Sexual and Reproductive Health Knowledge, Contraception Uptake, and Factors Associated with Unmet Need for Modern Contraception among Adolescent Female Sex Workers in China

Abstract

ObjectiveIn China, policy and social taboo prevent unmarried adolescents from accessing sexual and reproductive health (SRH) services. Research is needed to determine the SRH needs of highly disadvantaged groups, such as adolescent female sex workers (FSWs). This study describes SRH knowledge, contraception use, pregnancy, and factors associated with unmet need for modern contraception among adolescent FSWs in Kunming, China.MethodsA cross-sectional study using a one-stage cluster sampling method was employed to recruit adolescents aged 15 to 20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months. A semi-structured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine correlates of low knowledge and unmet need for modern contraception.ResultsSRH knowledge was poor among the 310 adolescents surveyed; only 39% had heard of any long-acting reversible contraception (implant, injection or IUD). Despite 98% reporting not wanting to get pregnant, just 43% reported consistent condom use and 28% currently used another form of modern contraception. Unmet need for modern contraception was found in 35% of adolescents, and was associated with having a current non-paying partner, regular alcohol use, and having poorer SRH knowledge. Past abortion was common (136, 44%). In the past year, 76% had reported a contraception consultation but only 27% reported ever receiving SRH information from a health service.ConclusionsThis study demonstrated a low level of SRH knowledge, a high unmet need for modern contraception and a high prevalence of unintended pregnancy among adolescent FSWs in Kunming. Most girls relied on condoms, emergency contraception, or traditional methods, putting them at risk of unwanted pregnancy. This study identifies an urgent need for Chinese adolescent FSWs to be able to access quality SRH information and effective modern contraception.

Prevalence and correlates of sexual and gender-based violence against Chinese adolescent women who are involved in commercial sex: a cross-sectional study

“…As previously reported,41 inconsistent condom use in the past month with any male partner was reported by 57% of participants; 54% with male intimate partners and 65% with male clients. However, when we included the situation of under illicit drug use in this analysis, the rate of inconsistent condom use was sharply raised for approximately two-thirds of the women, and almost equal with male intimate partners (65%) as with male clients (70%; data not shown).…”

“…Similarly concerning, only 3% of participants had ever used long-acting reversible contraception, and currently using dual methods was reported by only 7% of adolescent FSWs 41. These findings indicate how tackling SGBV and related SRH risks might also help to reduce young women's risk and vulnerability to HIV/STI infection and unwanted pregnancy.…”

“…A detailed methodology of the study has been described elsewhere 41. In brief, the study was implemented in collaboration with Kunming-based, FSW-led, grassroots organisations and the district level Chinese Centres of Disease Control (CDC).…”

Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya

“…We note that while some FSWs know that contraceptives are useful for pregnancy prevention, general knowledge remained poor with some resorting to abortion to terminate an unwanted pregnancy. Elsewhere, a study in China conducted among adolescent FSWs also found general sexual and reproductive health knowledge to be low, and while 98% reported not wanting the pregnancy, less than half (43%) reported consistent condom use with another 28% reporting current use of another contraceptive method [27]. A separate study examining contraceptive use among female entertainment sex workers in Cambodia found several factors to be linked to unwanted pregnancy such as the increase in a number of clients, inconsistent condom use, condom breakage and forced unprotected sex [28].…”

Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010

“…Our finding, however, should not overshadow the importance of providing early access to contraceptives among young and adolescent FSWs as about one-fourth of 18-24-year-old FSWs in our sample reported a lifetime abortion. Indeed, studies suggest that given the illegal nature of abortion in several settings (e.g., Iran), the profound stigma associated with premarital pregnancy and sexual activity, limited sexual health education for youth and adolescents, and negative attitudes of healthcare providers towards teenage pregnancy, young women and FSWs’ abortion practices are highly under-reported and often carried out within unauthorized and underground health facilities [36–38]. …”