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Background: HIV and AIDS have caused untold harm and human suffering globally. Over 90% of people infected with this deadly virus live in sub-Saharan Africa including Malawi. In Malawi HIV disproportionally affects women in comparison with men. According to Demographic and Health Survey (2015-2016) key indicators, HIV prevalence among women aged 15-64 was 12.8% compared to men 8.2% public health. As per 2010 Malawi demographic and health survey, HIV prevalence in the southern region was twice as high as prevalence in the other regions (Southern 14.5%, Central 7.6% and northern region (6. 6%).Women and children are more affected than the rest of the general population. HIV infection in children below 15 years is largely due to mother-to-child transmission (MTCT). Worldwide, over two million children have been infected through MTCT. Type of Research Study: The study adopted a qualitative research design using the inductive research technique or grounded theory research in which the steps occur simultaneously, observing, collecting data and forming theory from the data at the same time. Problem Statement: HIV prevalence in Southern Region of Malawi is twice as high as Northern and Central regions, at 14.5% where fertility rate at 5.7% are also high. A combination of high fertility rate and high HIV prevalence have contributed to the undermining of an effective PMTCT continuum of prevention, care and treatment programme towards achieving virtual elimination of mother to child HIV transmission and keeping the mothers alive. Therefore, there is need to examine how and through what pathways learning about one’s HIV positive status could alter one’s childbearing decisions. Objectives: This study explored the decision-making process on pregnancy decisions among PMTCT participants and their family support systems; Examined factors that influence decision making process among PMTCT participants and their immediate family networks; Determined the gaps in the PMTCT service delivery; Explored the knowledge and attitudes of health providers PMTCT mothers; and analysed the gap between the PMTCT policy guidelines and their implementation This study revealed factors that influence fertility decisions among pregnant women with HIV attending ANC and ART clinic at Chiradzulu District Hospital. Some of participants became pregnant because they desired to have another child and others because their partners wanted a child. A proper understanding of factors associated with pregnancies among these women is essential to guide interventions and counselling strategies to better inform and support them. Religious doctrines, beliefs about having a healthy baby, personal desire and familial desires to have a baby, combined with the social stigma that accompanies HIV, puts women who are HIV-positive in a difficult situation. HIV-positive women must be appropriately counselled about the risks of childbearing rather than focusing only on issues related to mother-to-child transmission of HIV.

Child Bearing Decisions among Women Enrolled In PMTCT Programme: A Comparative Study of the Rural and Semi-Urban Setting of Malawi Chiradzulu District