What is the research about?
Researchers spoke to a wide range of people in Malawi, South Africa, Uganda and Zimbabwe to identify different beliefs about sex during pregnancy. And to see how these beliefs affect behaviour.
Around 130 pregnant and breastfeeding women and their male partners (aged 18+) took part in focus groups, along with pregnant women’s mothers and mothers-in-law. Clinicians, traditional care providers, community health workers and community leaders were also interviewed.
Why is this research important?
Women in sub-Saharan Africa are more at risk of HIV than men.
Understanding this risk in the context of pregnancy and breastfeeding is important for preventing HIV among both pregnant women and their infants. Women who get HIV during pregnancy and breastfeeding are more likely to passing HIV to their child than women who get HIV at other times.
What did they find out?
Making decisions about sex during pregnancy
Women particularly trust healthcare practitioners. A woman’s partner is also very influential. Mothers and mothers-in-law, sisters and aunts also have influence.
Beliefs that discourage condom use
1. Myths about the benefits of sperm
Many participants thought that sperm helps to open the birth canal, so having condomless sex would make delivery easier. Some participants thought sperm would help the foetus to grow.
2. No need to prevent pregnancy
Many participants associated condoms with contraception, not HIV prevention. So they felt they didn’t need to use condoms during pregnancy.
The attractiveness of pregnant women
Many participants spoke about the attractiveness of pregnant women and linked it to HIV risk. Many said pregnant women experience increased advances from men because men find pregnant women more attractive. Some also felt that pregnancy makes women promiscuous. But some said men found pregnant women unattractive, causing them to be unfaithful.
Most men and women abstained from sex at some point during pregnancy. This was most common during the final three months of pregnancy or after the birth.
Abstinence and the issue of attractiveness led to infidelity, particularly among men. Men were open about finding sex outside their relationship during pregnancy and after birth. But they also expected to have sex with their wives when appropriate. There was some awareness that this could increase their partner’s risk of getting HIV.
Some women said they had sex during pregnancy or breastfeeding to prevent their partner from being unfaithful.
HIV prevention practices
Participants did various things to prevent HIV during pregnancy and breastfeeding. This includes HIV testing, using condoms, not having sex and being faithful. But participants said a lot of men refused to use condoms or test for HIV because they did not want to know their HIV status or admit infidelities.
What does this mean for HIV services?
Because condom use is low, pregnant and breastfeeding women need access to PrEP, either in pill form or as a vaginal ring.
It is also important to encourage pregnant couples to use condoms. This could be done by addressing myths about sperm, and letting people know that women are more likely to pass HIV to their babies if they get HIV while pregnant. Reminding people that condoms prevent HIV as well as pregnancy is also key. Awareness campaigns should not only target pregnant women but others with influence, such as partners, health practitioners, grandmothers, aunts and sisters.