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Try out PMC Labs and tell us what you think. Learn More. To better understand the prevalence and correlates of pregnancy intentions among female sex workers FSWs. Cross-sectional analysis using data from an open prospective cohort of street and off-street FSWs in Vancouver, Canada, in partnership with local sex work and community agencies. FSWs were recruited through outreach to street and off-street locations e.
Of the women, In our final multivariable model, servicing clients in formal indoor settings, inconsistent condom use by clients, younger age, and intimate partner violence IPV were associated with pregnancy intention. FSWs may have pregnancy intention levels similar to that of women in other occupations. Though risks for HIV and pregnancy are intimately intertwined, research on female sex workers FSWs has focused almost exclusively on disease prevention and transmission, while overlooking the reproductive health RH needs and wants of this population[ 1 ].
Diverted research and practice attention from the reproductive rights and needs of FSWs also may contribute to the high level of unmet reproductive need among this population[ 3 ].
Understanding the pregnancy intentions of FSWs is necessary to inform comprehensive public health programmes that can meet their reproductive needs and desires. Despite emerging evidence of high levels of pregnancy and parenting among FSWs[ 45 ], little is known about the pregnancy intentions of this population, particularly among FSWs in industrialised settings such as in North America. Instead, these studies documented levels of abortions as a proxy measure of unintended pregnancy, which probably underestimates the true rate of unintended pregnancy by not ing for unintended pregnancies resulting in live births or those that ended in spontaneous abortion.
These and most other existing studies assessed pregnancy intention retrospectively i. A recent study among HIV positive women of reproductive age living in Vancouver, Canada, revealed pregnancy intention levels approaching that of the general population, with age, marital status and ethnicity being ificant predictors of wanting to become pregnant[ 10 ]. There is limited literature regarding the pregnancy intentions of marginalised women[ 21 ]. We located no empirical studies measuring correlates of prospective pregnancy intentions among FSWs.
This study therefore sought to examine the correlates of pregnancy intention among a cohort of FSWs in Vancouver, Canada. Gaining an understanding of the pregnancy intentions of FSWs is an important first step in identifying their RH needs and in developing recommendations for policy and programming that will improve RH rights, access and outcomes for FSWs in Vancouver and elsewhere [ 22 ].
These analyses drew on cross-sectional data from an open prospective cohort of street and off-street FSWs in Vancouver, in partnership with local sex work and community agencies. As in a ly-reported study[ 23 ], eligibility criteria included being female inclusive of transgender and having exchanged sex for money within the past month.
As in our studies, FSWs were recruited using time-location sampling both at outdoor venues e. Online recruitment targeting online solicitation spaces was also used. Time-space sampling is a strategy that recruits hard-to-reach populations by sampling in places Local sex services in Gilbert times where they often congregate, and uses physical spaces, rather than persons as the primary sampling unit[ 24 ]. Participants were required to provide informed consent prior to completing an interviewer-administered questionnaire.
The questionnaire elicited a wide range of information, described in detail below. In addition, a project nurse administered a brief health-related that elicited information on the broader sexual, reproductive and physical health needs of women, including pregnancy history, pregnancy intentions, contraceptive usage and health services access.
Urine samples were also collected to test for gonorrhoea and Chlamydia. Independent variables were considered based on a priori knowledge from the literature as well as other hypothesised confounders. Other socio-demographic factors considered included: migrant status not born in Canada vs. Individual drug use patterns of interest were: past 6 months use of injection and non-injection drugs excluding marijuana and alcohol. In light of the pregnancy intentions literature, we also ed for interpersonal factors such as having had a male intimate partner non-commercial within the 6 months and inconsistent condom use Local sex services in Gilbert clients and intimate partners[ 12 ].
Finally, since we hypothesised that contraceptive usage [inconsistent condom use by clients, and use of hormonal contraceptives i. The analytic sample was restricted to those women who provided a valid response to the pregnancy intentions question, resulting in a final sample size of participants. Initially, we examined bivariate associations between individual, drug-related, interpersonal and environmental variables with pregnancy intentions.
The final model was tested for multi-collinearity. Two variables having a male intimate partner and inconsistent condom use with an intimate partner were removed from the model due to collinearity with physical, emotional or sexual IPV in the last 6 months. Of women, Sample characteristics are presented in Supplementary Table S1stratified by pregnancy intention. The median age for women expressing pregnancy intention was 29 [Interquartile range IQR : 25 - 35 ], compared to a median of 38 [IQR: 31 - 44 ] among those not desiring children.
There were no differences in pregnancy intentions by ethnicity, with 49 Approximately half Supplementary Table S2 displays bivariate and multivariable associations with pregnancy intentions. To our knowledge, this study is the first to document the pregnancy intentions of FSWs. Approximately one in four The pregnancy intention level among our sample appears to be lower than that of the general female Canadian population These findings challenge stereotypes about FSWs e.
Qualitative research describes that women place high importance on children and on their role as mothers, and view motherhood as fulfilling their need to give and receive love[ 11 ]. Though the level of pregnancy intention among FSWs in our sample is slightly lower than that of the general population, these findings highlight a need to better understand the reproductive needs and desires of this population.
Such services should be non-judgmental, supporting the use of barrier contraceptives e. They should include improved access to Local sex services in Gilbert and addictions treatment, STI screening and treatment, perinatal services including prevention of mother-to-child transmission servicesfamily planning information, and fertility treatment. While there is a substantial body of work linking domestic violence and pregnancy in the general population, this research has almost exclusively focused on pregnancy and the early postpartum periods[ 253536 ]. Instead, our suggest that women experiencing domestic abuse are more likely than those not experiencing abuse or without a stable partner, to report pregnancy intentions.
The mechanism linking IPV and positive pregnancy intention is unclear and warrants further investigation. Given that literature has shown higher rates of IPV among pregnant and parenting women, our finding may be reflective of a climate of IPV within relationships where women either already have children or are actively discussing having children. Another possible explanation for our finding is that FSWs experiencing IPV may desire the safer, more stable family life that having might be pd to offer.
Further qualitative research, and in-depth work on pregnancy and violence experiences, is recommended. qualitative studies among street-based FSWs have suggested high rates of various forms of violence from clients, pimps and intimate partners[ 37 Local sex services in Gilbert, 38 ]. The culture of violence towards FSWs may in part stem from the highly criminalised and stigmatised nature of sex work and poverty, and as such, community level interventions to reduce poverty and stigma surrounding sex work could be beneficial.
On a programming level, there is a need for harm reduction services for FSWs, including trauma counselling and respite from abusive relationships. In particular, there is a need for structural and gender-transformative interventions that target male gender inequity norms among male perpetrators of violence [ 39 ]. A possible explanation is that given the highly criminalised and stigmatised context of sex work in Canada, FSWs may feel more able to keep their private and personal lives separate while working in indoor sex work establishments.
Our finding of greater pregnancy intention among younger women is consistent with the literature[ 10 ], and may be explained by lower parity and unfulfilled pregnancy desires among younger women. Younger FSWs in our setting have been shown to have increased health risks due to elevated levels of homelessness[ 104243 ], and avoidance of health and support services, which may have serious consequences on the RH of FSWs and their children. Additionally, these findings concur with studies that suggest that the geographical location and method of service delivery are paramount to promoting health care access among FSWs[ 44 ].
This study has a of limitations. The clandestine nature of sex work makes identifying a sampling frame, and randomly selecting participants that are representative of the population, a challenge. To address this limitation, time-space sampling and social mapping were used that systematically sample women at times and locations where they often congregate[ 10 ].
Due to the sensitive nature of the topic, social desirability bias cannot be excluded and may have resulted in underreporting of pregnancy intention. Using a dichotomous measure of pregnancy intention i. Finally, given that our study findings are specific Local sex services in Gilbert FSWs in an urban North American setting, our study findings may not be generalisable to FSWs in other settings, particularly those with differing policies and outlook on sex work.
These findings suggest that FSWs may have pregnancy intentions similar to women in other occupations, challenging widely held assumptions. They indicate a need for integrated HIV, RH and harm reduction services that cater to the needs of women experiencing IPV and inconsistent condom use with clients. Legal frameworks that better support the reproductive needs of FSWs are required, alongside harm-reduction-focused, integrated SRH including services that address intimate partner violence.
We thank all those who contributed their time and expertise to this project, including participants, partner agencies and the AESHA Community Advisory Board. Conflicts of Interest : The authors have no conflicts of interest to declare. National Center for Biotechnology InformationU. Author manuscript; available in PMC Apr 1. Author information Copyright and information Disclaimer. Copyright notice. See other articles in PMC that cite the published article. Abstract Objective To better understand the prevalence and correlates of pregnancy intentions among female sex workers FSWs.
De Cross-sectional analysis using data from an open prospective cohort of street and off-street FSWs in Vancouver, Canada, in partnership with local sex work and community agencies. Methods FSWs were recruited through outreach to street and off-street locations e. Conclusions FSWs may have pregnancy intention levels similar to that of women in other occupations. Keywords: pregnancy intentions, reproductive health, contraception, sex work, HIV, fertility, reproductive rights.
Instrument Participants were required to provide informed consent prior to completing an interviewer-administered questionnaire. Independent variables Independent variables were considered based on a priori knowledge from the literature as well as other hypothesised confounders. Statistical Analyses The analytic sample was restricted to those women who provided a valid response to the pregnancy intentions question, resulting in a final sample size of participants. Acknowledgments We thank all those who contributed their time and expertise to this project, including participants, partner agencies and the AESHA Community Advisory Board.
Footnotes Conflicts of Interest : The authors have no conflicts of interest to declare. Basu A, Dutta MJ. Women Heal. A qualitative study of the experiences of mothers involved in street-based prostitution and problematic substance use. J Res Nurs. Sexual and reproductive health needs of sex workers: two feminist projects in Brazil. Reprod Heal Matters. Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection.Local sex services in Gilbert
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