Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

Feldblum, Paul J.; Nasution, Marlina D.; Hoke, Theresa; Damme, Kathleen Van; Turner, Abigail Norris; Gmach, Rebecca; Wong, Emelita L.; Behets, Frieda

doi:10.1016/j.contraception.2007.04.009

Cited by 81 publications

(98 citation statements)

References 10 publications

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“…This work builds on earlier, mostly secondary, analyses of the contraceptive needs of FSWs [4][5][6] . The only other mixed-method, primary study of the unmet needs of FSWs of which the authors are aware was conducted in Southeast Asia 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have reported on pregnancy desires and contraceptive use among FSWs. The limited amount of existing research has shown high incidences of unintended pregnancy and a low contraceptive prevalence in this particular group [3][4][5][6] . All studies report that sex workers who do use contraception resort most often to condoms yet the latter are not consistently used in all sex acts 3,[5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…The limited amount of existing research has shown high incidences of unintended pregnancy and a low contraceptive prevalence in this particular group [3][4][5][6] . All studies report that sex workers who do use contraception resort most often to condoms yet the latter are not consistently used in all sex acts 3,[5][6][7][8][9] . FSWs may have difficulties in negotiating the consistent use of condoms with clients, and also may deliberately use condoms with some types of partners (such as casual clients) while deliberately not using condoms with other types of partners (such as emotional partners or regular clients) 10 .…”

Section: Introductionmentioning

confidence: 99%

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Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Sutherland

Alaii²,

Tsui

et al. 2011

The European Journal of Contraception & Reproductive Health

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A B S T R A C TBackground and objectives Female sex workers (FSWs) are thought to be at heightened risk for unintended pregnancy, although sexual and reproductive health interventions reaching these populations are typically focused on the increased risk of sexually transmitted infections. The objective of this study of FSWs in Kenya is to document patterns of contraceptive use and unmet need for contraception. Methods This research surveys a large sample of female sex workers (N ¼ 597) and also uses qualitative data from focus group discussions. Results The reported level of modern contraceptives in our setting was very high. However, like in other studies, we found a great reliance on male condoms, coupled with inconsistent use at last sex, which resulted in a higher potential for unmet need for contraception than the elevated levels of modern contraceptives might suggest. Dual method use was also frequently encountered in this population and the benefits of this practice were clearly outlined by focus group participants. Conclusion These findings suggest that the promotion of dual methods among this population could help meet the broader reproductive health needs of FSWs. Furthermore, this research underscores the necessity of considering consistency of condom use when estimating the unmet or undermet contraceptive needs of this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Sutherland

Alaii²,

Tsui

et al. 2011

The European Journal of Contraception & Reproductive Health

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“…63,78,79 Abortion is common among sex workers, though less is known about the safety of abortions or access to post-abortion care. 70,[80][81][82] Existing information suggests that many abortions are unsafe and complications common.…”

Section: Resultsmentioning

confidence: 99%

Fertility-related research needs among women at the margins

Schwartz¹,

Baral

2015

Reproductive Health Matters

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Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain underrepresented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on postconception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.

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“…The intersecting sexual and reproductive risks among sex workers in conflict affected northern Uganda are particularly concerning, given recent estimates documenting a HIV prevalence of 8.51% among the general population, and 37.2% among sex workers 13 . While several studies in sub-Saharan Africa have documented high levels of pregnancy and parenting among sex workers 14,15 , data on pregnancy intentions (both prospectively or retrospectively) among sex workers are scarce 16 . This is especially true of sex workers in the Ugandan context, where sex work criminalization has hindered collection of data surrounding sex workers' sexual and reproductive health 17 .…”

Section: Introductionmentioning

confidence: 99%

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use

Duff

Muzaaya

Muldoon

et al. 2017

Afr J Reprod Health

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This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to examine the correlates of ever having an unintended pregnancy. Among 400 sex workers (median age=20 years; IQR 19-25), 175 (43.8%) reported at least one unintended pregnancy. In multivariable analysis, primarily servicing clients in lodges/brothels [Adjusted Odds Ratio (AOR= 2.24; 95% Confidence Interval: 1.03-4.84)], hormonal contraceptive usage [AOR=1.68; 95%CI 1.11-2.59] and drug/alcohol use while working [AOR= 1.64; 95%CI 1.04-2.60] were positively correlated with previous unintended pregnancy. Given that unintended pregnancy is an indicator of unmet reproductive health need, these findings highlight a need for improved access to integrated reproductive health and HIV services, catered to sex workers' needs. Sex work-led strategies (e.g., peer outreach) should be considered, alongside structural strategies and education targeting brothel/lodge owners and managers. RésuméCette étude visait à examiner les corrélats des grossesses non désirées chez les femmes prostituées dans le nord de l'Ouganda touché par le conflit. Les données ont été tirées de l'étude sur la Santé Sexuelle de Gulu, une étude transversale des jeunes femmes engagées dans le travail du sexe. Une régression logistique bivariée et multivariable a été utilisée pour examiner les corrélats d'une grossesse non souhaitée. Parmi les 400 travailleuses du sexe (âge médian = 20 ans, IQR 19-25), 175 (43,8%) ont signalé au moins une grossesse non souhaitée. Dans l'analyse multivariable, principalement l'entretien des clients dans les lodges / bordels [Ratio de cotes ajusté (AOR = 2,24; Intervalle de confiance 95%: 1,03-4,84)], l'utilisation de contraceptifs hormonaux [AOR = 1,68; IC 95%: 1,11-2,59] et consommation de drogue / alcool pendant le travail [AOR = 1,64; 95% IC 1.04-2.60] ont été positivement corrélés avec une grossesse non souhaitée antérieure. Étant donné que la grossesse non désirée est un indicateur des besoins de santé de la reproduction non satisfaits, ces résultats soulignent la nécessité d'améliorer l'accès aux services intégrés de santé de la reproduction et du traitement du VIH, répondant aux besoins des travailleurs du sexe. Les stratégies axées sur le travail sexuel (par exemple, la sensibilisation des pairs) devraient être considérées, parallèlement aux stratégies structurelles et à l'éducation ciblant les propriétaires et les gestionnaires de bordel / d'hôtel. (Afr J Reprod Health 2017; 21[2]: 64-72).

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Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

Cited by 81 publications

References 10 publications

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Fertility-related research needs among women at the margins

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use

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