There is limited information on contraceptive values and preferences of sex workers. We conducted a mixed-method study to explore contraceptive values and preferences among sex workers. We conducted an online survey with individuals from 38 countries (n = 239), 6 focus group discussions (FGD, n = 68) in Zimbabwe, and 12 in-depth phone interviews (IDI) across 4 world regions, in June and July of 2019.Participants were asked about awareness of contraceptives, methods they had used in the past, and the determinants of their choices. Differences between respondents from high-, low-and middle-income countries were examined. Qualitative data were analysed thematically. Survey participants reported an awareness of modern contraceptive methods. FGDs found that younger women had lower awareness. Reports of condomless sex were common and modern contraceptive use was inconsistent. Determinants of contraceptive choices differed by setting according to results of the survey, FGD, and IDI. Regardless of country income level, determinants of contraceptive choices included ease of use, ease of access to a contraceptive method, and fewer side effects. Healthcare provider attitudes, availability of methods, and clinic schedules were important considerations. Most sex workers are aware of contraceptives, but barriers include male partners/clients, side effects, and health system factors such as access and clinic attitudes towards sex workers.
All individuals, including sex workers, are entitled to the full spectrum of sexual and reproductive health (SRH) and rights. Yet sex workers continue to bear significant SRH inequities and unmet needs for appropriate SRH services at every step along their sexual and reproductive lives. To illustrate the complex and nuanced barriers that currently impede sex workers’ access to SRH services, this chapter describes the current gaps in access to SRH services experienced by sex workers globally, drawing on in-depth interviews and focus group discussions with 171 sex workers and sex worker organisations from across ten countries. Interviews highlight the lack of tailored, comprehensive, and integrated SRH services. These gaps are driven by intersecting structural forces such as: the criminalisation of sex work, same-sex relationships, and gender non-conformance; harmful and coercive SRH policies; sex work and gender-based stigma; and logistical and practical barriers. To support the SRH needs and rights of sex workers, participants recommended improved access to comprehensive, integrated services addressing sex workers’ broader SRH needs, including family planning, abortion and pregnancy needs, SRH screening, hormone therapy, and other gender-affirming services. Crucial steps towards ensuring equitable SRH access for sex workers include addressing stigma and discrimination within healthcare settings, removal of coercive SRH policies and practices, and dedicating appropriate resources towards sex worker-led SRH models within the context of decriminalisation of sex work.
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