Childbearing Dynamics in a Setting of High HIV Prevalence and Massive ART Rollout (2008-2013)
The massive rollout of antiretroviral therapy (ART) and of Prevention of Mother-to-Child Transmission (PMTCT) programs in many sub-Saharan countries is rapidly and radically changing the epidemiological and social meanings and implications of HIV/AIDS. The study focus on the intersections of childbearing with the scaling-up of HIV Voluntary Counseling and Testing (VCT) and treatment and resulting changes in individuals’ knowledge and views about HIV infection and its consequences. It combines different types of data collection and analysis to build upon the research team’s previous work (R21HD048257, Agadjanian PI) in four contiguous rural districts of southern Mozambique (Chibuto, Mandlakaze, Chókwè, and Guijá) an area of precipitous erosion of traditional agrarian livelihoods, massive labor mobility, profound changes in marriage and family systems, high and growing HIV prevalence, and a vigorous expansion of VCT/ART/PMTCT. The scientific aims of the study are to examine in this changing context: how rural women’s knowledge and perceptions of own HIV status affect their reproductive intentions, contraceptive choices, and fertility outcomes; how the characteristics of rural women’s social environments influence the above relationships; how institutional characteristics and mechanisms of the Maternal and Child Health (MCH) clinics affect the ability of HIV+ and HIV- rural women to implement their reproductive intentions and contraceptive preferences. A separate aim of the project is to develop and disseminate practical recommendations on the basis of the analyses.
To achieve these aims, this five-year project uses a longitudinal design that involves two waves of population-based survey and of qualitative data collection--in 2009 and 2011. The two waves of survey re-interview a representative sample of c. 1680 married rural women residing in 54 villages of the four districts who were first interviewed for an earlier study in 2006. In parallel to the individual survey, in each village, a community survey is carried out. In addition to the surveys, 72 of the survey respondents from eight of the sampled villages (nine per village), with whom semi-structured in-depth interviews were conducted in 2006, participate in two waves of in-depth interviews. To complement the individual/household and community perspectives with an institutional one, in every year of the project, statistical data on MCH/VCT/PMTCT/ART service provision and utilization are collected from the four districts’ MCH clinics and a survey combining close-ended and open-ended questions that focus on challenges and barriers involved in the provision of MCH/VCT/PMTCT/ART is carried out with the clinics’ nurses. The results of the project will contribute to a better understanding of changes effected by the evolving HIV/AIDS epidemic in reproductive intentions and behaviors and to the optimization of integrated MCH with VCT/PMTCT services for rural women.
The project is funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD058365) and is conducted in collaboration with the Centre for African Studies of Eduardo Mondlane University (Mozambique).
Study area map
Instruments (2009):
Women's Main Questionnaire [Portuguese] [English translation]
Questionnaire on 2006 respondents who died [Portuguese] [English translation]
Questionnaire on 2006 respondents who moved [Portuguese] [English translation]
Appendix for located respondents who moved [Portuguese] [English translation]
Community Questionnaire [Portuguese] [English translation]
Publications:
Agadjanian, Victor, and Sarah R. Hayford. 2009. "PMTCT, HAART, and Childbearing in Mozambique: An Institutional Perspective" AIDS & Behavior 13, Suppl.1: 103-112
Hayford, Sarah R., and Victor Agadjanian. 2010. "Providers’ views on family planning service delivery to HIV+ women in Mozambique" Studies in Family Planning 41(4): 291-300
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