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

2. 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’ abortion- seeking attitudes and behaviors as well as access

3. 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

4. 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

5. 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

6. 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

7. Sample Characteristics Men (N = 839)Women (N = 956) Mean age3330 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

8. Past abortion experience p = 0.002 %

9. 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

10. A woman should be able to end a pregnancy if she wants to In generalIf the woman has AIDS

11. 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

12. It is better for a woman to get an abortion than for her to carry a pregnancy that is harmful to her health

13. 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?

14. Support for abortion in vignette scenario %

15. 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

16. 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

17. 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

18. Thank you mkavanaugh@guttmacher.org