Pregnancy decision making among Thai women living with HIV: a grounded theory study

Kownaklai, Jaruwan, Graham, Moira and Hayter, Mark ORCID: https://orcid.org/0000-0002-2537-8355 (2022) Pregnancy decision making among Thai women living with HIV: a grounded theory study. Midwifery, 115. p. 103490. ISSN 0266-6138

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Abstract

Objective: this qualitative research study aims to understand and generate a model of the pregnancy decision-making process in Thai women living with HIV. Method: the constructivist grounded theory of Charmaz was chosen as the research approach and method to generate a pregnancy decision-making process which is shaped and constructed by personal and social processes. Data collection: was undertaken in antenatal clinics (ANCs) at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making. Findings: the substantive model consists of 6 categories; 1) concealing HIV positive status from partner; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting the decision; and 6) adapting to the decision. This research finds that the main concerns women living with HIV have in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found amongst these women that relates to personal and Thai social beliefs. Conclusions and implications for practice: the concept illustrates not only the process of decision making but also highlights the main stages, issues and concerns of women living with HIV wanting a child. This study recommends that health care providers need to pay more attention to counselling women and couples living with HIV by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy, in advance of this happening, and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.