Relationship between mental health and unmet need for contraception and method type among women living with HIV in Kenya

Abstract

IntroductionContraception is a cornerstone of efforts to prevent vertical HIV transmission for women living with HIV(WLWH), but contraceptive use may be impacted by depression and anxiety. We examined the relationship between depression, anxiety and unmet need for contraception and method type. MethodsWe conducted a cross-sectional survey at baseline among 3300Kenyan WLWH receiving routine HIV care participating in a cluster randomized clinical trial evaluating a reproductive health counselling intervention at 10 HIV clinics. Women who did not desire a pregnancy in the next two years or were not sexually active were ineligible for this analysis. Study staff administered surveys on depression, anxiety, stigma and social support. Participants used a tablet to self-administer a survey on family planning, which assessed fertility intentions and contraceptive use. We utilized univariable and multivariable generalized linear models to assess the relationship between depression, anxiety and unmet need for contraception and method type. Results Among 964 women eligible and enrolled, 10% had at least mild depression,14% had anxiety, 17% had either depression or anxiety, and 7% had both. Overall, 78% used a modern method of contraception and 10% had an unmet need for contraception. Prevalence of unmet need was 18% among women who were depressed and 9% among women who were not depressed. Women with at least mild depression were twice as likely to have unmet need for contraception (PR 1.96[95%CI 0.95, 3.52]; aPR 2.32 [95%CI 1.47,3.67]) compared to women without depression. The most commonly used methods of contraception were implants (37%) and injectables (33%). Over one-third (34%) of contraceptive users were using dual methods. Proportion of anxious women who used long acting reversible contraceptive (LARC [intra uterine devices and implants) was 35% and 42% among women without anxiety. Among women with stigma the prevalence of LARC use as opposed to short acting methods (pills, condoms, injectables, fertility based, lactation amenorrhea) was 49% (PR 0.51, CI [0.36,0.71]) lower in depressed or anxious women compared to women without depression or anxiety, p<0.001 Conclusion Unmet need was higher, while LARC use lower, among women with either depression or anxiety compared to women without. Screening WLHIV for depression or anxiety may help identify women who have more difficulty using contraception, or have additional barriers to using LARC and who need better support to realize their reproductive health goals.