in HIV care that were not currently pregnant and who did not want to become pregnant in the future, stratified by whether or not they received any FP counselling; and if so, whether or not they received FP counselling during ANC visit, at the time of delivery or at the post-natal care (PNC) visit. Slightly more than three quarters (76%) of the women reported that they received FP counselling at any of the three points of care (ANC, delivery and PNC). Receipt of FP counselling was highest at ANC (62.1%, n=1,715) but was slightly lower at the time of delivery (59%, n=1,629) and at the PNC visit (46.2%, n=1,276). By region, the proportion of women who received FP counselling was highest in the Western region (81.8%), the Eastern (79.4%) and the Northern region (76%) but was lowest in the Central region (72.8%) and Kampala (70.8%) (Table1). Approx. 58% of the women were found to have received FP counselling at two (24.9%) or three visits (33.1%), with wide variations across regions (Table 1).
Table 2 also shows that receipt of FP counselling differed by age, region of residence, point of delivery, health facility where women were enrolled, and ART status. At least 60% of all women across all age groups received FP counselling during ANC with the highest proportion recorded among those aged 30 to 39 years. At the time of delivery, women aged 25-29 were the highest recipients of FP counselling at nearly 64%. Younger women below 24 years and women aged 40 or more years were the lowest recipients of FP counselling at post-natal care. The Western region had the highest proportion of women who received any form of FP counselling at 82%. Kampala and Central region had the lowest proportion of women receiving FP counselling during ANC with nearly half of women reporting that they did not receive any form of FP counselling during contact with a healthcare provider.
At the point of delivery, the Northern region and Kampala recorded at least half of the women receiving FP counselling while the other half missed out on this service. During postnatal care, the Northern region registered the lowest proportion of women who received FP counselling at 40%. Provision of FP counselling was highest at health Centre IIs and IVs with approximately 80% of the women receiving FP counselling at these facilities. A higher proportion of married women and women educated up to secondary level received FP counselling across the three points of care than unmarried and divorced women although PNC was the least used point for FP counselling. Women on ART were beneficiaries of FP counselling across the three levels of care with 62% of them obtaining FP counselling at ANC, 60% during delivery and 46% at postnatal care. A higher proportion of women (80% or higher) who had been on ART for two years and those with four or more biological children received FP counselling more than their counterparts across the three points of care.
Association between receipt of any FP counselling and current use of modern contraception
Table 3 shows the association between receipt of any FP counselling and current use of modern contraception among women who were not pregnant and who did not want to have any other children in the future. Overall, current use of a modern contraceptive method was 21% higher among women who received any FP counselling compared to those who did not (adjusted [adj.] PR: 1.21; 95% confidence interval [CI]: 1.10, 1.33). Current use of modern contraception was also 28% higher among women who had attained more than secondary level of education compared to those with primary level of education and 28% higher among those who had spent more than two years on ART. Current use of modern contraceptive use was also more than 30% higher among women who had two or more biological children than their counterparts. We found that current use of modern contraception increased with the increasing number of FP counselling visits but this analysis was restricted to the bivariate analysis due to collinearity between ‘any FP counselling’, the primary outcome, and ‘number of FP counselling visits’.