Articles

Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa

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 researchproject. FWSs were recruited in Durban, South Africa (n= 400), Mombasa, Kenya (n= 400), Mysore, India (n=458)andTete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16‘seeds’identified by thepeer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptivemethods 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 citiesusing 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),whilenon-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 havingbeen screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p< 0.001), and having gone to a health facilityfor a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p< 0.001). Having soughtmedical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p= 0.860). Many of the differencesbetween 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 insocio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRHservices. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particulargaps in each city.