Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Michael M Chanda,Katrina F Ortblad,Magdalene Mwale,Steven Chongo,Catherine Kanchele,Nyambe Kamungoma,Leah G Barresi,Guy Harling,Till Bärnighausen,Catherine E Oldenburg

doi:10.1016/j.contraception.2017.07.003

Abstract

ObjectivesAccess to reproductive healthcare, including contraceptive services, is an essential component of comprehensive healthcare for female sex workers (FSW). Here, we evaluated the prevalence of and factors associated with contraceptive use, unplanned pregnancy, and pregnancy termination among FSW in three transit towns in Zambia. Study designData arose from the baseline quantitative survey from a randomized controlled trial of HIV self-testing among FSW. Eligible participants were 18 years of age or older, exchanged sex for money or goods at least once in the past month, and were HIV-uninfected or status unknown without recent HIV testing (<3 months). Logistic regression models were used to assess factors associated with contraceptive use and unplanned pregnancy. ResultsOf 946 women eligible for this analysis, 84.1% had been pregnant at least once, and among those 61.6% had an unplanned pregnancy, and 47.7% had a terminated pregnancy. Incarceration was associated with decreased odds of dual contraception use (aOR=0.46, 95% CI 0.32–0.67) and increased odds of unplanned pregnancy (aOR=1.75, 95% CI 1.56–1.97). Condom availability at work was associated with increased odds of using condoms only for contraception (aOR=1.74, 95% CI 1.21–2.51) and decreased odds of unplanned pregnancy (aOR=0.63, 95% CI 0.61–0.64). ConclusionsFSW in this setting have large unmet reproductive health needs. Structural interventions, such as increasing condom availability in workplaces, may be useful for reducing the burden of unplanned pregnancy.

Highlights

Female sex workers (FSW) in sub-Saharan Africa face large barriers to accessing essential healthcare services, including stigma and discrimination, criminalization of sex work and fear of repercussions of seeking care, and challenges with logistically accessing care
An unmet need for contraception has been documented in several settings in sub-Saharan Africa among FSW [3,4,5,6]
Lack of access to contraceptive services may lead to unplanned pregnancies or pregnancy termination [4], which can in turn lead to increased maternal mortality, continued dependence on sex work to financially support children, or HIV transmission to children if prevention of mother-to-child transmission services are not utilized

Summary

Introduction

Female sex workers (FSW) in sub-Saharan Africa face large barriers to accessing essential healthcare services, including stigma and discrimination, criminalization of sex work and fear of repercussions of seeking care, and challenges with logistically accessing care (e.g., difficulty with transportation or clinic hours). FSW bear a disproportionately large burden of HIV in sub-Saharan Africa [1]. Lack of access to contraceptive services may lead to unplanned pregnancies or pregnancy termination [4], which can in turn lead to increased maternal mortality, continued dependence on sex work to financially support children, or HIV transmission to children if prevention of mother-to-child transmission services are not utilized. Increasing access to contraception may reduce unplanned pregnancy and pregnancy termination, which could in turn lead to reduced maternal mortality and improved birth outcomes

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