Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Bowring, Anna L; Schwartz, Sheree; Lyons, Carrie; Rao, Amrita; Olawore, Oluwasolape; Njindam, Iliassou Mfochive; Nzau, Jimmy; Fouda, Ghislaine; Fako, Guy H.; Turpin, Gnilane; Levitt, Daniel; Georges, Sandra; Tamoufé, Ubald; Billong, Serge Clotaire; Njoya, Oudou; Zoung-Kanyi, Anne Cécile; Baral, Stefan

doi:10.9745/ghsp-d-19-00330

Cited by 18 publications

(26 citation statements)

References 79 publications

(113 reference statements)

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“…Sub-Saharan Africa was at the epicenter of the epidemic and continues to carry the full brunt of its health and socioeconomic impact due to resistance to condom use that was found to be strongly related to STIs (including HIV/AIDS). 16 Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection.…”

Section: Introductionmentioning

confidence: 99%

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia

Yohannes¹,

Bala²,

Bulto³

et al. 2021

RMHP

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Background Ethiopia is one of the Sub-Saharan African countries with an increasingly risky sexual practice and mostly affected by the Human Immunodeficiency Virus (HIV) epidemic. Dual protection is an important preventive approach which can prevent both unwanted pregnancy and sexually transmitted infections including HIV/AIDS. Therefore, this study aimed to assess the dual contraceptive utilization and associated factors among reproductive-age women on Anti-Retroviral Therapy (ART) in central Ethiopia. Methods An-institution based cross-sectional study was conducted among 311 women on ART at public hospitals of West Shewa Zone from June to September 2019. A systematic random sampling technique was used to select the study participants. A pretested structured interviewer-administered questionnaire was used for data collection. The data were entered into Epi data version 3.1 and exported to IBM SPSS statistical software version 25 for analysis. Bivariate and multivariable logistic regression analysis were computed. Odds ratio along with 95% confidence interval was computed to ascertain the association. Results The prevalence of dual contraceptive utilization among women on ART was 21.4% (95% CI: 16.8–25.9). Age of respondents between 15 and 24 years [AOR=8.35, (95% CI: 3.12–17.78)], living in urban [AOR=2.59, 95% CI: 1.15–4.22], separated women [AOR=2.28, 95% CI (1.26–5.04)], had post-diagnosis counselling on family planning [AOR=5.33, 95% CI: 1.52–18.68], disclosed HIV status [AOR=5.98, 95% CI: 1.63–21.93], freely discuss with their husband [AOR=4.22, 95% CI, 1.84–12.36], have no fertility desire [AOR=2.46, (95% CI: 1.34–6.44)] were significantly associated with dual contraceptive utilization. Conclusion and Recommendation The overall magnitude of dual contraceptive utilization among women on ART was found to be low. Factors like age, residence, marital status, post-diagnosis counselling, disclosure of HIV status, and free discussion with husband were significantly associated with dual contraceptive method utilization. Therefore, it is necessary to expand the range of strategies and tools available to married and single women’s for protecting themselves from being infected with other strains and pregnancy. The concerned stakeholders also should emphatically consider those identified factors for intervention.

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Section: Introductionmentioning

confidence: 99%

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia

Yohannes¹,

Bala²,

Bulto³

et al. 2021

RMHP

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“…The reluctance of health care workers to provide care to FSWs and avoidance of health services by FSWs is prevalent in sub–Saharan Africa [ 9 , 14 , 63 , 64 ]. A qualitative study in Kenya identified long waiting time, user fees and inconvenient operating hours as factors that impede contraceptive access [ 65 ] whereas in Cameroon, experiences of health-care related stigma was common among FSWs using non-barrier contraception [ 6 ] . To reduce stigma and discrimination against sex workers in clinical settings, health care workers should be engaged in sensitization meetings to raise awareness of FSWs’ needs and the hardship they face, in order to reduce vulnerability when seeking care.…”

Section: Discussionmentioning

confidence: 99%

“…Female sex workers (FSWs) have a higher unmet need for contraceptives compared to women in the general population [1,2]-which is evident from the high rate of unintended pregnancies [3][4][5][6], high abortion rates [4,[6][7][8] and a great desire to prevent future pregnancies [9,10]. In Tanzania, the incidence of unintended pregnancy among FSWs ranges from 12 to 18 per 100 years of exposure [11,12], although it is slightly lower than the incidence in other lower and middle income countries of 27 per 100 years of exposure [7].…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence that the available SRH services are not tailored to meet the specific needs of FSWs [ 1 , 13 ]. Stigmatization, discrimination, policing and criminalization of sex work contribute to poor access to contraceptive services [ 6 , 9 , 10 , 14 ]. Use of modern non-barrier contraceptive methods among FSWs in Dar es Salaam is 5.7% [ 3 ], which is lower than the 40% reported from cities in other sub-Saharan African countries [ 1 , 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

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“I did not plan to have a baby. This is the outcome of our work”: a qualitative study exploring unintended pregnancy among female sex workers

et al. 2020

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Background High number of unintended pregnancies—often leading to induced abortions—are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW’s pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW’s pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. Methods We conducted in-depth interviews with 11 FSWs (January–June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. Results FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs’ commitment to good contraceptive practices. Conclusion Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.

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“…These further suggest a big gap in LARC use among FSWs and threaten future fertility of FSWs who still desire to have children (11). Majority of the key population programs in LMICs target HIV services with little attention and resources accorded to the sexual reproductive health of FSWs (12)(13)(14)(15). Subsequently, HIV preventive packages like condoms have seen a drastic improvement in availability and coverage.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with use of long-acting reversible contraception among female sex workers operating in Gulu district, Northern Uganda – a cross-sectional study

Ouma

Tumwesigye

Abbo

et al. 2021

Preprint

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Background: Long-acting reversible contraception (LARC) are the most effective and reliable contraceptives for female sex workers (FSWs) and require periodic users’ involvement only at the time of application or re-application. However, information on LARC use among FSWs in Uganda is scarce. To fill this gap, we determined the prevalence of LARC use among FSWs and examined factors associated with LARC use among FSWs operating in Gulu district, Northern Uganda.Methods: Across-sectional study was conducted among 300 FSWs aged 18 years and above and operating in Gulu district. Semi-structured questionnaires were used to measure factors associated with the use of LARC: intrauterine device (IUD), Implants, and injectables. Data analyses were conducted using STATA 14.0 and restricted to 280 non-gravid adult FSWs aged 18-49 years who were not on permanent contraception method. To examine factors associated with LARC use, prevalence ratios (PR) with robust standard errors were computed using Poisson regression.Results: Among the participants, the mean age (SD, range) was 26.5 (5.9, 18 - 45) years, 53.2% never married, 66.1% reported consistent condom use independent of LARC, 58.9% had unintended pregnancy during a lifetime, 48.6% had at least one unintended pregnancy during sex work, and 37.4% had at least one induced abortion. The prevalence of LARC use was 58.6%; the majority were using Implants (48.2%), followed by injectables (42.7%), and IUDs (9.1%). Independent factors associated with LARC use included: longer duration of sex work [≥ two years] (adjusted PR=1.44, 95% CI: 1.03-2.02), higher parity [≥ two] (adjusted PR=1.13, 95% CI: 1.02-1.26), history of unintended pregnancy during sex work (adjusted PR=1.24 CI: 1.01-1.51), and being a brothel/lodge-based FSWs (adjusted PR=1.28, 95% CI: 1.01-1.63).Conclusions: There is a big gap in LARC use with only 58.6% of FSWs using LARC. LARC use was associated with longer duration of sex work, higher parity, history of sex work-related unintended pregnancy, and being a brothel/lodge-based FSW. Therefore, interventions to improve LARC use should intensively target the newly recruited FSWs, FSWs with low parity, and FSWs not based in brothels or lodges.

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Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Cited by 18 publications

References 79 publications

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia

“I did not plan to have a baby. This is the outcome of our work”: a qualitative study exploring unintended pregnancy among female sex workers

Factors associated with use of long-acting reversible contraception among female sex workers operating in Gulu district, Northern Uganda – a cross-sectional study

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