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. 2023 May;79(5):1898-1911.
doi: 10.1111/jan.15651. Epub 2023 Mar 22.

Contraceptive decision-making through the lens of social determinants of health among female sex workers: A qualitative descriptive study

Jessica L Zemlak  1   2 , Kamila A Alexander  1   3 , Deborah Wilson  1 , Susan G Sherman  4
Affiliations

Contraceptive decision-making through the lens of social determinants of health among female sex workers: A qualitative descriptive study

Jessica L Zemlak et al. J Adv Nurs. 2023 May.

Abstract

Aims: The aim of the study was to examine how female sex worker's motivations, desires, intentions and behaviours towards childbearing and childbearing avoidance inform their contraceptive decision-making. We explored the influence of social determinants of health in the domains of social context (sexual partners and experiences of violence), healthcare access, economic instability on the contraceptive decision-making process.

Design: We conducted a qualitative descriptive study informed by Miller's Theory of Childbearing Motivations, Desires and Intentions through the lens of social determinants of health.

Methods: Participants were recruited from a parent study, EMERALD, in July-September, 2020. Data were collected from 22 female sex workers ages 18-49 using semi-structured 45 to 60-min audio-recorded interviews and transcribed verbatim. Theory guided the development of the study's interview guide and thematic analytic strategy.

Results: Five themes emerged related to contraceptive decision-making: Motivations (value of fatherhood), Desires (relationships with love), Intentions and Behaviours (drugs overpower everything, contraceptive strategies and having children means being a protector). Women's contraceptive decision-making often included intentions to use contraception. However, social determinants such relationships with clients and intimate partners, interpersonal violence and challenges accessing traditional health care offering contraceptive services often interfered with these intentions and influenced contraceptive behaviours.

Conclusion: Women's contraceptive decision-making process included well-informed desires related to childbearing and contraceptive use. However, social determinants across domains of health interfered with autonomous contraceptive decision-making. More effort is needed to examine the influence of social determinants on the reproductive health of this population.

Impact: Findings from this study build on existing research that examines social determinants impacting reproductive health among female sex workers. Existing theoretical frameworks may not fully capture the influence constrained reproductive autonomy has on contraceptive decision-making. Future studies examining interpersonal and structural barriers to contraception are warranted.

Patient or public contribution: The parent study, EMERALD, collaborated with community service providers in the study intervention.

Keywords: decision-making; inequalities in health; nursing; reproductive health; sexual health; violence.

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Conflict of interest statement

Conflict of interest statement

Dr. Susan Sherman is an expert witness for plaintiffs in opioid litigation.

Figures

Figure 1
Figure 1. Miller’s Theory of Childbearing Motivations, Desires, and Intentions among FSW: The Influence of Social Determinants of Health
Note: FSW (Female Sex Workers); SDOH (Social Determinants of Health)
See this image and copyright information in PMC

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