This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation.
There has been an unusually high media reporting of the impact on sex workers across the globe in relation to Covid -19 and related government lockdown, movement restrictions and reduced employment. This paper utilises a media analysis which examined N=541 media articles identified for the period 1st March to 31st May. N=103 of these focused on different countries in Africa and n=43 articles had a Kenyan focus. The media analysis is important as it is a lens through which sex workers are constructed, discourses are reinforced and knowledge is transferred throughout the globe. In this paper we reflect on: 1) The global effects on sex workers to show generic trends around economic impacts and health care across the global north and south; 2) core themes which affected sex workers daily lives across the African continent such as changes in mobility in cities and across borders, reduced movements, police interactions and violence, homelessness; 3) outline some of the global and localised responses from sex worker rights organisation, support projects and NGO's, in the absence of government safety nets. These media reports have illuminated the crisis experienced by sex workers during the period of initial first wave occurrences of Covid in countries globally and governmental measures to suppress the virus. These reductions in income, access to health care and medicines and challenges for housing will persist for some time with devastating effects on an already vulnerable and marginalised community.
The COVID-19 response has profoundly affected women’s access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women’s FP choices. In this qualitative study, we interviewed 16 women (aged 18–25 years), 10 men in partnerships with women, and 14 people in women’s social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.
Cislaghi (2021): 'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya, Culture, Health & Sexuality,
Background
To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP).
Methods
Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data.
Results
Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks.
Conclusions
Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women’s wider networks.
This baseline pilot study was the joint work of the University of Leicester and Bar Hostess Empowerment and Support Programme. Bar Hostess Empowerment & Support Programme (BHESP) is an organisation for and by sex workers (known as bar hostesses) in Nairobi, Kenya. The project consisted of experts in public health, human rights interventions and the sociology of sex work, who came together to develop and administer a unique research activity. The study further provided BHESP with baseline information on the various services provided and the gaps at the clinic, as well as barriers that young female sex workers face in returning to formal education, and /or pursuing their careers.
There exist significant inequities in access to family planning (FP) in Kenya, particularly for nomadic and semi-nomadic pastoralists. Health care providers (HCP), are key in delivering FP services. Community leaders and religious leaders are also key influencers in women's decisions to use FP. We found limited research exploring the perspectives of both HCPs and these local leaders in this context. We conducted semistructured interviews with HCPs (n=4) working in facilities in Wajir and Mandera, and community leaders (n=4) and religious leaders (n=4) from the nomadic and semi-nomadic populations the facilities serve. We conducted deductive and inductive thematic analysis. Three overarching themes emerged: perception of FP as a health priority, explanations for low FP use, and recommendations to improve access. Four overlapping sub-themes explained low FP use: desire for large families, tension in FP decision-making, religion and culture, and fears about FP. Providers were from different socio-demographic backgrounds to the communities they served, who faced structural marginalisation from health and other services. Programmes to improve FP access should be delivered alongside interventions targeting the immediate health concerns of pastoralist communities, incorporating structural changes. HCPs that are aware of religious and cultural reasons for non-use, play a key role in improving access.
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