高终生妊娠率和低避孕使用率在吸毒性工作者中-未满足的生殖健康需求。
High lifetime pregnancy and low contraceptive usage among sex workers who use drugs- an unmet reproductive health need.
机构信息
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
出版信息
BMC Pregnancy Childbirth. 2011 Aug 18;11:61. doi: 10.1186/1471-2393-11-61.
BACKGROUND
The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs) in Vancouver.
METHODS
The study sample was obtained from a community-based prospective cohort study (2006-2008) of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody), and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4) were examined.
RESULTS
Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5). The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR): 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3), apprehension (median = 2; IQR:1-4) and adoption (median = 1; IQR:1-2) among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45]), and permanent contraceptives (e.g., tubal ligation and hysterectomy) (OR = 2.76; [95%CI = 1.36-5.59]) were both significantly associated with having five or more pregnancies.
CONCLUSION
These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver.
背景
本研究旨在描述温哥华街头女性性工作者（FSWs）队列的妊娠和避孕使用水平。
方法
研究样本来自 2006-2008 年一项基于社区的街头性工作女性吸毒者前瞻性队列研究（211 名女性），其中 176 名女性报告至少有一次既往妊娠。使用描述性统计来估计终生妊娠率、妊娠结局（流产、堕胎、领养、儿童逮捕、儿童监护）和避孕使用情况。在二次分析中，检查了避孕使用与个体和人际风险因素以及高数量的终生妊娠（定义为大于样本平均值 4）之间的关联。
结果
在我们的样本中，84%的女性报告有过一次既往妊娠，平均有 4 次终生妊娠（中位数=3；四分位距：2-5）。报告有 5 次以上妊娠的女性的中位年龄为 38 岁[四分位距（IQR）：25.0-39.0]，而报告有 4 次或更少既往妊娠的女性的中位年龄为 34 岁[IQR：25.0-39.0]。45%为白种人，47%为原住民。我们观察到报告既往妊娠的 FSWs 中，以前堕胎（中位数=1；IQR：1-3）、逮捕（中位数=2；IQR：1-4）和领养（中位数=1；IQR：1-2）的比例较高。激素和插入式避孕药的使用受到限制。在单变量分析中，输卵管结扎术（OR=2.49；[95%置信区间（CI）=1.14-5.45]）和永久性避孕药（如输卵管结扎术和子宫切除术）（OR=2.76；[95%CI=1.36-5.59]）均与有 5 次或更多次妊娠显著相关。
结论
这些发现表明，在有效避孕措施利用率较低的情况下，意外妊娠率较高，这表明需要改善生殖健康服务的可及性和利用率，包括计划生育，这应针对温哥华的 FSWs 进行适当的目标定位和调整。
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