Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis

Ampt, Frances H; Willenberg, Lisa; Agius, Paul A.; Chersich, Matthew; Luchters, Stanley; Lim, Megan S C

doi:10.1136/bmjopen-2018-021779

Cited by 46 publications

(61 citation statements)

References 89 publications

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“…Older age is usually a factor associated with abortion [19,55,57,58]. In our analysis, we could not observe a clear trend as we did for the association between age and pregnancy occurrence.…”

Section: Factors Associated With At Least One Abortion Among Women Whcontrasting

confidence: 63%

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

Sullivan

Guédou²,

Batona³

et al. 2020

Preprint

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BACKGROUND: Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs.METHODS: Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, n=450; 2016, n=504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p<0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p≤0.05) was used to generate the final models.RESULTS: Median age was 39 years (N=866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p<0.05) associated with more pregnancies.CONCLUSION: One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.

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Section: Factors Associated With At Least One Abortion Among Women Whcontrasting

confidence: 63%

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

Sullivan

Guédou²,

Batona³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…[3][4][5] The use of LARCs among FSWs is low in many countries, 6 particularly in sub-Saharan Africa, where prevalence is reported as less than 5% in most studies. 8,9 Access to family planning services has increased in parts of Africa in recent decades. 8,9 Access to family planning services has increased in parts of Africa in recent decades.…”

mentioning

confidence: 99%

“…1,7 Use of IUDs among FSWs varies considerably between regions, with higher levels in parts of Latin America and Asia. 8,9 Access to family planning services has increased in parts of Africa in recent decades. 10 In Kenya, LARCs are offered at low or no cost in many public health facilities, and are used by approximately 22% of married women.…”

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confidence: 99%

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Ampt

Lim

Agius

et al. 2019

Intl J Gynecology & Obste

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Objective To assess correlates of long‐acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya. Methods Baseline cross‐sectional data were collected between September 2016 and May 2017 in a cluster‐randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16–34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex‐work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues. Results Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra‐uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25–30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods. Conclusion The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.

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“…This is consistent with studies done elsewhere. LARCs are highly recommended globally as effective contraceptives, have less side effects as compared to non-barrier methods but are rarely used by FSWs in many sub-Saharan Africa due to non-availability and utilization problems [34]. With low contraceptives use among FSWs there is high risk of unintended pregnancy among FSWs which in most cases result in termination [35,36] In countries where abortion laws are not explicit or are restrictive FSWs opt for unsafe abortions which have unfavorable results [35,36].…”

Section: Discussionmentioning

confidence: 99%

Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi

Twizelimana¹,

Muula

2020

Preprint

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Introduction:Research has paid limited attention to understanding factors that are associated with unmet contraceptives needs among female sex workers (FSWs). In order to fill this knowledge gap we estimated the prevalence of unmet contraceptives needs and examined factors that were associated with unmet contraceptives needs among FSWs in semi urban Blantyre, Malawi.MethodsWe used systematic sampling to recruit 290 FSWs in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexual transmitted infections.ResultsOut of the 290 study participants 102 (35.2%) reported unmet needs for contraceptives. The following factors were significantly associated with unmet contraceptives needs in multivariate analysis: FSWs’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p < 0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p < 0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p < 0.001.ConclusionThere is need to improve awareness of contraceptives among FSWs in semi urban Blantyre. Sexual and Reproductive Health services (SRH) should address barriers to contraceptives use such as sexual transmitted infections, clients’ violence, fear and misinformation on contraceptives. There is also a need to improve the knowledge, attitudes, and counseling skills of health providers in order to address unmet contraceptives needs among FSWS.

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Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis

Cited by 46 publications

References 89 publications

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi

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