Transcript Slide 1

Men’s abortion attitudes in the
context of HIV in Zambia
Megan L. Kavanaugh, Oyedunni Arulogun, Isaac Adewole,
Adesina Oladokun and Kumbutso Dzekedzeke
October 15, 2010
Why is it important to understand the
relationship between HIV and abortion?
• Increased attention to linkages between HIV field and
reproductive health field
• Little is known about how pregnancy termination attitudes
or behaviors are differentially shaped by the risk of HIV
• Stigma against HIV-positive women having more children
may lead to an increased demand for, or pressure to
have, abortions
• Men’s attitudes may influence their partners’ abortionseeking attitudes and behaviors as well as access
What do we know about the relationship
between HIV and abortion?
• Individuals weigh risk of having an HIV-positive child with
risk of unsafe abortion (Zimbabwe, Uganda)
• HIV-positive women pressured to abort (S Africa,
Tanzania)
• Community disapproval of women who have abortions
(Kenya, Zambia)
• Limitations of existing research
– HIV-positive women make up samples
– Recruitment at health facilities
– Studies are small in scale
Objectives
• Describe and compare men’s and women’s
attitudes towards abortion and women who have
abortions in Zambia
• Determine the associations between attitudes
towards abortion and perceived HIV risk
• Describe men’s and women’s support for abortion
as the best pregnancy outcome for a couple in
hypothetical vignette scenarios
Zambian Context
• Moderately liberal abortion
law, access difficult
• High HIV rate (14.3% all)
• High contraceptive
prevalence (40% among
married women)
• Moderate desired family
size (4.6 for women vs. 4.9
for men)
Zambia
Data Collection:
Community-based interviews
• Setting: 3 provinces in Zambia
– Lusaka: high HIV, medium fertility, high contraceptive use
– Central: medium HIV, high fertility, low contraceptive use
– Northern: low HIV, high fertility, medium contraceptive use
• Sample: community-based
– Multi-stage, cluster sample of households
– ~2600 reproductive-age women and men
• Interviews: in person
– Survey translated into major languages
– Mostly sex-matched
– Interviewers from same region as respondents
Sample Characteristics
Men (N = 839)
Women (N = 956)
33
30
Marital status
Married
Living with partner
Not in union
63.3
0.1
33.6
64.6
1.5
33.9
Highest level of schooling attended
Primary
Secondary
Higher
35.5
54.4
10.0
52.2
41.3
6.4
Form of income
Only money
Only in kind
Both money and in kind
None
38.9
11.0
10.4
39.7
27.6
1.4
3.0
68.0
Perceived HIV risk
No risk
Some risk
56.8
43.2
52.8
47.2
Mean age
Past abortion experience
p = 0.002
%
Measures and Hypotheses
• Support for abortion
– A woman should be able to end a pregnancy if she
wants to
– Hypothesis: Perceived risk associated with increased
support
• Judgment about women who have abortions
– I would think poorly of a woman if I knew that she had
ended her pregnancy
– Hypothesis: Perceived risk associated with decreased
judgment
A woman should be able to end a
pregnancy if she wants to
In general
If the woman has AIDS
If I knew that a woman had ended her
pregnancy…
I would think poorly of her
I would think less poorly of her if
she had AIDS
p < 0.001
It is better for a woman to get an abortion
than for her to carry a pregnancy that is
harmful to her health
Vignette
• [Aisha] is a 30 year old married woman with 3 children.
She and her husband found out she is pregnant. They are
unsure about this pregnancy because she had bad health
problems with her past pregnancies. What should she do?
– Continue pregnancy
– End pregnancy
– Not sure
• Now she has the AIDS virus but is not taking any ART.
What should she do?
• Now she has started taking ART. What should she do?
Support for abortion in vignette scenario
%
Summary
• Majority of men and women in Zambia do not support abortion
and have low opinions of women who have them
• Overall, men are slightly less likely to support abortion than
women but men and women are equally judgmental
• Perceived risk of HIV makes men and women less supportive
of abortion but less judgmental of women who have them
• Women who perceive themselves to be at some risk for HIV
are more supportive of abortion for health reasons – not the
case for men
• Support for abortion among men and women increases and
judgment decreases for HIV-positive pregnant women
Conclusions
• HIV-positive status, as well as health, makes abortion
more acceptable as an option for others
• Individuals who perceive themselves to be at risk for HIV
may place even greater emphasis on having children
• Men should be made aware of consequences that their
attitudes can have on women’s health related to abortion
• Initiatives to improve access to safe abortion in Zambia
should address men’s largely unsupportive attitudes
towards abortion
We would like to thank our funders:
NIH, the Consortium for Research on Unsafe
Abortion in Africa, the Netherlands government, the
Ellertson post-doctoral fellowship
For more information, please visit
www.guttmacher.org
Thank you
[email protected]