TY - JOUR
T1 - Unmet need for family planning and experience of unintended pregnancy among female sex workers in urban cameroon
T2 - Results from a national cross-sectional study
AU - Bowring, Anna L.
AU - Schwartz, Sheree
AU - Lyons, Carrie
AU - Rao, Amrita
AU - Olawore, Oluwasolape
AU - Njindam, Iliassou Mfochive
AU - Nzau, Jimmy
AU - Fouda, Ghislaine
AU - Fako, Guy H.
AU - Turpin, Gnilane
AU - Levitt, Daniel
AU - Georges, Sandra
AU - Tamoufe, Ubald
AU - Billong, Serge C.
AU - Njoya, Oudou
AU - Zoung-Kanyi, Anne Cécile
AU - Baral, Stefan
N1 - Funding Information:
Funding: This research was generously supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under the terms of the Continuum of prevention, care, and treatment of HIV/AIDS with Most at-risk Populations project. AB is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship. SB’s and SS’s efforts were funded in part by a grant from the National Institute of Nursing Research of the National Institutes of Health (R01NR016650) and the Johns Hopkins University Center for AIDS Research (CFAR). CFAR is an National Institute of Health (NIH)-funded program (P30AI094189) that is supported by the following NIH co-funding and participating institutes and centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Child and Human Development, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Mental Health, National Institute on Aging, Fogarty International Center, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, and Office of AIDS Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID, PEPFAR, NIH, NHMRC, or other supporting agencies.
Funding Information:
This research was generously supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under the terms of the Continuum of prevention, care, and treatment of HIV/AIDS with Most at-risk Populations project. AB is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship. SB's and SS's efforts were funded in part by a grant from the National Institute of Nursing Research of the National Institutes of Health (R01NR016650) and the Johns Hopkins University Center for AIDS Research (CFAR). CFAR is an National Institute of Health (NIH)-funded program (P30AI094189) that is supported by the following NIH cofunding and participating institutes and centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Child and Human Development, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Mental Health, National Institute on Aging, Fogarty International Center, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, and Office of AIDS Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID, PEPFAR, NIH, NHMRC, or other supporting agencies.*%blankline%*
Publisher Copyright:
© 2020 Bowring et al.
PY - 2020/3/30
Y1 - 2020/3/30
N2 - Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]= 1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
AB - Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]= 1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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U2 - 10.9745/GHSP-D-19-00330
DO - 10.9745/GHSP-D-19-00330
M3 - Article
C2 - 32234842
AN - SCOPUS:85082790782
SN - 2169-575X
VL - 8
SP - 82
EP - 99
JO - Global Health Science and Practice
JF - Global Health Science and Practice
IS - 1
ER -