Interpersonal Violence and Contraceptive Method Use by Women Sex Workers

Contraceptive decision‐making through the lens of social determinants of health among female sex workers: A qualitative descriptive study

“…Among marginalized populations such as FSW, broader SDOH such as healthcare access and social and work environments might impact reproductive autonomy and the contraceptive decision‐making process (Zemlak, et al, 2020; Schwartz and Baral, 2015). Social factors such as relationship contexts with different types of sexual partners (clients and intimate partners), interpersonal violence, healthcare access and economic instability may have important implications on health outcomes such as contraceptive decision‐making and unintended pregnancy (Zemlak et al, 2021). A deeper understanding of the contraceptive decision‐making process and how these SDOH impact this process may provide an understanding of how to reduce inequities in FSW experiences of unintended pregnancy.…”

“…FSW may have many different types of sex partners with varied relationship contexts. Sexual partnerships among FSW can include intimate partners (sex partner for whom there is no monetary exchange for sex acts) and client partners (sexual partner who pays for sex with food, drugs, money, shelter or goods) that add to the complexity of contraceptive decision‐making (Zemlak et al, 2021). The nature of sex work often requires substantial rapid overlap of sexual encounters within short time periods, differentiating FSW from women in other types of sexual relationships and necessitating examination of contraceptive decision‐making in these circumstances.…”

“…Previous contraceptive decision‐making studies within a marital dyad or while women were casually dating might be less applicable among FSW who have simultaneous relationships that consist of different sexual partner types (Ulibarri et al, 2019). Contraceptive decision‐making among FSW may change according to sex partner type (Zemlak et al, 2020). For example, a FSW might engage in condomless sex with intimate partners, that might include emotional ties, to show closeness, trust or a desire for childbearing.…”

“…Violence perpetrated by sex partners can affect economic stability and often occurs within a neighbourhood environment where other dangers are present. Thus, violence is a SDOH that can be associated with these contraceptive decisions and play a role in women's childbearing intentions and behaviours (Zemlak et al, 2021). FSW experience high rates of interpersonal violence (physical or sexual violence) and condom coercion (partner removal or refusal to use a condom) by multiple partner perpetrators (Decker et al, 2020); prevalence of lifetime violence by clients 58% and intimate partners is 52% (Decker et al, 2020; Zemlak et al, 2021).…”

“…Thus, violence is a SDOH that can be associated with these contraceptive decisions and play a role in women's childbearing intentions and behaviours (Zemlak et al, 2021). FSW experience high rates of interpersonal violence (physical or sexual violence) and condom coercion (partner removal or refusal to use a condom) by multiple partner perpetrators (Decker et al, 2020); prevalence of lifetime violence by clients 58% and intimate partners is 52% (Decker et al, 2020; Zemlak et al, 2021). Cumulative, lifetime experiences of violence influence how women make contraceptive decisions because women who experience interpersonal violence may not have the ability to safely execute their contraceptive intentions with actual behaviours (Alexander et al, 2012).…”