Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

Abstract

Background: Women living with HIV (WLH) lack evidence-based information about reproductive options while man‑ aging pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination infu‑ ence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproduc‑ tive decision-making process for WLH in developed countries. Methods: A systematic review with qualitative research synthesis was conducted through searches in 10 elec‑ tronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfspo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country wasoperationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. Results: Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinfor‑ mation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process infu‑ enced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difcult to manage. Conclusion: WLH encounter reproductive decision-making with knowledge defcits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could beneft from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical prac‑ tice guidelines need to be tailored for the family planning and sexual health needs of WLH. Keywords: AIDS, HIV, Decision-making, Pregnancy, Reproductive health, Women