Child Replacement Theory as a Tool for Understanding Fertility Behavior Among HIV-Infected Sub Saharan Women

By Nancy Smee.

Published by The Social Sciences Collection

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Article: Print $US10.00
Article: Electronic $US5.00

Integrating family planning services with prevention of mother-to- child transmission of HIV (PMTCT) programs is crucial in sub Saharan Africa, where HIV seroprevalence and rates of unintended pregnancy are high. HIV- infected women in sub Saharan Africa continue to seek pregnancy at the same rate as their uninfected peers. Women of childbearing age account for nearly half of those infected with HIV. Without prevention of maternal to child interventions, approximately 12-40% of HIV-infected women will transmit infections to their infants, and it is estimated that 15.7 million African children will be orphaned by the end of 2010. Fertility and reproductive behavior among HIV-infected women is poorly understood and one of the most complex problems facing health care providers and policy makers. The purpose of this paper is to provide a theoretical context for the study of fertility in sub Saharan Africa, and to offer partial explanation for what may be driving the reproductive choices of HIV-infected women. Child Replacement Theory is presented as a functional theory that has been used across disciplines. A chronological description of the development of the theory tracing its origins to the study of demographics, economics and loss and grief is presented in order to outline major periods of influence on the theory and the corresponding researcher’s contributions. A critique of the theory using the Walker and Avant criteria for theory analysis is presented, as well as a conceptual model of mechanisms affecting fertility in HIV-infected and HIV-negative women in sub-Saharan Africa. These components diagram the integration and interrelationships of the contributing theorists’ concepts. There is a need for further investigation into cultural attitudes and sexual practices of HIV-positive women in order to minimize the threat of maternal to child transmission of HIV. Child Replacement Theory is a key piece to understanding and culturally contextualizing fertility practices among sub Saharan women.

Keywords: Women, Fertility, HIV-infected, Sub-saharan Africa

International Journal of Interdisciplinary Social Sciences, Volume 5, Issue 3, pp.13-22. Article: Print (Spiral Bound). Article: Electronic (PDF File; 1.527MB).

Dr. Nancy Smee

Assistant Professor, School of Nursing, University of San Francisco, San Francisco, California, USA

Nancy Smee has worked for many years as a nurse-midwife and women’s health nurse practitioner. During her studies at the University of California, Berkeley for her masters in public health she became interested in the vulnerability of women with HIV. She received her PhD from the University of California, San Francisco doing her research in Zimbabwe and Tanzania on the prevention of maternal to child transmission of HIV, and she completed a post-doctoral fellowship at the University of California, San Francisco in the prevention and treatment of HIV. Her on-going research is centered on the sexual behaviors and reproductive choices of HIV-infected women in under-developed countries. She is an assistant professor at the University of San Francisco.


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