“A Baby Was an Added Burden”: Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study

Luchters, Stanley; Bosire, Wilkister; Feng, Amy; Richter, Marlise; King’ola, Nzioki; Ampt, Frances H; Temmerman, Marleen; Chersich, Matthew

doi:10.1371/journal.pone.0162871

Cited by 46 publications

(95 citation statements)

References 40 publications

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“…1 LARCs are considered safe for nulliparous women and women with multiple sexual partners, provided that those with a very high risk of sexually transmitted infections (STIs) receive STI screening or treatment at the time of IUD insertion. 1 LARCs are considered safe for nulliparous women and women with multiple sexual partners, provided that those with a very high risk of sexually transmitted infections (STIs) receive STI screening or treatment at the time of IUD insertion.…”

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confidence: 99%

“…1 LARCs are considered safe for nulliparous women and women with multiple sexual partners, provided that those with a very high risk of sexually transmitted infections (STIs) receive STI screening or treatment at the time of IUD insertion. 1,7 Use of IUDs among FSWs varies considerably between regions, with higher levels in parts of Latin America and Asia. 1,7 Use of IUDs among FSWs varies considerably between regions, with higher levels in parts of Latin America and Asia.…”

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confidence: 99%

“…11 Uptake by FSWs, however, is unknown. 1 The WHISPER or SHOUT study evaluated the impact of a mobile phone intervention on knowledge and attitudes to contraception (with a focus on LARCs) and on unintended pregnancy rates in a population of FSWs. 12,13 Misconceptions and limited knowledge about contraception have further limited access.…”

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confidence: 99%

“…male partners. 1 LARCs are considered safe for nulliparous women and women with multiple sexual partners, provided that those with a very high risk of sexually transmitted infections (STIs) receive STI screening or treatment at the time of IUD insertion. [3][4][5] The use of LARCs among FSWs is low in many countries, 6 particularly in sub-Saharan Africa, where prevalence is reported as less than 5% in most studies.…”

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confidence: 99%

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Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Ampt

Lim

Agius

et al. 2019

Intl J Gynecology & Obste

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Objective To assess correlates of long‐acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya. Methods Baseline cross‐sectional data were collected between September 2016 and May 2017 in a cluster‐randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16–34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex‐work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues. Results Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra‐uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25–30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods. Conclusion The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.

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confidence: 99%

“…1 LARCs are considered safe for nulliparous women and women with multiple sexual partners, provided that those with a very high risk of sexually transmitted infections (STIs) receive STI screening or treatment at the time of IUD insertion. 1,7 Use of IUDs among FSWs varies considerably between regions, with higher levels in parts of Latin America and Asia. 1,7 Use of IUDs among FSWs varies considerably between regions, with higher levels in parts of Latin America and Asia.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Ampt

Lim

Agius

et al. 2019

Intl J Gynecology & Obste

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“…Other factors contributing to poor SRH outcomes include high sexually transmitted infections (STI) prevalence [1], HPV infection and thus risk for cervical cancer [5], unintended pregnancies [6, 7], repeated physical and emotional abuse [8], high mobility and frequently an illegal immigrant status [2, 9]. In most countries the prevalence of HIV is 10 to 20 times higher among female sex workers than it is among women in the general population [10–12].…”

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confidence: 99%

Sexual and reproductive health outcomes among female sex workers in Johannesburg and Pretoria, South Africa: Recommendations for public health programmes

et al. 2017

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BackgroundThe sexual and reproductive health (SRH) status of female sex workers is influenced by a wide range of demographic, behavioural and structural factors. These factors vary considerably across and even within settings. Adopting an overly standardised approach to sex worker programmes may compromise its impact on some sub-groups in local areas.MethodsRecords of female sex workers attending clinic-, community-, or hotel-based health services in Johannesburg (n = 1422 women) and Pretoria (n = 408 women), South Africa were analysed. We describe the population’s characteristics and identified factors associated with sexual and reproductive health outcomes, namely HIV status; previous symptomatic sexually transmitted infection (STI); modern contraceptive use and number of child dependents.ResultsThe women in Johannesburg were less likely than those in Pretoria to have HIV (42.2% vs 52.9%), or previous symptomatic STIs (44.3% vs. 8.3%), and were 1.4 fold less likely to have child dependents (20.1% vs. 15.3%). About 43% of women in Johannesburg were Zimbabwean and 40% in Pretoria. Of concern, only about 15% of women in both sites were using modern contraceptives. Johannesburg women were also more likely to access health services at a hotel (85.0% vs. 80.6%) or clinic (5.7% vs. 0.5%), to have completed secondary education (57.1% vs. 36.0%), and moved house more than twice during the past year (19.6 vs. 2.0%). In both cities, risk of HIV rose rapidly with age (23.8%–58.2% vs. 22.0%–64.8%). Of interest, HIV prevalence was considerably higher in those with consistent condom use with one’s main partner than inconsistent users.ConclusionsSex worker populations are heterogeneous. Local health programmes must prioritise services that reflect the variety and complexity of sex worker needs and behaviours, and should be designed in consultation with sex workers. Segmenting sex worker populations according to age, country of origin and place of service delivery, and training healthcare providers accordingly, could help prevent new HIV infections, improve adherence to antiretroviral treatment and increase uptake of SRH services.

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HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

et al. 2020

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Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women’s rights.

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“A Baby Was an Added Burden”: Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study

Cited by 46 publications

References 40 publications

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Sexual and reproductive health outcomes among female sex workers in Johannesburg and Pretoria, South Africa: Recommendations for public health programmes

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

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