"A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study

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dc.contributor.authorLuchters, Stanleyen_ZA
dc.contributor.authorBosire, Wilkisteren_ZA
dc.contributor.authorFeng, Amyen_ZA
dc.contributor.authorRichter, Marlise Len_ZA
dc.contributor.authorKing'ola, Nziokien_ZA
dc.contributor.authorAmpt, Francesen_ZA
dc.contributor.authorTemmerman, Marleenen_ZA
dc.contributor.authorChersich, Matthew Fen_ZA
dc.date.accessioned2016-10-31T07:43:58Z
dc.date.available2016-10-31T07:43:58Z
dc.date.issued2016en_ZA
dc.description.abstractIntroduction Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. METHODS: A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. RESULTS: Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as "bad luck". They described numerous negative consequences of unintended pregnancy. CONCLUSION: Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use.en_ZA
dc.identifier.apacitationLuchters, S., Bosire, W., Feng, A., Richter, M. L., King'ola, N., Ampt, F., ... Chersich, M. F. (2016). "A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study. <i>PLoS One</i>, http://hdl.handle.net/11427/22378en_ZA
dc.identifier.chicagocitationLuchters, Stanley, Wilkister Bosire, Amy Feng, Marlise L Richter, Nzioki King'ola, Frances Ampt, Marleen Temmerman, and Matthew F Chersich ""A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/22378en_ZA
dc.identifier.citationLuchters, S., Bosire, W., Feng, A., Richter, M. L., King’ola, N., Ampt, F., ... & Chersich, M. F. (2016)."A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study. PloS one, 11(9), e0162871. doi:10.1371/journal.pone.0162871en_ZA
dc.identifier.ris TY - Journal Article AU - Luchters, Stanley AU - Bosire, Wilkister AU - Feng, Amy AU - Richter, Marlise L AU - King'ola, Nzioki AU - Ampt, Frances AU - Temmerman, Marleen AU - Chersich, Matthew F AB - Introduction Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. METHODS: A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. RESULTS: Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as "bad luck". They described numerous negative consequences of unintended pregnancy. CONCLUSION: Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0162871 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - "A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study TI - "A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study UR - http://hdl.handle.net/11427/22378 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0162871en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22378
dc.identifier.vancouvercitationLuchters S, Bosire W, Feng A, Richter ML, King'ola N, Ampt F, et al. "A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods study. PLoS One. 2016; http://hdl.handle.net/11427/22378.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Luchters et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherFemale contraceptionen_ZA
dc.subject.otherMale contraceptionen_ZA
dc.subject.otherSex worken_ZA
dc.subject.otherTermination of pregnancyen_ZA
dc.subject.otherContraceptionen_ZA
dc.subject.otherContraceptivesen_ZA
dc.subject.otherSex workersen_ZA
dc.title"A Baby Was an Added Burden": Predictors and consequences of unintended pregnancies for female sex workers in Mombasa, Kenya: a mixed-methods studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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