Pregnancy intentions among female sex workers: recognising their rights and wants as mothers

Abstract

Objective To better understand the prevalence and correlates of pregnancy intentions among female sex workers (FSWs). Design Cross-sectional analysis using data from an open prospective cohort of street and off-street FSWs in Vancouver, Canada, in partnership with local sex work and community agencies. Methods FSWs were recruited through outreach to street and off-street locations (e.g., massage parlours, micro-brothels) and completed interviewer-administered questionnaires and HIV/STI testing. Bivariable and multivariable logistic regression was used to evaluate correlates of pregnancy intention, based on a “yes” versus “no” response to “are you planning on have any (any more) children in the future?”. Results Of the 510 women, 394 (77.3%) reported prior pregnancy, with 140 (27.5%) of the entire sample reporting positive pregnancy intentions. 35.3% were Caucasian, and 26.3% were Asian/visible minority, with no differences in pregnancy intention by ethnicity or HIV status. 38.4% reported Canadian Aboriginal ancestry. In our final multivariable model, servicing clients in formal indoor settings, inconsistent condom use by clients, younger age, and intimate partner violence (IPV) were associated with pregnancy intention. Conclusions FSWs may have pregnancy intention levels similar to that of women in other occupations. Policy changes are needed to improve FSWs’ access to integrated HIV and reproductive health services and harm reduction services, particularly for FSWs experiencing IPV.

Reproductive health needs of female sex workers and opportunities for enhanced prevention of mother-to-child transmission efforts in sub-Saharan Africa

“…While positive fertility desires have been documented before among women engaged in sex work,11 19 our cross-country data demonstrate the PMTCT importance of considering conception, not just contraception, as part of family planning programming for FSW. In this analysis, FSW living with HIV but without a previous reported HIV diagnosis were 51% more likely to be trying to become pregnant as compared to HIV-negative FSW.…”

“…Women who sell sex, like other women, often have desires or plans to expand their families 3 11. Pregnancy planning in the context of sex work is more complex though, as FSW may have different reproductive goals with different sexual partners including husbands and other non-paying partners, as compared with clients.…”

Fertility-related research needs among women at the margins

“…Studies assessing reproductive histories of female sex workers suggest that the majority of sex workers have children and the relationship between fertility and sex work may be complex. [58][59][60] The need to provide for children may push some women into sex work, while other women may plan to conceive as an attempt to solidify a partnership and/or leave sex work. 61,62 Women may also desire children for a multitude of reasons independent of their occupation as sex workers.…”

“…Recent studies from Canada and two countries in Sub-Saharan Africa have documented that female sex workers, like many other women, desire children. 60,76 However, their reproductive health needs are complicated by divergent reproductive goals with different sexual partners during the same time period. Specifically, pregnancy intentions may be low with certain clients, but high with non-commercial partners, resulting in reliance on barrier contraceptive methods with clients over potentially more effective non-barrier contraceptive methods.…”

A study on epidemiological determinants and reproductive health practices among female commercial sex workers of Dharwad district

“…Addressing the knowledge gaps with respect to STIs and HIV will go a long way in preventing the spread of these in the community and also NACO envisages targeted interventions among the high-risk populations that include behaviour change, health care, treatment of sexually-transmitted diseases, provision of condoms, and creating an enabling environment for behaviour change to reduce HIV/AIDS incidence. 9 From our study, 46% had no history of substance abuse, while 6% had abused alcohol; 29%, tobacco and both tobacco and alcohol was seen in 19%. 29% responded saying that alcohol abuse helps them to carry out this trade of theirs.…”