CLINICAL ARTICLE Unintended pregnancy among HIV-positive pregnant women in Enugu, southeast Nigeria Euzebus C. Ezugwu a, ⁎, Chukwuemeka A. Iyoke a , Peter O. Nkwo a , Hygenius U. Ezegwui a , Jude C. Akabueze a , Polycap U. Agu a,b a Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria b Department of Obstetrics & Gynecology, Enugu State University Teaching Hospital, Parklane, Enugu State, Nigeria abstract article info Article history: Received 24 February 2015 Received in revised form 8 June 2015 Accepted 7 September 2015 Keywords: Enugu HIV infection Nigeria Unintended pregnancy Unplanned pregnancy Unwanted pregnancy Objective: To determine the prevalence and factors associated with unintended pregnancy among HIV-positive pregnant women in Enugu, southeast Nigeria. Methods: A questionnaire-based cross-sectional study was performed of HIV-positive pregnant women receiving prenatal care at two tertiary health institutions in Enugu between March 1 and August 31, 2012. The women were interviewed with a pretested questionnaire. Results: Overall, 180 HIV-positive pregnant women were recruited, 67 (37.2%) of whom declared that their pregnancy was unintended. Overall, 174 (96.7%) patients were receiving antiretroviral therapy and 99 (55.0%) had future fertility intensions. Participants with regular partners (married or cohabiting) had a significantly higher rate of unintended pregnancy than those with unstable partners (40.3%, n = 64/159 vs 14.3%, n = 3/21 P = 0.029). Age, parity, educational level, and current treatment with antiretroviral therapy did not significantly affect the prevalence of unintended preg- nancy. Conclusion: A substantial number of HIV-positive pregnant women declared their pregnancies to be unin- tended. Modern contraceptives should be made readily available and accessible to HIV-positive women to help eliminate mother-to-child transmission of HIV and subsequent new pediatric HIV infections. © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction HIV infection is a global public health problem: by the end of 2012, an estimated 35.3 million people were living with HIV and approxi- mately 1.6 million AIDS-related deaths had occurred. Sub-Saharan Africa is the worst affected region, which accounts for approximately 71% of people living with HIV globally, with an estimated one in every 20 adults living with HIV infection [1]. The majority (60%) of these adults living with HIV infection in Sub-Saharan Africa are women [2]. Despite efforts aimed at combating HIV/AIDS by both government and donor agencies, Nigeria still ranks amongst the worst hit countries in the Sub-Saharan region, with an estimated 3.1 million Nigerians living with HIV/AIDS in 2010, the second highest prevalence in the world after South Africa [3]. A HIV seroprevalence rate of 5.1% has been reported among pregnant women in Enugu [4], which is greater than the Nigerian national HIV seroprevalence rate of 4.1% [3]. According to the 2013 UNAIDS report, Nigeria had the largest number of children acquir- ing HIV infection in 2012, with approximately 60 000 new infections among children [5]. The majority of these infections were acquired by mother-to-child transmission of HIV. There are concerns that if urgent preventive measures are not taken immediately, Nigeria may not achieve global HIV targets by the end of 2015 [5]. Although the prevention of unintended pregnancy among women living with HIV infection has been judged by WHO to be one of the four pillars in the prevention of new pediatric HIV/AIDS infections, this preventive strategy has not been effectively utilized in many low- and middle-income countries [6]. Generally, unintended/unwanted pregnancy continues to be a burden in Sub-Saharan Africa, with an estimated 14 million cases oc- curring each year [7]. A recent survey of 42 countries in Sub-Saharan Africa—a region known for an unacceptably high prevalence of HIV infection—indicated that 10%–65% of women reported that their last pregnancy was unintended [7]. With the reportedly high unmet need for family planning among married women in general in Nigeria (16%) [8], and specifically among HIV-positive women (26.9%) [9], it may be suggested that some pregnancies among women living in Nigeria may be unintended, thereby posing a challenge to efforts intended to prevent new pediatric HIV infection. The aim of the present study was to determine the rate and factors associated with unintended pregnancy among HIV-positive pregnant women attending prenatal clinics at two government-owned tertiary health institutions in Enugu, southeast Nigeria. It is hoped that this in- formation will be relevant for public health officers, and governmental International Journal of Gynecology and Obstetrics 132 (2016) 60–63 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, PMB 01129, Enugu State, Nigeria. Tel.: +234 8037020295. E-mail addresses: ezugwueuzebus@yahoo.com, euzebus.ezugwu@unn.edu.ng (E.C. Ezugwu). http://dx.doi.org/10.1016/j.ijgo.2015.06.039 0020-7292/© 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo