Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility-based survey

Abstract

Introduction Female sex workers (FSWs) are marginalized due to social rejection and stigma, especially in countries where the practice is illegal. Many FSWs are mothers but little is known about their utilization of maternal services. This study investigated the determinants of utilization of maternal services by FSWs in Uganda. Methods FSWs were recruited from the “Most at-Risk Initiative” clinics in Uganda. We analyzed data for 318 FSWs who had given birth within two years of the study to estimate the proportion of FSWs who used all the components of maternal services (antenatal, facility-based delivery and postnatal). The outcome variable (utilization of maternal services) was categorized as “recommended package” if the women received all the three services, “moderate” if they received any two and “limited/none” if they received only one or none of the services. Multinomial logistic regression analysis was used to quantify the impact of pregnancy planning and other factors on the utilization of maternal services. Results Overall, 25.2% (80) utilized all the three services in the recommended package of maternal services, 47.5% (151) had moderate utilization, while 27.3% (87) utilized limited or no services. Factors that influenced utilization of the recommended package compared to “limited/none” use were having a planned pregnancy (adjusted RRR (aRR) = 3.87; 95% CI = 1.40-10.67), knowing four as the minimum number of ANC visits (aRR = 2.43; 95% CI = 1.22-4.87), never having been criminalized for sex work (aRR = 2.48; 95% CI = 1.30-4.74) and not believing that health providers deny services to FSWs believing (aRR = 2.63; 95% CI = 1.37-5.07). Conclusion These findings confirm the relevance of pregnancy planning in the utilization of maternal services among FSWs. However, maternal health service utilization was generally low and interventions to reduce barriers including inadequate knowledge of ANC visits, internal stigma and criminalization of sex work are required. These are necessary steps in the move towards universal health coverage.

Sexual and Reproductive Health Service Needs Associated with Underage Initiation of Selling Sex among Adult Female Sex Workers in Guinea-Bissau

“…This is much higher than the 3% of all women aged 15-49 in Guinea-Bissau who did not receive antenatal care [51]. Destigmatizing and making antenatal care services friendly toward adolescents who sell sex may improve uptake among this population [52].…”

Sexual and reproductive health service needs associated with underage initiation of selling sex among adult female sex workers in Guinea-Bissau

“…Destigmatizing and making antenatal care services friendly toward FSW and adolescents may improve uptake among these populations. [24] Over half of FSW in this study who started selling sex while underage reported current use of male condoms for contraception, which can also help protect them from HIV and other STIs. However, over one third had experienced STI symptoms in the past 12 months, suggesting the need for further prevention and treatment services.…”

“…Destigmatizing and making antenatal care services friendly toward FSW and adolescents may improve uptake among these populations. [24]…”

Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi

“…However, the continuum of care is often narrowed to concentrate on antenatal, delivery and postnatal care provided by skilled healthcare workers [11]. Although it is accepted that each element of care will improve outcomes, an integrated approach has been shown to be the most effective [10,12,13], and utilisation of the continuum of care is recognised as an important means of reducing maternal and neonatal mortality rates [10,14,15].…”

“…While previous studies have highlighted the importance of maternal healthcare [2][3][4][5][6][7][8][9] and identified some of the factors that influence the individual utilisation of antenatal care, delivery care and postnatal care [23][24][25][26][27][28][29][30][31], very few studies have investigated the continuum of care. Given the importance of the integrated use of maternal healthcare, it is vital that the barriers preventing women accessing the continuum are understood [10,[12][13][14][15]. This information is key for policy makers to be able to design and implement effective strategies to increase utilisation of maternal healthcare across the continuum.…”