"A Baby Was an Added Burden": Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study.
BACKGROUND
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.


CONCLUSIONS
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.
Burnet Institute, Melbourne, Australia.|International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.|Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Stanley
S
Luchters
International Centre for Reproductive Health (ICRH), Mombasa, Kenya.
Wilkister
W
Bosire
Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia.
Amy
A
Feng
Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.|African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa.
Marlise L
ML
Richter
International Centre for Reproductive Health (ICRH), Mombasa, Kenya.
Nzioki
N
King'ola
Burnet Institute, Melbourne, Australia.|Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Frances
F
Ampt
International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.|Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
Marleen
M
Temmerman
International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.|Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Matthew F
MF
Chersich
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