Unmet need for contraception among sex workers in Madagascar

Abstract

Background The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers.

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

“…This work builds on earlier, mostly secondary, analyses of the contraceptive needs of FSWs [4][5][6] . The only other mixed-method, primary study of the unmet needs of FSWs of which the authors are aware was conducted in Southeast Asia 3 .…”

“…Few studies have reported on pregnancy desires and contraceptive use among FSWs. The limited amount of existing research has shown high incidences of unintended pregnancy and a low contraceptive prevalence in this particular group [3][4][5][6] . All studies report that sex workers who do use contraception resort most often to condoms yet the latter are not consistently used in all sex acts 3,[5][6][7][8][9] .…”

“…The limited amount of existing research has shown high incidences of unintended pregnancy and a low contraceptive prevalence in this particular group [3][4][5][6] . All studies report that sex workers who do use contraception resort most often to condoms yet the latter are not consistently used in all sex acts 3,[5][6][7][8][9] . FSWs may have difficulties in negotiating the consistent use of condoms with clients, and also may deliberately use condoms with some types of partners (such as casual clients) while deliberately not using condoms with other types of partners (such as emotional partners or regular clients) 10 .…”

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

“…The lifetime prevalence of abortion among female sex workers in Asia and Africa ranges from 22% to 86%, [6][7][8][9][12][13][14] suggesting that sex workers' pregnancies frequently are unintended. These high rates of abortion should not be surprising, considering the burdens that pregnancy may pose to such women.…”

“…Female sex workers may use condoms inconsistently because they lack the autonomy to insist on condom use with husbands, boyfriends or other steady partners, agree to have condomless sex with clients who will pay extra, are unable to negotiate condom use with clients and or are forced to have sex. [6][7][8][9][10][11] Using condoms inconsistently, rather than every time, increases the risk not only of acquiring an STI, but also of pregnancy if a second contraceptive method is not used.…”