title: Unmet need for contraception among sex workers in Madagascar.
abstract: BACKGROUND
  The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers.
  
  
  METHODS
  We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months.
  
  
  RESULTS
  Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having "unmet need" for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4-3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4-3.0).
  
  
  CONCLUSIONS
  Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. maria_khan@unc.edu
authors.forename: Maria R
authors.initials: MR
authors.lastname: Khan
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
authors.forename: Kathleen
authors.initials: K
authors.lastname: Van Damme
authors.forename: Ny Lovaniaina
authors.initials: NL
authors.lastname: Rabenja
authors.forename: Noro
authors.initials: N
authors.lastname: Ravelomanana
authors.forename: Teresa
authors.initials: T
authors.lastname: Swezey
authors.forename: D'Nyce
authors.initials: D
authors.lastname: Williams
authors.forename: Denise
authors.initials: D
authors.lastname: Jamieson
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008270:Madagascar; D020380:Needs Assessment; D011247:Pregnancy / Q000706:statistics & numerical data*; D011446:Prospective Studies; D017584:Reproductive History; D011477:Sex Work / Q000706:statistics & numerical data*; D055815:Young Adult