Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion

Abstract

Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA).Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues.Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS.Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.

Heightened risk of unintended pregnancy among sex workers and sex worker organizations’ response during the stringent COVID-19 containment measures in East and Southern Africa

“…FSWs have a higher unmet need for contraception than women in the general population (Ippoliti et al, 2017). A scoping review of literature published since 2010 revealed that unintended pregnancy among FSW in different settings ranged from 24 to 91%, and abortion from 11 to 48% in the East and Southern Africa region (Macleod et al, 2022). A similar picture has been painted in Asia (Ippoliti et al, 2017) and North America (Zemlak et al, 2020).…”