Yves Lafort 1, Ross Greener 2, Anuradha Roy 3, Letitia Greener 2, Wilkister Ombidi 4, Faustino Lessitala 5, Jolene Skordis-Worrall 6, Mags Beksinska 2, Peter Gichangi 7 4 8, Sushena Reza-Paul 9, Jenni A Smit 2, Matthew Chersich 7 10, Wim Delva 7 11 12
Affiliations
- 1International Centre for Reproductive Health, Ghent University, Ghent, Belgium. yves.lafort@ugent.be.
- 2MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
- 3Ashodaya Samithi, Mysore, India.
- 4International Centre for Reproductive Health-Kenya, Mombasa, Kenya.
- 5International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
- 6Institute for Global Health, University College London, London, UK.
- 7International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
- 8University of Nairobi, Nairobi, Kenya.
- 9University of Manitoba, Winnipeg, Canada.
- 10Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- 11The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.
- 12Center for Statistics, Hasselt University, Diepenbeek, Belgium.
PMID: 28103896 PMCID: PMC5247811
DOI: 10.1186/s12978-017-0277-6
- Abstract
Background: Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, we identified gaps in service utilization in four different cities.
Methods: A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 ‘seeds’ identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. RDS-adjusted proportions and surrounding 95% confidence intervals were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests with Dunn-Šidák correction.
Results: Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs’ sociodemographic characteristics.
Conclusion: The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particular gaps in each city.
Keywords: Care seeking behaviour; Female sex workers; India; Sexual and reproductive health; Sub-Saharan Africa.
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