Assessment of the lifetime prevalence and incidence of induced abortion and correlates among female sex workers in Mombasa, Kenya: a secondary cohort analysis

Prevalence and Factors Associated With Consistent Contraceptive Use among Female Sex Workers in the Greater Banjul Area, The Gambia

Consistent contraceptive use (CCU) is an important public health intervention for the prevention and spread of STIs, as well as unintended pregnancies and abortions, especially among female sex workers (FSWs). This study determines the prevalence and identifies factors influencing CCU among FSWs in The Gambia. Utilizing a cross-sectional study design with a snowball sampling technique, respondents were recruited from various locations within the Greater Banjul Area. Data was collected using a structured questionnaire with the Research Electronic Data Capture application. Descriptive and logistic regression analyses were used to determine the prevalence and examine factors associated with CCU among FSWs. In total 429 respondents were recruited. More than 23% of FSWs reported CCU with majority being male condoms (95.3%), followed by oral contraceptive pills (56.9%), and Intra-Uterine Contraceptive Devices (54%). Results of the multivariate logistic regression analysis showed that having a boyfriend (aOR = 12.44, 95%CI: 4.30 ~ 35.94), obtaining contraceptives from Worldview International Foundation (aOR = 6.34, 95%CI: 2.21 ~ 18.14) and local pharmacy (aOR = 4.83, 95%CI: 1.75 ~ 13.32), ever used OCP (aOR = 5.82, 95%CI: 2.91 ~ 11.67), ever used natural methods (aOR = 2.26, 95%CI: 1.06 ~ 4.84), negative attitude of boyfriend toward contraceptives (aOR = 0.06, 95%CI: 0.03 ~ 0.13), and having a negative HIV test result (aOR = 0.14, 95%CI: 0.02 ~ 0.80) were significantly associated with CCU among FSWs. The study revealed a low prevalence of CCU among female sex workers in GBA. Associated factors with CCU identified in this study as well as increasing access to and education on the importance of contraceptive use should be considered when planning targeted interventions for increase in CCU uptake.

How does the rise in contraceptive usage predict pregnancy termination among young women in Kenya? an in-depth multilevel analysis

BACKGROUND

Young women were less likely to practise consistent contraceptive use and are also known to exhibit risky sexual behaviours, which could lead to unintended pregnancy. Studies have also shown that about half of the Kenyan population is young, an age bracket that predominantly experiences unwanted pregnancy. However, adequate attention has not been given to the relationship between pregnancy termination and contraceptive use among this teeming population in Kenya. Thus, this study examined the association between pregnancy termination history and contraceptive use among women aged 15-24 years old in Kenya.

METHODS

A total of 12,166 women aged 15-24 years old from Kenya were drawn using a secondary dataset from the most recent Kenya Demographic Health Surveys conducted in the year 2022. Frequency distribution and multilevel logistic regression analyses were employed to determine the association between contraceptive use and pregnancy termination history among young women aged 15-24 years old with covariates at p < 0.05.

RESULTS

The results showed that the higher percentage of contraceptive users among young women are those aged 15-19 years (50.1%); consequently, a higher percentage of pregnancy termination was also found among women who reported the use of contraceptive methods (6.2%) compared to 2.9% among non-users. The main findings of the study showed that young women who reported using contraceptives were more likely to have a history of pregnancy termination [aOR = 1.03; 95% CI: 0.80-1.26] compared to those who were non-users. Also, age, marital status, and parity are significantly associated with the history of pregnancy termination.

CONCLUSION

Our analyses established an association between history of contraceptive use and termination of pregnancy among young women between 20 and 24 years in Kenya. Place of residence, age, wealth index, level of education, and met needs of children have been identified as risk factors. Intervention to reduce pregnancy termination in Kenya should focus on women aged 20-24 years, those with no formal education, urban residence, and women with met need for children.

HIV prevention and treatment cascades among female sex workers in Ghana: gaps and priorities that should be addressed by the national programme

BACKGROUND

There is currently limited knowledge about HIV prevention and treatment cascades among female sex workers (FSW) in Ghana. This study sought to use the 2020 bio-behavioural survey (BBS) among FSWs to identify gaps and priorities in HIV treatment and prevention cascades to help achieve the 95-95-95 fast track targets.

METHOD

The study used a cross-sectional design with Time Location Sampling (TLS) technique in all regions of Ghana. All eligible FSW at the selected venues and stipulated time frame were interviewed and tested for HIV onsite using the national testing algorithm. For condom use and HIV testing cascades, each step of the cascade was calculated as a percentage of all FSW. Analysis of treatment cascade was restricted to HIV positive participants and was presented using both conditional (% eligible PLHIV) and unconditional (% all PLHIV) approaches. Viral suppression level was defined as < 1000 copies/ml.

RESULTS

A total of 6,773 participants took part in the behavioral interviews while 6,217 took part in the biological component which involves HIV testing. In all, 33% and 80% of all FSW do not consistently use condoms with their paying clients and non-paying partners respectively. The findings further show that 26.6% of FSW have never tested for HIV, and contrary to the HIV testing policy of every six months for FSW, 70.0% did not test for HIV 6 months preceding the survey and 40.7% of all FSW did not test for HIV 12 months preceding the survey. The conditional treatment cascade was 32%-71%-57% while the unconditional cascade was 32%-23%-49%. The study further shows 68% of the HIV positive FSW were not aware of their HIV positive status, 77% were not on treatment, while nearly 51% were not virally suppressed regardless of treatment status.

CONCLUSION

The results show that both the prevention and treatment cascades are suboptimal. Key gaps identified include low: HIV testing, viral load suppression, condom use with both paying clients and non-paying partners. There is therefore the need to scale prevention and treatment interventions particularly HIV testing, treatment initiation, consistent condoms use with both paying clients and non-paying partners to help achieve the 95-95-95 fast track targets.

The prevalence and correlates of unintended pregnancy among female sex workers in South China: a cross-sectional study

BACKGROUND

Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China.

METHODS

In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy.

RESULTS

Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71-4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74-7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14-0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10-0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy.

CONCLUSIONS

Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW.

Induced abortion in Africa: A systematic review and meta-analysis

BACKGROUND

One of the main factors contributing to maternal morbidity and mortality is induced abortion. The WHO estimates that over 44 million induced abortions take place annually around the world. The majority of these abortions-about 50%-are unsafe, significantly increasing maternal morbidity and contributing to 13% of maternal deaths. Thus, this review aimed to estimate the pooled prevalence of induced abortion and its associated factors in Africa.

METHODS

To find literature on the prevalence of induced abortion and its associated factors, a thorough search of the internet databases such as PubMed/MEDLINE, African Journals Online, and Google Scholar was conducted. The data were extracted using a structured method of data collection. Software called STATA 14 was used to do the analysis. funnel plot and Egger regression test were used to evaluate potential publication bias. I2 statistics and Cochrane's Q were used to measure the heterogeneity at a p-value < 0.05.

RESULTS

976 studies were found through a thorough search of electronic databases. Finally, 46 full-text abstract papers were included in this study. The estimated pooled prevalence of induced abortion was 16% (95% CI: 13%-19%). According to the sub-group analysis, most studies were conducted in Ethiopia, and the pooled prevalence was 19% (95% CI: 10%-30%). Similarly, the subgroup analysis by year of study showed that the prevalence of induced abortion was 39% (95% CI: 17%-64%) among studies conducted in 2019.

CONCLUSION

The results of this study thus imply that the pooled prevalence of induced abortion is higher than that of earlier studies that were published in some nations. the data from this study are needed to support reproductive and adolescent health programmers and policymakers and to formulate recommendations for future clinical practice and guidelines.

Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression

PURPOSE

Despite the evidence of a high rate of unintended pregnancy, there remains limited information about the prevalence and experiences of abortion among female sex workers (FSWs). In response, we aimed to summarize the available evidence on abortion among FSWs.

METHODS

We searched Medline, Embase, PsycINFO, CINAHL, Scopus, and Web of Science from inception to January 29, 2023 . We pooled data from the included studies using random-effects meta-analyses. We also grouped countries for the legality of elective abortion stratified by the United Nations database on abortion laws and policies.

RESULTS

We identified 60 eligible studies from 2031 potentially eligible records. The pooled lifetime prevalence of at least one and multiple induced abortions was 37.7% (95% confidence interval, 31.8-43.7) and 21.7% (14.9-29.2), respectively. Among FSWs recruited in countries where elective abortion is illegal, at least one induced abortion prevalence was 35.1% (28.1-42.4), and multiple induced abortion prevalence was 23.1% (12.4-35.9). In countries where elective abortion is legal, at least one induced abortion prevalence was 44.6% (34.8-54.6), and multiple induced abortion prevalence was 19.9% (11.9-29.3). Among FSWs experiencing abortion, self-managed abortion prevalence was estimated at 32.8% (23.6-42.7) overall, 42.8% (37.2-48.5) for countries where elective abortion is illegal, and 15.6% (3.9-32.7) for countries that legally allow elective abortion.

CONCLUSIONS

Induced abortion is prevalent among FSWs, highlighting the need for interventions to increase access to effective contraception and safe abortion care. While induced abortion prevalence did not significantly differ across the legal grounds for abortion, self-managed abortion prevalence was higher in countries where elective abortion was illegal, highlighting the urgent need for accessible abortion services for FSWs in criminalized settings. Moving forward necessitates implementing and evaluating culturally acceptable models of safe abortion and post-abortion care for FSWs to increase access to the full spectrum of sexual and reproductive health services.