Unintended Pregnancy in Gaborone, Botswana: A Cross-Sectional Study.

Rates of unintended pregnancy in sub-Saharan Africa range from 20-40%. Unintended pregnancy leads to increased maternal and infant mortality, and higher rates of abortions. Potentially high levels of unintended pregnancy in Botswana, against the backdrop of the popularity of short-acting, less-effective contraception, could suggest that the methods available to women are not meeting their contraceptive needs. Little data exists on unintended pregnancy in Botswana. We assessed levels of unintended pregnancy and contraceptive use among 231 pregnant women presenting to the antenatal clinic at the largest hospital in Botswana. Forty-three percent of pregnancies were reported as unintended. Of women with an unintended pregnancy, 72% reported using a contraceptive method to prevent pregnancy at the time of conception. Of the women with unintended pregnancy despite contraceptive use, 88% were using male condoms as their only method of contraception. Women reporting unintended pregnancy were more likely to have had more previous births (p=0.05). While barrier protection with condoms is essential for the prevention of HIV and other STIs, condom use alone may not be meeting the contraceptive needs of women in Botswana. Increased promotion of dual-method contraceptive use with condoms is needed.

Partner notification and treatment for sexually transmitted infections among pregnant women in Gaborone, Botswana.

Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with adverse birth outcomes. Untreated partners contribute to high rates of STI reinfection; thus, partner notification and treatment remain important components of STI care and control. A prospective cohort study was conducted among 300 pregnant women presenting to the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana who enrolled in an STI screening study. Following informed consent and sample collection for CT/NG/TV testing, participants were asked if they were willing to disclose their STI result and to deliver medications to their partner(s). Those who tested positive were asked at a follow-up appointment if they notified their partners. Among the 300 participants, 294 (98%) said they would be willing to tell their partner(s) about their test results if they tested positive, and 284 (95%) said they would be willing to give their partner(s) medication if the option was available. Of those who tested positive and returned for a test of cure, 27 of 32 (84%) reported that they told their partner about the results, and 20 of 32 (63%) reported that their partner received treatment. Almost all pregnant women reported willingness to tell their partner the STI test result and give their partner medications. At test of cure, most women reported informing their partner, although actual treatment receipt was lower. Our findings suggest that pregnant women are willing to utilize patient-based partner notification, but actual partner treatment might be lower than intended.

Acceptability and Feasibility of Sexually Transmitted Infection Testing and Treatment among Pregnant Women in Gaborone, Botswana, 2015.

INTRODUCTION: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are curable sexually transmitted infections (STIs) that can cause adverse maternal and birth outcomes. Most countries do not conduct routine testing during antenatal care. We present data on the acceptability and feasibility of testing and treating pregnant women for STIs in an antenatal clinic in Gaborone, Botswana. MATERIALS AND METHODS: We offered CT, NG, and TV testing using self-collected vaginal swabs to eligible pregnant women. Participants received same-day test results. Those who tested positive were given treatment. RESULTS: Among the 225 women who were eligible and recruited, 200 (89%) agreed to participate. The median age of our study sample was 30 years; most were unmarried (77%), with a median gestational age of 27 weeks and a 23% HIV prevalence. All participants received their results with at least 72% (n = 143) on the same day. Thirty participants (15%) tested positive for an STI, all were treated, and 24 (80%) were treated on the same day. CONCLUSION: The acceptability of STI testing was high, and the intervention was feasible. This study provides support for continued research into STI prevalence, cost-effectiveness, and the association of STIs with adverse maternal and infant outcomes.