Availability of antiretroviral therapy and prevention of mother to child transmission of HIV programmes have increased childbearing decisions in people living with HIV. However, pregnancy decisions of married women living with HIV have not been adequately reported in Malawi. In order to provide information to inform the development of antiretroviral and family planning services targeted to the unique needs of women living with HIV, this study explored pregnancy decisions of women living with HIV in rural southern Malawi. Twenty in-depth interviews on married women living with HIV selected purposively were conducted in two antiretroviral clinics of patrilineal Chikhwawa and matrilineal Chiradzulu districts in 2010. With their pregnancy and child rearing experiences, the women who got pregnant after a positive HIV diagnosis decided to never get pregnant again. Their lived experiences of motherhood when living with HIV play a major role in their pregnancy decisions despite free access to antiretroviral therapy, which has improved the quality of their life’s and survival. Societies in Malawi must accept this behavioural change by married women living with HIV and their needs for family planning. Health care workers must be knowledgeable and sensitive about it and assist women living with HIV who are willing to adapt their pregnant decisions based on living experiences.
 McIntyre, J. (2005) More features. Maternal health and HIV. Reproductive Health Matters, 13, 129-135.
 Ratsma, Y., Lungu, K., Hoffman, J. and White, A. (2005) Why more mothers die: Confidential enquiries into institutional maternal deaths in the southern region of Malawi, 2001. Malawi Medical Journal, 17, 75-80.
 Chimbiri, A.M. (2007) The condom is an “intruder” in marriage: Evidence from rural Malawi. Social Science & Medicine, 64, 1102-1115.
 Zulu, E. (1997) The role of men and women in decision making about reproductive issues in Malawi. Paper presented at the Annual Meeting of the Population Association of America, Washington DC, 27-29 March 1997.
 Grieser, M., Gittelsohn, J., Shankar, A.V., Koppenhaver, T., Legrand, T.K., Marindo, R., Mavhu, W.M. and Hill, K. (2001) Reproductive decision making and the HIV/AIDS epidemic in Zimbabwe. Journal of Southern African Studies, 27, 225-243.
 Dadoo, F. and Frost, A. (2008) Gender in African population research: The fertility/reproductive health example. Annual Review of Sociology, 34, 431-452.
 Cooper, D., Harries, J., Myer, L., Omer, P. and Bracken, H. (2007) Life is still going on: Reproductive intentions among HIV-positive women and men in South Africa. Social Science & Medicine, 65, 274-283.
 Paiva, A., Santos, N., Junior-Franca, I., Filipe, E., Ayers, J. and Segurado, A. (2007) Desire to have children: Gender and reproductive rights of men and women living with HIV: A challenge to health care in Brazil. AIDS Patient Care and STDs, 21, 268-277.
 Volberding, P. and Deeks, S. (2010) Antiretroviral therapy and management of HIV infection. The Lancet, 376, 49-62. http://dx.doi.org/10.1016/S0140-6736(10)60676-9
 Hebling, E. and Hardy, E. (2007) Feelings related to motherhood among women living with HIV in Brazil: A qualitative study. AIDS Care, 19, 1095-1100.
 Heard, I., Sitta, R., Lert, F. and the VESPA Study Group (2007) Reproductive choice in men and women living with HIV: Evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study). AIDS, 21, S77-S82.
 Sowell, R., Murdaugh, C., Addy, C., Moneyham, L. and Tayokoli, A. (2002) Factors influencing intent to get pregnant in HIV-infected women living in the southern USA. AIDS Care, 14, 181-191.
 Peltzer, K., Chao, L. and Dana, P. (2009) Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS and Behaviour, 13, 973-979. http://dx.doi.org/10.1007/s10461-008-9365-5
 Chasela, C., Hudgens, M., Jamieson, D., Kayira, D., Hosseinipour, M., Kourtis, A., et al. (2010) Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. The New England Journal of Medicine, 362, 2271-2281.
 Kanniappan, S., Jeyapaul, M. and Kalyanwala, S. (2008) Desire for motherhood: Exploring HIV-positive women’s desire, intentions and decision making in attaining motherhood. AIDS Care, 20, 625-630.
 Hoffman, I., Martinson, F., Powers, F., Chilongozi, D., Msiska, E., Kachipapa, E., et al. (2008) The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use and pregnancy incidence among Malawian women. Journal of Acquired Immune Deficiency Syndromes, 47, 477-483.
 Taulo, F., Berry, M., Tsui, A., Makanani, B., Kafulafula, G., Li, Q., et al. (2009) Fertility intentions of HIV-infected and uninfected women in Malawi: A longitudinal study. AIDS Behaviour, 13, S20-S27.
 Sallis, J. and Owen, N. (2002) Ecological models of health behaviour. In: Glanz, K., Rimer, B. and Lewis, F. Eds., Health Behaviour and Health Education: Theory, Research and Practice, 3rd Edition, Calif, San Francisco, 462-484.
 Graneheim, U. and Lundman, B. (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112.
 Kakaire, O., Osinde, M. and Kaye, D. (2010) Factors that predict fertility desires for people living with HIV infection at a support treatment centre in Kabale, Uganda. Reproductive Health, 7, 27.
 MacCarthy, S., Rasanathan, J., Ferguson, L. and Gruskin, S. (2012) The pregnancy decisions of HIV-positive women: The state of knowledge and way forward. Reproductive Health Matters, 20, 119-140.
 Yeatman, S. (2009) HIV infection and fertility preferences in rural Malawi. Studies in Family Planning, 40, 261-276.
 Chi, B., Rasch, V., Hanh, N. and Gammeltoft, T. (2011) Pregnancy decision-making among HIV positive women in Northern Vietnam: Reconsidering reproductive choice. Anthropology & Medicine, 18, 315-326.
 Gipson, J. and Hindin, M. (2007) Marriage means having children and forming your family so what is the need of discussion? Communication and negotiation of childbearing preferences among Bangladeshi couples. Culture, Health & Sexuality, 9, 185-198.
 Rabindranathan, S. (2003) Women’s decision to undergo abortion. A study based on Delhi clinics. Indian Journal of Gender Studies, 10, 457-473.
 Fotso, J.C., Ezeh, A. and Essendi, H. (2009) Maternal health in resource-poor urban settings: How does women’s autonomy influence the utilization of obstetric care services? Reproductive Health, 6.
 Elul, B., Delvaux, T., Munyana, E., Lahuerta, M., Horowitz, D., Ndagije, F., Roberfroid, D., Mugisha, V., Nash, D. and Asiimwe A. (2009) Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda. AIDS, 23, S19-S26.
 Maier, M., Andia, I., Emenyonu, N., Guzman, D., Kaida, A. and Pepper, L. (2009) Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV positive women in an early HIV treatment program in rural Uganda. AIDS and Behaviour, 13, 28-37. http://dx.doi.org/10.1007/s10461-008-9371-7
 Rankin, S., Lindgren, T., Rankin, W. and Ngoma, J. (2005) Donkey work: Women, religion and HIV/AIDS in Malawi. Health Care for Women International, 26, 4-16.
 Bentley, M., Corneli, A., Piwoz, E., Moses, A., Nkhoma, J. and Tohil, B. (2005) Perceptions of the role of maternal nutrition in HIV-positive breast-feeding women in Malawi. Journal of Nutrition, 135, 945-949.
 Chunga, P., Jabu, G., Taulo, S. and Grimason, A. (2004) “Sanitary Capitaos”: Problems and challenges facing Environmental Health Officers and Environmental Health Assistants in Chikwawa, Malawi. The Magazine of the International Federation of Environmental Health, 6, 14-24.
 Kaida, A., Gray, G., Bastos, F., Andia, I., Maier, M. and McIntyre, J. (2008) The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa and Uganda. AIDS Care, 20, 21-25.
 Ezeanolue, E., Stumpf, P., Soliman, E., George, F. and Jacka, I. (2011) Contraception choices in a cohort of highly active antiretroviral therapy. Contraception, 84, 94-97.
 Feldman, R. and Maposhere, C. (2003) Safer sex and reproductive choice: Findings from “positive women: voices and choices” in Zimbabwe. Reproductive Health Matters, 11, 162-173.
 Kaida, A., Laher, F., Strathdee, S., Money, D. and Janssen, P. (2010) Contraceptive use and method preference among women in Soweto, South Africa. The influence of expanding access to HIV care and treatment services. PLos One, 5, e13868.
 Cleland, J., Ali, M. and Capo-Chichi, V. (1999) Postpartum sexual abstinence in West Africa: Implications for AIDS-control and family planning programmes. AIDS, 13, 125-131.
 Achana, F., Debpurr, C., Akweongo, P. and Cleland J. (2010) Postpartum abstinence and risk of HIV among young mothers in the Kassena-Nankana district of northern Ghana. Culture, Health & Sexuality, 12, 569-581.
 Ajzen, I. (2011) Behavioral interventions: Design and evaluation guided by theory of planned behaviour. In: Mark, M.M., Donaldson, S.I. and Campbell, B.C., Eds., Social Psychology Program and Policy Evaluation. Guildford, New York, 74-100.