Relevance of traditional approaches to assessing unmet need for contraception among HIV-service clients

Background: Integration of family planning (FP) with HIV services is an international best-practice, particularly where access to testing, treatment and care are widespread. In Uganda, studies show high levels of unmet need for contraception among HIV clients. In response, an intervention was implemented to integrate FP into HIV services in eight post-conflict districts. A baseline survey explored unmet need among this population.

Methods: All women visiting 13 purposively selected facilities for HIV services on select days were invited to participate. A total of 1,235 women aged 15-49 years responded regarding their socio-demographic characteristics, FP and HIV service utilization, and sexual activity. Descriptive statistics and comparisons of proportions were calculated using STATA.

Results: Overall, 18% of the women had unmet need for contraception but 30% of respondents had not had sex in the past year and 24% said they were infecund; overall 40% of respondents were not at risk of pregnancy. Women not at risk for pregnancy were older, unmarried and less educated. Unmet need was 14% among women who were at risk of pregnancy and 20% among those not at risk (p=0.03).

Conclusions: In northern Uganda, a significant proportion of women using HIV services are not at risk of pregnancy because they are not sexually active or are infecund. Traditional approaches to assessing unmet need may, therefore, lead to distorted estimates for purposes of service provision. In such settings, first screening for pregnancy risk will increase efficiency when screening for unmet need among HIV clients.