Understanding pregnancy planning and contraceptive use is important in preventing unplanned/unwanted
pregnancies among women on antiretroviral therapy (ART). Through a cross-sectional survey of 155 women
living with HIV on ART in Botswana (mean age = 36), bivariate/multivariate analyses were used to identify and
understand pregnancy planning and contraceptive use. Women who did not plan to have a child (n = 85) were
older, less educated, had more children and worried about stigmatisation from family and healthcare workers
(HCWs). Multivariate analyses found age (OR:3.41; CI:1.57–7.45; p = 0.002); perceived stigmatisation from family
and healthcare workers (OR:3.62; CI:1.47–8.96; p = 0.005); and believing it is irresponsible for women living with
HIV to want a child (OR:2.40; CI:1.10–5.24; p = 0.028) to be significantly associated with not planning to have a
child. Although reported condom use among 85 women who did not plan to have a child was nearly 90%, a total of
26 of these women (34%) believed they did not have control over condom use. Lack of contraception was reported
by 6 women who did not plan a child; this, coupled with the lack of control over condom use, puts unmet need for
contraception at 38%. Most women reported feeling comfortable talking with HCWs about contraceptives. However,
almost a quarter of the women indicated they were infrequently advised about contraceptives at ART clinics. This
study found discordance between pregnancy planning and contraceptive use among women on ART. Lack of
control over condom use coupled with low hormonal contraceptive use creates unmet need for contraception and
increases the risk of unwanted pregnancies. Regular clinic visits for women on ART present excellent opportunities
to address contraceptive needs in a considerate and comprehensive manner.