Values and preferences of contraceptive methods: a mixed-methods study among sex workers from diverse settings

Abstract

There is limited information on contraceptive values and preferences of sex workers. We conducted a mixed-method study to explore contraceptive values and preferences among sex workers. We conducted an online survey with individuals from 38 countries (n = 239), 6 focus group discussions (FGD, n = 68) in Zimbabwe, and 12 in-depth phone interviews (IDI) across 4 world regions, in June and July of 2019.Participants were asked about awareness of contraceptives, methods they had used in the past, and the determinants of their choices. Differences between respondents from high-, low-and middle-income countries were examined. Qualitative data were analysed thematically. Survey participants reported an awareness of modern contraceptive methods. FGDs found that younger women had lower awareness. Reports of condomless sex were common and modern contraceptive use was inconsistent. Determinants of contraceptive choices differed by setting according to results of the survey, FGD, and IDI. Regardless of country income level, determinants of contraceptive choices included ease of use, ease of access to a contraceptive method, and fewer side effects. Healthcare provider attitudes, availability of methods, and clinic schedules were important considerations. Most sex workers are aware of contraceptives, but barriers include male partners/clients, side effects, and health system factors such as access and clinic attitudes towards sex workers.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion

“…Fourteen of the studies were conducted in Kenya [ 10 – 23 ], eight in South Africa [ 13 , 14 , 24 – 29 ], eight in Uganda [ 30 – 37 ], six in Mozambique [ 13 , 14 , 38 – 40 ], five in Tanzania [ 41 – 45 ], three in Eswatini [ 46 – 48 ] and in Malawi [ 49 – 51 ], two in Ethiopia [ 52 , 53 ], in Zambia [ 54 , 55 ], and in Zimbabwe [ 56 , 57 ] and one each in Democratic Republic of Congo [ 58 ], Lesotho [ 59 ], Rwanda [ 60 ], and online (Australia, Brazil, El Salvador, France, Kenya, Malawi, Russia, South Korea, Spain, Tanzania, the United States of America, and Zimbabwe) [ 56 ]. Thus, knowledge production concerning WSS in relation to non-barrier contraception, pregnancy and abortion is dominated by studies conducted in Kenya.…”

“…desire for (more) children [ 11 ], being nulliparous [ 46 ], history of incarceration or arrest [ 55 ], intoxication [ 42 ], and being older than 35 [ 31 ]; interpersonal factors—male partners’ or clients’ disapproval [ 10 ], physical or sexual abuse [9, 16], having a steady partner [ 51 ]; and systemic issues—poor clinic access [ 10 , 42 ], negative healthcare provider attitudes [ 10 ], and condom availability at work [ 55 ]. Use of non-barrier contraception was found in to be associated with ease of access, positive healthcare provider attitudes, conducive clinic schedules, fewer side effects [ 56 ], previous pregnancy, positive attitude to and knowledge of family planning, younger age, and lower education [ 18 ]. Independent correlates of emergency contraception use were younger age, higher education, higher income, having two or more children, and never having been married [ 47 ].…”

Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance

“…Among the 1.9 billion women of reproductive age (15-49 years old) worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. Across regions, evidence indicates that sex workers are at higher risk of both acquiring human immunodeficiency virus (HIV) and having an unintended pregnancy, have a greater unmet need for contraception than the general population, rely excessively on using condoms alone instead of the recommended dual protection, and face stigma from health care providers (1)(2)(3)(4)(5). The proportion of the need for sexual and reproductive health including contraception services that was satisfied by modern methods was 76% globally in 2019, but this fell to <50% in western and central Africa.…”