Contraceptive use, prevalence and predictors of pregnancy planning among female sex workers in Uganda: a cross sectional study

Justine Nnakate Bukenya,Fredrick Makumbi,Geraldine Barrett,Rhoda K Wanyenze,Jennifer Hall,David Guwatudde

doi:10.1186/s12884-019-2260-4

Justine Nnakate Bukenya, Fredrick Makumbi + Show 4 more

Open Access

https://doi.org/10.1186/s12884-019-2260-4

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Abstract

BackgroundUnintended pregnancies are associated with negative consequences to both mother and baby. Female Sex Workers (FSWs) are at high risk of unintended/unplanned pregnancies. However, prevalence of pregnancy planning and its predictors among FSWs has not been comprehensively investigated. This study was designed to determine contraceptive use, the prevalence, and predictors of pregnancy planning among FSWs in Uganda.MethodsIn this cross-sectional study, 819 FSWs attending most at risk populations initiative (MARPI) clinics were recruited using systematic sampling and interviewed with a pretested questionnaire that included collection of data on pregnancy intention using the London Measure of Unplanned Pregnancy (LMUP). Data were analysed using STATA version 14.0. Multinomial logistic regression model was used to identify predictors of pregnancy planning,ResultsOf the 819 study participants, only 90 (11.0%) had planned pregnancies. Overall, 462 (56.4%) were hazardous alcohol users and 335 (40.9%) abused drugs; 172 (21.0%) had been raped in the last 2 years and 70 (40.7%) of these accessed emergency contraception post-rape. Dual contraception use (condom and other modern method) was 58.0%.Having a non-emotional partner as a man who impregnated the FSW compared to emotional partner was significantly associated with less planned relative to unplanned pregnancy, (aRR = 0.15 95%Cl =0.08, 0.30), so was lack of reported social support compared to support from friends, (aRR = 0.44; 95% CI = 0.22–0.87), keeping all factors constant in the model. Being raped (aRR = 0.51; 95% CI = 0.31–0.84) or abuse of substances (aRR = 0.65; 95% CI = 0.45–0.93) were significantly associated with lower ambivalence relative to unplanned pregnancy but not with planned relative to unplanned pregnancy.ConclusionCompared to women in the general population, pregnancy planning was low among FSWs amidst modest use of dual contraceptive. There is an urgent need to promote dual contraception among FSWs to prevent unplanned pregnancies especially with non-emotional partners, drug users, and post-rape.

Highlights

Unintended pregnancies are associated with negative consequences to both mother and baby
This study investigated contraceptive use and prevalence and predictors of pregnancy planning among Female Sex Workers (FSWs) in Uganda using the validated Ugandan London Measure of Unplanned Pregnancy (LMUP)
Participants were recruited from four hospitals where clinics for the ‘most at risk populations initiative’ (MARPI), including FSWs, have been established, in the four regions of Uganda including Central, Northern, Western and Eastern

Summary

Introduction

Unintended pregnancies are associated with negative consequences to both mother and baby. On the contrary, unplanned pregnancies are associated with poor economic, social, and health consequences. Such negative outcomes include low-birth weight and increased risk of infant mortality [2], and among women abortion-related mortalities [3] and financial expenses while procuring abortion and care [4, 5]. Planning pregnancies provides an opportunity to harness the biomedical, behavioural and social health interventions to improve the health status of women in preparation for safe conception [6]. This contributes to better maternal and child health outcomes

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