Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya

Rhoune Ochako,Steven Kimetu,Ian Askew,Marleen Temmerman,Jerry Okal

doi:10.1186/s12905-018-0601-5

Abstract

BackgroundFemale Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives.MethodsWe focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’ResultsFindings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives.ConclusionsWe recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV prevention.

Highlights

Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/Human Immunodeficiency Virus (HIV), unintended pregnancy, violence, sexual exploitation, stigma and discrimination
The content analysis highlighted several themes concerning FSWs’ experiences with existing contraceptive methods, while considering perceptions on male partners influence on contraceptive use
Our analysis covers the folling themes, practical experience with contraceptive use, opportunities and barriers to contraceptive use with different client types, dual protection and other barriers to contraceptive use. Many of these themes are underscored by gender power issues and reveal how sex work and contraceptive use in this setting are often areas of antagonism between FSWs and their clients

Summary

Introduction

Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs) including HIV/AIDS, unintended pregnancy, exploitation, stigma and discrimination, and violence [1,2,3]. Ochako et al BMC Women's Health (2018) 18:105 medical services; and negative partner influences, including both nonpaying and paying partners [6] All these vulnerabilities, coupled with women’s low status, repeated human rights violations, poor educational or economic opportunities and poor attitudes towards sex and sexuality, poor knowledge and access to modern contraceptive methods predispose women, and FSWs, to a host of other STI risk factors [7,8,9]. Evidence indicates that correct and consistent condom use may be complicated by the lack of autonomy to insist on condom use especially with steady and emotional partners, or through coercion by other clients who refuse to use condoms by promising to pay more or using violence [15, 16]

Objectives

Methods

Results

Conclusion