HIV and unintended fertility in sub-Saharan Africa: multilevel predictors of mistimed and unwanted fertility among HIV-positive women.

© 2020, Springer Nature B.V. Sub-Saharan Africa (SSA) has a disproportionate burden of both unintended fertility and HIV infection, but the relationship between these two reproductive health risks is not well understood. This paper investigates the association between HIV status and unintended (mistimed and unwanted) fertility and examines multilevel predictors and national variations of unintended fertility among HIV-positive women across countries in SSA. Multilevel multinomial logistic regression models are applied to Demographic and Health Surveys data collected during 2006–2014 from 25 countries of SSA. Overall findings reveal that across countries of SSA, pregnancies of HIV-positive women are, on average, less likely to be mistimed (RR = 0.90, p < 0.05) but more likely to be unwanted (RR = 1.18, p < 0.05), rather than wanted, compared to pregnancies among HIV-negative counterparts with similar characteristics. Besides, knowledge of HIV status is associated with lower unintended fertility among HIV-negative, but not HIV-positive women. At country level, higher HIV prevalence and testing coverage are associated with higher mistimed and unwanted, rather than wanted fertility. Interaction effects suggest different effect sizes between HIV-positive and HIV-negative women: pregnancies among HIV-positive women are more likely than those among HIV-negative women to be unwanted rather than wanted among those who know their HIV status, are of older age, are married, have higher parity or reside in rural areas. The results further reveal notable country effects on unintended fertility, depicting regional variations that mirror HIV prevalence—being highest in Southern Africa and lowest in Western/Central Africa