Abstract

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.