Understanding the Broader Sexual and Reproductive Health Needs of Female Sex Workers In Dhaka, Bangladesh

Katz,; McDowell, D.A.; Green, Douglas R.; Jahan,; Johnson, _______; Chen, Guihai

doi:10.1363/intsexrephea.41.4.0182

Cited by 18 publications

(15 citation statements)

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“…). For example, a study of FSWs in Bangladesh found that 25 percent of hotel‐based FSWs and 36 percent of street‐based FSWs have unmet need for family planning (Katz ). Similar trends are observed in Africa.…”

Section: Unmet Need Unintended Pregnancy and Termination Of Pregnancymentioning

confidence: 99%

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

Ippoliti¹,

Nanda²,

Wilcher³

2017

Studies in Family Planning

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S ex workers, injection drug users, men who have sex with men, and transgender individuals shoulder a disproportionate burden of HIV (Wheeler et al. 2015). UNAIDS (2014a) estimates that 40-50 percent of all new HIV infections among adults worldwide occur among these key populations. HIV among these key populations is driven by a myriad of behavioral and structural factors, including drug use, violence, sex with multiple and concurrent partners, inconsistent condom use, stigma and discrimination, and criminalization. Although these factors also increase the risk of poor reproductive health outcomes (WHO 2014), relatively little attention has been paid to the reproductive health needs of key populations.

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Section: Unmet Need Unintended Pregnancy and Termination Of Pregnancymentioning

confidence: 99%

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

Ippoliti¹,

Nanda²,

Wilcher³

2017

Studies in Family Planning

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“…FSWs are also ostracized by the community besides suffering legal and human rights violations thereby necessitating clandestine operations that often prevent them from accessing and/or using formal health services [4]. A qualitative study on the psychological stressors in the context of commercial sex in China showed FSWs face a host of stressors precipitated by poverty, unemployment, lack of social protection, violence from clients, and limited social support from peers and stable partners [5].…”

Section: Introductionmentioning

confidence: 99%

“…Unprotected sex further complicates the reproductive health needs of FSWs by predisposing them to abortion and other associated the risk factors. In Asia and Africa, for example, the prevalence of abortion among FSWs range between 22 and 86%, a pointer that FSWs’ pregnancies are ill attended [4]. A study among FSWs in Zambia showed that women who reported a lifetime pregnancy also had a history of unplanned pregnancy, depicting a large unmet need for contraception among FSWs [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundFemale Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives.MethodsWe focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’ResultsFindings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives.ConclusionsWe recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV prevention.

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“…Current programmes providing PrEP to FSWs are predominantly implemented through FSW‐focused services, which include drop‐in centres and clinics led by community‐based organizations . Acceptability studies indicate that these focused services are often the preferred way for FSWs to access healthcare due to staff friendliness, lower cost, shorter waiting times, privacy, proximity to places of work and greater quality of care . There are several advantages of building upon this model for integrated PrEP and family planning delivery.…”

Section: Discussionmentioning

confidence: 99%

“…However, the use of effective non‐barrier contraception methods among FSWs is sub‐optimal, resulting in high rates of unintended pregnancy . Similarly, FSWs’ condom use, even when the primary method of pregnancy prevention, is often inconsistent, particularly with non‐paying partners .…”

Section: Introductionmentioning

confidence: 99%

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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Understanding the Broader Sexual and Reproductive Health Needs of Female Sex Workers In Dhaka, Bangladesh

Abstract: Female sex workers in Dhaka need family planning and other sexual and reproductive health services and prefer receiving them from drop-in centers.

Cited by 18 publications

References 0 publications

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

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

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

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