Relationship between mental health and unmet need for contraception and method type among women living with HIV in Kenya

Contraception is important for preventing unintended pregnancies and reducing maternal and infant mortality. Among women living with HIV (WLHIV), it is also central to preventing vertical HIV transmission. Yet unmet need for contraception remains high among WLHIV in sub-Saharan Africa. Mental health symptoms may contribute to unmet need, but evidence among WLHIV remains limited. We examined the relationship between depression and anxiety and unmet need for contraception.

We used baseline survey data from Kenyan WLHIV receiving routine HIV care participating in a cluster randomized clinical trial evaluating a reproductive health counselling intervention at 10 HIV clinics. Women who were fecund, did not desire a pregnancy within two years, and not using a modern method of contraception were considered to have unmet need for contraception and were eligible for this analysis. Surveys captured data on depression, anxiety, fertility intentions and contraceptive use. We constructed separate generalized linear models to assess the relationship between depression and/or anxiety and unmet need for contraception.

Among 2,334 women in the analysis, the median age was 34; 9% (n=221) reported symptoms of at least mild depression, 9% (n=200) anxiety, 13% (n=305) either condition, and 5% (n=116) both. Overall, 84% (n=1,952) used a modern contraceptive method, 16% (n=378) had an unmet need for contraception, and 41% (n=784) used LARC. In univariate analysis, unmet need for contraception was 43% higher among women with either at least mild depression or at least mild anxiety (Prevalence Ratio [PR]=1.43, 95% Confidence Interval [CI]: 1.22-1.67); results were similar in the adjusted model (adjusted PR [aPR]=1.30, 95% CI: 1.08-1.58). No relationships were detected between anxiety or depression alone and unmet need.

WLHIV with either depression or anxiety had higher unmet need which suggests that mental health conditions may pose barriers to contraceptive use and may need additional support to achieve their reproductive health goals. Additional attention to mental health needs during contraceptive counselling may support informed contraceptive decision-making.