Chanda Michael M, Ortblad Katrina F, Mwale Magdalene, Chongo Steven, Kanchele Catherine, Kamungoma Nyambe, Barresi Leah G, Harling Guy, Bärnighausen Till, Oldenburg Catherine E
John Snow, Inc, Lusaka, Zambia.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Contraception. 2017 Sep;96(3):196-202. doi: 10.1016/j.contraception.2017.07.003. Epub 2017 Jul 12.
Access to reproductive healthcare, including contraceptive services, is an essential component of comprehensive healthcare for female sex workers (FSW). Here, we evaluated the prevalence of and factors associated with contraceptive use, unplanned pregnancy, and pregnancy termination among FSW in three transit towns in Zambia.
Data arose from the baseline quantitative survey from a randomized controlled trial of HIV self-testing among FSW. Eligible participants were 18 years of age or older, exchanged sex for money or goods at least once in the past month, and were HIV-uninfected or status unknown without recent HIV testing (<3 months). Logistic regression models were used to assess factors associated with contraceptive use and unplanned pregnancy.
Of 946 women eligible for this analysis, 84.1% had been pregnant at least once, and among those 61.6% had an unplanned pregnancy, and 47.7% had a terminated pregnancy. Incarceration was associated with decreased odds of dual contraception use (aOR=0.46, 95% CI 0.32-0.67) and increased odds of unplanned pregnancy (aOR=1.75, 95% CI 1.56-1.97). Condom availability at work was associated with increased odds of using condoms only for contraception (aOR=1.74, 95% CI 1.21-2.51) and decreased odds of unplanned pregnancy (aOR=0.63, 95% CI 0.61-0.64).
FSW in this setting have large unmet reproductive health needs. Structural interventions, such as increasing condom availability in workplaces, may be useful for reducing the burden of unplanned pregnancy.
获得包括避孕服务在内的生殖健康护理，是女性性工作者全面医疗保健的重要组成部分。在此，我们评估了赞比亚三个中转城镇女性性工作者中避孕措施使用情况、意外怀孕及终止妊娠的患病率及其相关因素。
数据来源于一项针对女性性工作者进行的HIV自我检测随机对照试验的基线定量调查。符合条件的参与者年龄在18岁及以上，在过去一个月内至少有过一次以性交易换取金钱或物品的行为，且未感染HIV或HIV感染状况未知且近期未进行HIV检测（<3个月）。采用逻辑回归模型评估与避孕措施使用和意外怀孕相关的因素。
在946名符合该分析条件的女性中，84.1%至少怀孕过一次，其中61.6%有过意外怀孕，47.7%有过终止妊娠。被监禁与双重避孕措施使用几率降低相关（调整后比值比[aOR]=0.46，95%置信区间[CI] 0.32 - 0.67）以及意外怀孕几率增加相关（aOR=1.75，95% CI 1.56 - 1.97）。工作场所提供避孕套与仅使用避孕套避孕的几率增加相关（aOR=1.74，95% CI 1.21 - 2.51）以及意外怀孕几率降低相关（aOR=0.63，95% CI 0.61 - 0.64）。
在这种情况下，女性性工作者有大量未满足的生殖健康需求。结构性干预措施，如增加工作场所避孕套的可及性，可能有助于减轻意外怀孕的负担。
