Advocating safe abortion: outcomes of a multi‐country needs assessment on the potential role of national societies of obstetrics and gynecology

“…The legal framework related to pregnancy termination differs in the two countries which could explain those differences. It is semiliberalized in Benin and restrictive in Mali [49]. In Mali, therapeutic abortion is permitted only in case of incest, fetal malformation, or risk for the mother's life.…”

Section: Discussionmentioning

confidence: 99%

“…In Benin, women can access therapeutic abortion to protect their health. However, it is not because the legal framework is more liberalized that the access to safe abortion is easier [49].…”

Section: Discussionmentioning

confidence: 99%

Reproductive History and Pregnancy incidence of Malian and Beninese Female Sex workers before and During Sex Work Practice

Alary¹

2021

JWHCI

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Aim/Background: To reduce maternal mortality (MM), access to family planning and reproductive health care services are key strategies. Access to and use by marginalized populations pose a substantial challenge. The objective of this study was to describe the reproductive history of female sex workers (FSWs) before and during sex work. Materials and methods: FSWs aged ≥18 years were recruited in Benin, and Mali, to answer a questionnaire during a face-to-face interview. Descriptive analyses were carried out and comparisons made between countries (Pearson chi-square) and between the periods before (BSW) and during sex work (DSW) practice within women in each country (McNemar chi-square). In addition, multiple imputations were used to estimate and compare the incidence rate of pregnancy BSW and DSW calculated with a generalized linear model for count data with a Poisson distribution and a log link. Results: Mean age was 26 years in Mali (n=322) and 35 years in Benin (n=330). More women had at least one pregnancy BSW compared to DSW in both Mali (62.1%-vs-33.5%) and Benin (91.2%-vs-32.7%). The pregnancies occurring DSW had lower livebirth rates (57.9%-vs-74.7% Mali, 17.6%-vs-60.6% Benin) and ended more often with a therapeutic abortion, DSW compared to BSW, especially in Benin (65.2%-vs-25.6%). The level of complications associated with therapeutic abortion was high, both DSW (23%) and BSW (20%). The incidence rate of pregnancy was about twice lower DSW compared to BSW [incidence rate ratio (IRR): 0.49; 95% confidence interval (95%CI): 0.37-0.66-Mali and IRR: 0.45; 95% CI: 0.32-0.63-Benin]. Conclusion: In both Benin and Mali, FSWs had more pregnancies during the period preceding sex work practice, about twice more than during sex work when considering the differences in incidence rates. Single mothers need to be supported to avoid sex work as a financial solution. On the other hand, the reproductive needs of FSWs need to be acknowledged to reduce maternal mortality within this marginalized population. It is of paramount importance that interventions remain focused on reproductive health and prevent unwanted pregnancies, answer contraceptive needs and provide safe therapeutic abortions.

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“…In Benin, private health centers are known to provide therapeutic abortion services. They are mostly centralized around Cotonou [40]. In Benin, the cost of a therapeutic abortion was estimated at between 24.50-89.00 US dollars [45].…”

Section: Do Sex Workers Have As Many Pregnancies During Their Sex Wormentioning

confidence: 99%

“…The legal framework related to pregnancy termination differs in the two countries which could explain those differences. It is semi-liberalized in Benin and restrictive in Mali [40].…”

Section: Do Sex Workers Have As Many Pregnancies During Their Sex Work Practice As Prior To It?mentioning

confidence: 99%

Reproductive History and Pregnancy Incidence of Malian and Beninese Sex Workers Before and Suring Sex Work Practice

Sullivan¹,

Tounkara²,

Béhanzin³

et al. 2021

Preprint

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BACKGROUND: To reduce maternal mortality, access to family planning and reproductive health care services is a key strategy. Access to and use by marginalized populations pose a substantial challenge. Sex workers in sub-Saharan Africa are a good example. The objective of this study was to describe the reproductive history of female sex workers (FSWs) before and during sex work.METHODS: FSWs aged ≥18 years were recruited in Cotonou (Benin), and Bamako (Mali), to answer a face-to-face questionnaire inquiring on reproductive history. Descriptive analyses were carried out and comparisons made between countries using Pearson chi-square and between the periods before (BSW) and during sex work (DSW) practice within women in each country using McNemar chi-square. In addition, multiple imputations were used to estimate and compare the incidence rate of pregnancy BSW and DSW.RESULTS: Mean age was 26 years in Mali (n=322) and 35 years in Benin (n=330). More women had at least one pregnancy BSW compared to DSW in both Mali (62.1% vs 33.5%) and Benin (91.2% vs 32.7%). The pregnancies occurring DSW had lower livebirth rates (57.9% vs 74.7% - Mali, 17.6% vs 60.6% - Benin) and ended more often with a therapeutic abortion, DSW compared to BSW, especially in Benin (65.2% vs 25.6%). The level of complications associated with therapeutic abortion was high, both DSW (23%) and BSW (20%). The incidence rate of pregnancy was about twice lower DSW compared to BSW [incidence rate ratio (IRR): 0.49; 95% confidence interval (95%CI): 0.37-0.66 in Mali and IRR: 0.45; 95% CI: 0.32-0.63 in Benin].CONCLUSION: In both Benin and Mali, FSWs had more pregnancies during the period preceding sex work practice, about twice more than during sex work when considering the differences in incidence rates. Single mothers need to be supported to avoid sex work as a financial solution. On the other hand, the reproductive needs of FSWs need to be acknowledged to reduce maternal mortality within this marginalized population. It is of paramount importance that interventions remain focused on reproductive health and prevent unwanted pregnancies, answer contraceptive needs and provide safe therapeutic abortions.

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Advocating safe abortion: outcomes of a multi‐country needs assessment on the potential role of national societies of obstetrics and gynecology

Cited by 10 publications

References 22 publications

Preventing death following unsafe abortion: a case series from urban Uganda

Preventing death following unsafe abortion: a case series from urban Uganda

Reproductive History and Pregnancy incidence of Malian and Beninese Female Sex workers before and During Sex Work Practice

Reproductive History and Pregnancy Incidence of Malian and Beninese Sex Workers Before and Suring Sex Work Practice

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