Barriers and facilitators for access and utilization of reproductive and sexual health services among Female Sex Workers in urban and rural Maharashtra, India

Shewale, Suhas; Sahay, Seema

doi:10.3389/fpubh.2022.1030914

Cited by 6 publications

(26 citation statements)

References 52 publications

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“…Six publications reported data on barriers that impacted FSWs' utilization of MHS. 44,[50][51][52][53][54] These factors are presented in Table 3 and organized by relevant phases of the Three Delays model.…”

Section: Barriers To Mhsmentioning

confidence: 99%

“…44,51 In addition, experiencing and anticipating stigma from family members, clients, and health care workers were cited by FSWs as reasons for avoiding or delaying the use of MHS. 44,50,51 A final factor identified as relevant to phase I delays was fear. For example, in South Africa, FSWs reported delaying or completely avoiding ANC during pregnancy because they feared receiving HIV diagnoses, particularly when they were experiencing potential symptoms.…”

Section: Parmley Et Al 51mentioning

confidence: 99%

“…Similarly, in India, FSWs with unwanted pregnancies described avoiding ANC and medical confirmation of pregnancy due to concerns that this would impede their access to medications or local remedies that were believed to induce abortions. 50 A third identified factor was FSWs' prior experiences with MHS. Data from in-depth interviews with FSWs in South Africa indicated that some women delayed or avoided ANC during subsequent pregnancies due to prior experiences at clinics where wait-times were long and/or maltreatment by providers occurred.…”

Section: Factors Influencing Delays In the Decision To Seek Care (Pha...mentioning

confidence: 99%

“…This perception contributed to care avoidance during pregnancy and the postpartum period. 51 Shewale and Sahay 50 Unwanted pregnancy Participants discussed avoiding ANC due to negative feelings about their unwanted pregnancies Dewey et al 44 Parmley et al 51 Participants discussed avoiding care to either facilitate pregnancy loss or to prevent medical professionals from confirming a pregnancy and barring women's access to potential abortifacients Dewey et al 44 Parmley et al 51 Shewale and Sahay 50 Past experiences with MHS Participants reported delaying ANC initiation because of discontentment with prior experiences caused by long wait-times and/or poor treatment by clinic staff Parmley et al 51 Participants reported that prior pregnancies and past experiences with ANC made them feel more comfortable delaying care with a current pregnancy Parmley et al 51 Perceptions of maternal health care…”

Section: Factors Influencing Delays In the Decision To Seek Care (Pha...mentioning

confidence: 99%

“…Participants reported avoiding ANC due to feelings of guilt, shame, and embarrassment in regards to engaging in sex work and/or using substances while pregnant Parmley et al 51 Dewey et al 44 Shewale and Sahay 50 External stigma toward sex work and pregnancy Participants discussed avoiding ANC to prevent disclosure to family members, health care providers, and/or clients who may react negatively Parmley et al 51 Dewey et al 44 Shewale and Sahay 50 Fear Participants discussed FSWs avoiding ANC due to a fear of HIV diagnoses Parmley et al 51 Participants reported further delaying or sporadically attending ANC due to fears of clinic staff reacting negatively about their limited care engagement Parmley et al 51 Participants discussed avoiding ANC because of the fear that clients or neighbors would discover their pregnancies Shewale and Sahay 50 Participants who were considering pregnancy termination reported avoiding ANC and medical confirmation of pregnancy due to fear of potential legal consequences of termination…”

Section: Internalized Stigma Toward Sex Work and Pregnancymentioning

confidence: 99%

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Maternal health and maternal health service utilization among female sex workers: A scoping review

Moore,

Govaerts,

Kapadia

2023

Womens Health (Lond Engl)

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Background: High proportions of female sex workers (FSWs) become pregnant and have children. Many FSWs are at increased risk of maternal health complications due to factors such as poverty, violence, and healthcare barriers. Despite this, FSWs’ maternal health and use of maternal health services (MHS) receive limited attention. Objectives: The objectives of this scoping review are to (1) synthesize existing data on FSWs’ maternal health and MHS utilization and (2) assess the state of peer-reviewed literature on FSWs’ maternal health in regard to methodological approaches and reported outcomes. Eligibility criteria: Included articles were peer-reviewed, published in English, and reported empirical data on FSWs for outcomes related to antenatal care, pregnancy, and labor complications, postnatal and delivery care, and/or barriers to MHS. Sources of evidence: Article searches were conducted in PubMed, Web of Science, Global Health, Sociological Abstracts, Sociological Index, PsychInfo, and CINAHL Charting methods: Information extracted from eligible articles included publication year, study design, location, sample size, outcome measures, and findings. The “Three Delays” model was used to synthesize findings on barriers to MHS as relevant to phase I, II, or III delays. Results: Eighteen publications met the eligibility criteria. Studies were conducted in 11 countries and primarily reported quantitative data from cross-sectional surveys. The most frequently reported outcome was antenatal care utilization (n = 14), whereas few studies reported findings related to postnatal care and breastfeeding counseling (n = 2). Across publications, there was a substantial range in the proportion of FSWs who reported accessing different types of MHS. Conclusion: Literature on FSWs’ maternal health is limited and heterogenous. More research is needed that specifically focuses on measuring outcomes related to FSWs’ maternal health and examines associated factors. Such work can inform future research directions and public health interventions for FSWs—a population of marginalized women whose maternal health has been overlooked in existing efforts.

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Section: Barriers To Mhsmentioning

confidence: 99%

Section: Parmley Et Al 51mentioning

confidence: 99%

Section: Factors Influencing Delays In the Decision To Seek Care (Pha...mentioning

confidence: 99%

Section: Factors Influencing Delays In the Decision To Seek Care (Pha...mentioning

confidence: 99%

Section: Internalized Stigma Toward Sex Work and Pregnancymentioning

confidence: 99%

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Maternal health and maternal health service utilization among female sex workers: A scoping review

Moore,

Govaerts,

Kapadia

2023

Womens Health (Lond Engl)

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Female transactional sex workers’ experiences and health-seeking behaviour in low-middle income countries: a scoping review

Wulifan

2024

BMC Public Health

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Background For a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson’s behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries. Methods Six relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods. Findings Results from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons – to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities. Conclusion Complex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs.

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Multi-stakeholder analysis of needs, perceptions, and sociocultural influences on multipurpose prevention technologies (MPT) in India

Shewale,

Bangar,

Chandhiok

et al. 2024

BMC Public Health

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Background To ensure the acceptability and effectiveness of potential Multipurpose Prevention Technologies (MPTs), understanding user needs, and preferences are crucial to inform the design of MPTs. This article aims to explore the perceptions towards potential MPT use and to explore the needs of multiple stakeholders in India within their social and behavioural contexts. Methods A qualitative multicentric study was conducted in three Indian states—Maharashtra, Karnataka, and Tamil Nadu. The study involved a total of 222 interviews: 77 in-depth interviews with women, including those from the general population, HIV-positive women, and street and brothel-based Female Sex Workers (FSWs); 84 in-depth interviews with men and 61 key informant interviews were conducted. Three focus group discussions were conducted with FSWs. Interviews explored perceptions of the potential MPTs, needs, and factors that may potentially affect their use and adherence. Interviews and FGDs were transcribed and translated verbatim. Thematic analysis approach was used to analyse the data in NVivo version 8. Result The following themes highlight the need and preferences among women for the potential MPT product: 1) Overall perceptions about new MPT, 2) People at high risk need long acting products, 3) Condom versus new MPT: potential of MPT, 4) Women empowerment through MPTs 5) Secrecy and confidentiality 6) Non-stigmatising MPT product positioning. Conclusion Several stakeholders in this study expressed their need for new MPTs, but concerns regarding confidentiality, privacy, stigma and, adherence were identified. Besides efficacy, characteristics such as the size, packaging, formulation, and texture of MPTs, should be taken into account when designing the MPT products, also considering the needs of women, specially, female sex workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-20613-7.

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Barriers and facilitators for access and utilization of reproductive and sexual health services among Female Sex Workers in urban and rural Maharashtra, India

Cited by 6 publications

References 52 publications

Maternal health and maternal health service utilization among female sex workers: A scoping review

Maternal health and maternal health service utilization among female sex workers: A scoping review

Female transactional sex workers’ experiences and health-seeking behaviour in low-middle income countries: a scoping review

Multi-stakeholder analysis of needs, perceptions, and sociocultural influences on multipurpose prevention technologies (MPT) in India

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