Abstract
To assess correlates of long-acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya. Baseline cross-sectional data were collected between September 2016 and May 2017 in a cluster-randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16-34years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex-work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues. Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra-uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25-30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods. The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.
Highlights
Implant use was approximately fourfold higher than, and the 1-year period prevalence of unintended pregnancy was approximately half of the values estimated in 2007 1 and 2008.7 the two earlier studies did not use random sampling and included a wider age range, the magnitude of the differences suggests that the present findings are due to real changes in the female sex workers (FSWs) population
The present findings suggest that implant use is more prevalent among FSWs (22.6%) than among the general population (11%).[20]
This population still faces considerable risks, owing to multiple paying and non-paying partners, low use of dual-method contraception, endemic intimate partner violence, and high-risk drinking with associated sexual risk-taking
Summary
Implant use was approximately fourfold higher than, and the 1-year period prevalence of unintended pregnancy was approximately half of the values estimated in 2007 1 and 2008.7 the two earlier studies did not use random sampling and included a wider age range, the magnitude of the differences suggests that the present findings are due to real changes in the FSW population.
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