How Perceptions of HIV-Related Stigma Affect Decision-Making Regarding Childbirth in Rural Kenya

作者：Medema Wijnveen Jose S^*; Onono Maricianah; Bukusi Elizabeth A; Miller Suellen; Cohen Craig R; Turan Janet M

来源：PLos One, 2012, 7(12): e51492.

DOI：10.1371/journal.pone.0051492

Introduction: HIV prevalence among pregnant women in Kenya is high. Furthermore, there is a high risk of maternal mortality, as many women do not give birth with a skilled healthcare provider. Previous research suggests that fears of HIV testing and unwanted disclosure of HIV status may be important barriers to utilizing maternity services. We explored relationships between women%26apos;s perceptions of HIV-related stigma and their attitudes and intentions regarding facility-based childbirth. %26lt;br%26gt;Methods: 1,777 pregnant women were interviewed at their first antenatal care visit. We included socio-demographic characteristics, stigma scales, HIV knowledge measures, and an 11-item scale measuring health facility birth attitudes (HFBA). HFBA includes items on cost, transport, comfort, interpersonal relations, and services during delivery at a health facility versus at home. A higher mean HFBA score indicates a more positive attitude towards facility-based childbirth. The mean HFBA score was dichotomized at the median and analyses were conducted with this dichotomized HFBA score using mixed effects logit models. %26lt;br%26gt;Results: Women who anticipated HIV-related stigma from their male partner had lower adjusted odds of having positive attitudes about giving birth at the health facility (adjusted OR = .63, 95% CI 0.50-0.78) and less positive attitudes about health facility birth were strongly related to women%26apos;s intention to give birth outside a health facility (adjusted OR = 5.56, 95% CI 2.69-11.51). %26lt;br%26gt;Conclusions: In this sample of pregnant women in rural Kenya, those who anticipated HIV-related stigma were less likely to have positive attitudes towards facility-based childbirth. Furthermore, negative attitudes about facility-based childbirth were associated with the intention to deliver outside a health facility. Thus, HIV-related stigma reduction efforts might result in more positive attitudes towards facility-based childbirth, and thereby lead to an increased level of skilled birth attendance, and reductions in maternal and infant mortality.

• 出版日期2012-12-12