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. 2018 Jun 20;18(1):105.
doi: 10.1186/s12905-018-0601-5.

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

Rhoune Ochako  1   2 , Jerry Okal  3 , Steven Kimetu  4 , Ian Askew  5 , Marleen Temmerman  6   7
Affiliations

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

Rhoune Ochako et al. BMC Womens Health. .

Abstract

Background: 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 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.

Methods: We 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.'

Results: Findings 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.

Conclusions: We 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.

Keywords: Condom use; Contraception; FSWs; Kenya; Pregnancy prevention.

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Conflict of interest statement

Authors’ information

RO has a Ph.D. in Health Sciences from Ghent University in Belgium; JO has a Ph.D. and is an Associate at Population Council, Nairobi. SK is a PhD student at Population Studies and Research Institute, University of Nairobi. IA has a Ph.D. and is the Director, Department of Reproductive Health and Research at WHO and was a co-promoter of RO at Ghent University. MT is a Professor and MD, at the Ghent University, Faculty of Medicine and Health Sciences and was the promoter of RO at the same institution.

Ethics approval and consent to participate

Permission to conduct this study was obtained from Family Health International’s Protection of Human Subjects Committee (USA), the Kenyatta National Hospital/University of Nairobi - Ethical Review Committee (Kenya), and the National Council for Science and Technology (Government of Kenya) approved the study protocol. Consent was not sought from parents/guardians of participants aged below 18 years for this study because a sex worker is emancipated, sexually active and most often live alone. Verbal consent was provided by the study participants and waiver of signed informed consent was requested in accordance with 45 CFR 46. The study posed minimal risk to participants and the only record linking participants with the study would be the signed informed consent form. Oral informed consent with signature by the Research Assistant attesting to adherence to proper informed consent procedures and to the reception of the informed consent of the participant was therefore used in the place of signed informed consent forms. No identifying information was connected with the interviews or retained following the completion of the analysis.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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