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Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study
  1. Victoria Iyun1,2,
  2. Kirsty Brittain1,2,
  3. Tamsin K Phillips1,2,
  4. Stanzi le Roux1,
  5. James A McIntyre1,3,
  6. Allison Zerbe4,
  7. Greg Petro5,
  8. Elaine J Abrams4,6,
  9. Landon Myer1,2
  1. 1 Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  2. 2 Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  3. 3 Anova Health Institute, Johannesburg, South Africa
  4. 4 ICAP at Columbia, Mailman School of Public Health, Columbia University, New York City, New York, USA
  5. 5 Department of Obstetrics and Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa
  6. 6 College of Physicians and Surgeons, Columbia University, New York City, New York, USA
  1. Correspondence to Professor Landon Myer; Landon.Myer{at}


Objectives Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission. There are few data investigating how HIV status and use of antiretroviral therapy (ART) may influence pregnancy planning in high HIV burden settings. Our objective was to examine the prevalence and determinants of unplanned pregnancy among HIV-positive and HIV-negative women in Cape Town, South Africa.

Design Cross-sectional analysis.

Settings Single primary-level antenatal care clinic in Cape Town, South Africa.

Participants HIV-positive and HIV-negative pregnant women, booking for antenatal care from March 2013 to August 2015, were included.

Main outcome measures Unplanned pregnancy was measured at the first antenatal care visit using the London Measure of Unplanned Pregnancy (LMUP). Analyses examined LMUP scores across four groups of participants defined by their HIV status, awareness of their HIV status prior to the current pregnancy and/or whether they were using antiretroviral therapy (ART) prior to the current pregnancy.

Results Among 2105 pregnant women (1512 HIV positive; 593 HIV negative), median age was 28 years, 43% were married/cohabiting and 20% were nulliparous. Levels of unplanned pregnancy were significantly higher in HIV-positive versus HIV-negative women (50% vs 33%, p<0.001); and highest in women who were known HIV positive but not on ART (53%). After adjusting for age, parity and marital status, unplanned pregnancy was most common among women newly diagnosed and women who were known HIV positive but not on ART (compared with HIV-negative women, adjusted OR (aOR): 1.43; 95% CI 1.05 to 1.94 and aOR: 1.57; 95% CI 1.13 to 2.15, respectively). Increased parity and younger age (<24 years) were also associated with unplanned pregnancy (aOR: 1.42; 95% CI 1.25 to 1.60 and aOR: 1.83; 95% CI 1.23 to 2.74, respectively).

Conclusions We observed high levels of unplanned pregnancy among HIV-positive women, particularly among those not on ART, suggesting ongoing missed opportunities for improved family planning and counselling services for HIV-positive women.

  • unplanned pregnancy
  • contraception
  • family planning
  • HIV
  • women

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  • Contributors EJA and LM conceptualised the study. TKP, SLR and AZ directed data collection. VI conducted the analysis, led data interpretation and drafted the manuscript, with critical inputs from KB, TKP, SLR, JAM, AZ, GP, EJA and LM. All authors read and approved the final manuscript to be published.

  • Funding This work was supported by the President’s Emergency Plan for AIDS Relief through the National Institute of Child Health and Human Development (grant 1R01HD074558). Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation, the South African Medical Research Council, the Fogarty Foundation (NIH Fogarty International Center grant 5R25TW009340), and the Office of AIDS Research.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Human Research Ethics Committee of the University of Cape Town, Faculty of Health Sciences, and the Columbia University Medical Centre Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.