‘I won’t be able to go home being pregnant’: sex work and pregnancy in Dhaka, Bangladesh

Abstract

Sex workers report high rates of unintended pregnancy that are inconsistent with widespread reports of condom use. Greater understanding of the implications of an unintended pregnancy and barriers to contraceptive use is needed to better meet the broader sexual and reproductive health needs of this population. We conducted in-depth interviews with 20 women sex workers in Dhaka, Bangladesh. Findings reveal that most women are trying to conform to societal norms and protect their reputations. They fear pregnancy would reveal that they are having unsanctioned sex and that they are sex workers. This could lead to ostracism from families and society, resulting in homelessness and abandonment by partners. Pregnancy may affect a sex worker's ability to work and leave her unable to meet financial obligations. All study participants were using condoms but most acknowledged they could not use them consistently. They had all tried other contraceptive methods, notably injectables and the pill, but some noted experience of side-effects, difficulties in adherence and the desire to use other methods. Understanding the context of sex workers' lives is an important step in informing stakeholders about the range of services needed to improve their sexual and reproductive health.

Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh

“…Correlates of stigmatizing attitudes by service providers toward PLHIV in Bangladesh include poor knowledge of HIV and rating religion of high importance in their personal lives [25]. Despite limited data on provider attitudes toward highly stigmatized populations in Bangladesh, some studies have reported that social stigma (unrelated to HIV) toward sex workers [26], MSM [27], and transgender people (hijra) [28] exists and inhibits trust between clients and providers.…”

Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization – A scoping review

“…Stigma on the societal level affected FSW's decision‐making regarding RHC service utilization. For example, Bangladeshi sex workers mentioned that disclosing their occupation could damage their reputation and relationships with family and community, and lead to physical abuse (Katz et al., 2016). In Tanzania, women suffered from stigma related to being a sex worker, often coinciding with HIV‐related stigma and stigma surrounding being a single mother (Beckham et al., 2015).…”

“…FSW's relationship with fellow FSW and with family members was mentioned as barriers in five studies (Chareka et al., 2021; Crankshaw et al., 2021; Katz et al., 2016; Marlow et al., 2014; Parmley et al., 2019). Sex workers in Uganda reported that the person with whom they consulted first had an impact on accessing RHC services; they often turned first to a friend and fellow sex worker, who referred them either to a health clinic or to an alternative carer/herbalist (Marlow et al., 2014).…”

“…They actively avoided them for fear that the latter would intentionally expose their HIV status (Crankshaw et al, 2021). Additionally, fearing a lack of support or damage to their relationship with partners and family members due to the disclosure of their sex work occupation (Chareka et al, 2021;Katz et al, 2016) or their pregnancy (Parmley et al, 2019), restrained FSW care seeking or delayed it until late into their pregnancies. For example, South African sex workers thought that they did not need contraceptives when experiencing irregular menstruation or viewed contraceptives as a cause of infertility or cancer (Parmley et al, 2019).…”

Reducing provider-held stigma and improving young client satisfaction in Bangladesh: Findings from a Link Up evaluation

“…6 Stigma has been associated with lower rates of HIV-related knowledge, testing, disclosure, social support, physical health, mental health, and adherence to antiretroviral treatment. [7][8][9] Furthermore, research in Bangladesh has documented stigma (unrelated to HIV) among healthcare providers toward sex workers 10 , MSM 11 , and transgender people (called "hijra" in Bangladesh) 12 , which inhibits disclosure of important health-related information to providers.…”