Factors associated with the uptake of long-acting reversible contraception among female sex workers in post-conflict Northern Uganda: a cross-sectional study

Simple Ouma,Rawlance Ndejjo,Nazarius Mbona Tumwesigye,Catherine Abbo

doi:10.1186/s12978-022-01345-6

Simple Ouma, Rawlance Ndejjo + Show 2 more

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https://doi.org/10.1186/s12978-022-01345-6

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Abstract

BackgroundLong-acting reversible contraception (LARC) is the most effective and reliable contraception option for female sex workers (FSWs) who desire future fertility. Unlike the other reversible contraceptive methods, LARC use requires only periodic users’ involvement at the time of application and re-application. However, only a few studies on LARC uptake among FSWs are available in Uganda. To fill this knowledge gap, we examined factors associated with the uptake of LARC among FSWs in post-conflict Northern Uganda.MethodsWe conducted a cross-sectional study among adult FSWs operating in the post-conflict Gulu district in Northern Uganda. We collected quantitative data among 280 FSWs of reproductive ages (18–49 years) who were neither pregnant nor using permanent contraception. We utilized a pretested semi-structured questionnaire to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex work-related characteristics, obstetric history, HIV status, and LARC uptake. Data were then entered into EPI INFO 7, cleaned, and analyzed using multivariable Poisson regression in STATA 14.0 to obtained adjusted prevalence ratios (PR).ResultsAmong the study participants: the mean age (SD, range) was 26.5 (5.9, 18–45) years, 48.6% reported at least one unintended pregnancy during sex work, and 37.4% had at least one induced abortion. Meanwhile, only less than two in three (58.6%) participants were using LARC. At multivariable level, factors that remained independently associated with LARC uptake included: longer duration of sex work (adjusted PR = 1.44, 95% CI: 1.03–2.02), higher parity (adjusted PR = 1.13, 95% CI: 1.02–1.26), history of unintended pregnancies during sex work (adjusted PR = 1.24 CI: 1.01–1.51), and being a brothel/lodge-based FSWs (adjusted PR = 1.28, 95% CI: 1.01–1.63).ConclusionsThe above findings revealed a gap in the uptake of LARC among FSWs in post-conflict Northern Uganda influenced by duration of sex work, parity, unintended pregnancies during sex work, and place of sex work. Interventions to improve LARC uptake should target the newly recruited FSWs with low parity and the non-brothel/lodge-based FSWs.

Highlights

Long-acting reversible contraception (LARC) is the most effective and reliable contraception option for female sex workers (FSWs) who desire future fertility
To fill the above knowledge gap, we examined the factors associated with the uptake of LARC among the FSWs in post-conflict Northern Uganda
The findings revealed a gap in the uptake of LARC among FSWs in post-conflict Northern Uganda

Summary

Introduction

Long-acting reversible contraception (LARC) is the most effective and reliable contraception option for female sex workers (FSWs) who desire future fertility. In 2019, up to 49% of all pregnancies in the low- and middle-income countries (LMICs) were unintended [1]. This high magnitude of unintended pregnancy in the LMICs poses a public health challenge to the national healthcare systems. Among the female sex workers (FSWs) in the LMICs, unintended pregnancy is a common phenomenon with a very high rate of 27.1 per 100 person-years [2]. Most of these unintended pregnancies among the FSWs result in induced abortions that lead to severe and often life-threatening post-abortion complications [3,4,5]. Sexual gender-based violence increases the risk of unintended pregnancy in this population [6]

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