title: High lifetime pregnancy and low contraceptive usage among sex workers who use drugs- an unmet reproductive health need.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Putu
authors.initials: P
authors.lastname: Duff
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Debbie
authors.initials: D
authors.lastname: Alexson
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D001294:Attitude to Health; D001955:British Columbia; D015331:Cohort Studies; D016001:Confidence Intervals; D003267:Contraception / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D060386:Sex Workers / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult