title: Sexual and reproductive health knowledge, contraception uptake, and factors associated with unmet need for modern contraception among adolescent female sex workers in China.
abstract: OBJECTIVE
  In China, policy and social taboo prevent unmarried adolescents from accessing sexual and reproductive health (SRH) services. Research is needed to determine the SRH needs of highly disadvantaged groups, such as adolescent female sex workers (FSWs). This study describes SRH knowledge, contraception use, pregnancy, and factors associated with unmet need for modern contraception among adolescent FSWs in Kunming, China.
  
  
  METHODS
  A cross-sectional study using a one-stage cluster sampling method was employed to recruit adolescents aged 15 to 20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months. A semi-structured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine correlates of low knowledge and unmet need for modern contraception.
  
  
  RESULTS
  SRH knowledge was poor among the 310 adolescents surveyed; only 39% had heard of any long-acting reversible contraception (implant, injection or IUD). Despite 98% reporting not wanting to get pregnant, just 43% reported consistent condom use and 28% currently used another form of modern contraception. Unmet need for modern contraception was found in 35% of adolescents, and was associated with having a current non-paying partner, regular alcohol use, and having poorer SRH knowledge. Past abortion was common (136, 44%). In the past year, 76% had reported a contraception consultation but only 27% reported ever receiving SRH information from a health service.
  
  
  CONCLUSIONS
  This study demonstrated a low level of SRH knowledge, a high unmet need for modern contraception and a high prevalence of unintended pregnancy among adolescent FSWs in Kunming. Most girls relied on condoms, emergency contraception, or traditional methods, putting them at risk of unwanted pregnancy. This study identifies an urgent need for Chinese adolescent FSWs to be able to access quality SRH information and effective modern contraception.
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Megan S C
authors.initials: MS
authors.lastname: Lim
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Zhang
authors.affiliation: Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Elissa
authors.initials: E
authors.lastname: Kennedy
authors.affiliation: School of Public Health, Kunming Medical University, Kunming, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of AIDS Management, Kunming the Third People's Hospital, Kunming, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Primary Health Care, Kunming Maternal and Child Health Care Centre, Kunming, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of AIDS Prevention, Kunming Maternal and Child Health Care Centre, Kunming, China.
authors.forename: Yun-Xia
authors.initials: YX
authors.lastname: Li
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium; Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D002681:China; D003267:Contraception / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D060386:Sex Workers; D012725:Sexual Behavior; D055815:Young Adult