Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies?|
Gombachika, B. Chimphamba; Chirwa, E.; Malata, A.; Sundby, J. & Fjeld, H.
The rapid scale-up of free antiretroviral therapy has lead to decline in adult
mortality at the population level and reduction of vertical transmission.
Consequently, some couples living with HIV are maintaining their
reproductive decisions; marrying and having children. This paper analyses
policies and guidelines on HIV, AIDS and sexual and reproductive health
in Malawi for content on marriage and childbearing for couples living with
A qualitative study using interpretive policy analysis approach was
conducted from July to December 2010 in two phases. First, data on access
to HIV, AIDS and sexual and reproductive health services were collected
using in-depth interviews with twenty couples purposively sampled in
matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly,
data were collected from Malawi policies and guidelines on HIV, AIDS
and sexual and reproductive health. The documents were reviewed for
content on marriage and childbearing for couples living with HIV. Data
were analysed using framework approach for applied policy analysis.
Four categories emerged from each phase. From the study, we extracted
health workers attitudes, weak linkage between HIV, AIDS and sexual
and reproductive health services, contradictory messages between media
and the hospitals and lack of information as factors directly related to
guidelines and policies. Analysis of guidelines and policies showed nonprescriptiveness
on issues of HIV, AIDS and reproduction: they do not
reflect the social cultural experiences of couples living with HIV. In
addition, there is; lack of clinical guidelines, external influence on adoption
of the policies and guidelines and weak linkages between HIV and AIDS
and sexual and reproductive health services.
This synthesis along with more detailed findings which are reported in
other published articles, provide a strong basis for updating the policies
and development of easy-to-follow guidelines in order to effectively
provide services to couples living with HIV in Malawi.