Research Article: Sexual and reproductive health behaviors of female sex workers in Dhaka, Bangladesh

Date Published: April 3, 2017

Publisher: Public Library of Science

Author(s): Tasnuva Wahed, Anadil Alam, Salima Sultana, Nazmul Alam, Ratana Somrongthong, Massimo Ciccozzi.

http://doi.org/10.1371/journal.pone.0174540

Abstract

The objective of this study was to document sexual and reproductive health (SRH) practices among female sex workers (FSWs) including abortion, pregnancy, use of maternal healthcare services and sexually transmitted infections (STIs) with the aim of developing recommendations for action.

A total of 731 FSWs aged between 15 and 49 years were surveyed using a stratified sampling in Dhaka, Bangladesh. A workshop with 23 participants consisted of policy makers, researchers, program implementers was conducted to formulate recommendations.

About 61.3% of 731 FSWs reported SRH-related experiences in the past one year, including abortion (15.5%), ongoing pregnancy (9.0%), childbirth (8.3%) or any symptoms of STIs (41.6%). Among FSWs who had an abortion (n = 113), the most common methods included menstrual regulation through manual vacuum aspiration (47.8%), followed by Dilation and Curettage procedure (31%) and oral medicine from pharmacies (35.4%). About 57.5% of 113 cases reported post abortion complications. Among FSWs with delivery in the past year (n = 61), 27.7% attended the recommended four or more antenatal care visits and more than half did not have any postnatal visit. Adopting sustainable and effective strategies to provide accessible and adequate SRH services for FSWs was prioritized by workshop participants.

There was substantial unmet need for SRH care among FSWs in urban areas in Dhaka, Bangladesh. Therefore, it is important to integrate SRH services for FSWs in the formal healthcare system or integration of abortion and maternal healthcare services within existing HIV prevention services.

Partial Text

Female sex workers (FSWs) are at high risk of mortality and morbidity related to both sexual and reproductive health (SRH), particularly from unsafe abortion and pregnancy-related complications including sexually transmitted infections (STIs). There is an increasing trend in the FSW population in many Asian countries, as women are often entering the sex trade at younger ages than in the past [1]. In Bangladesh, a small country in Asia, approximately 0.22% of 15–49 aged female population is engaged as FSWs [2]. Commercial sex is not legal in Bangladesh, and as a result, there are limited services available in formal healthcare systems which are an important public health issue.

This study demonstrated higher menstrual regulation, abortion and birth rate among FSWs compared to non-FSWs of reproductive age. The national MR and abortion rate annually was 18 per 1000 women [17] and childbirth status was 20 live births/thousands women [18]. Our findings related to abortion is similar to another recent study by Katz et al where abortion rate among FSWs in Dhaka was 13% to 16% [19]. In addition, there are other studies outside of Bangladesh which have documented life time abortion rates of more than 50% among FSWs, which further corroborate our findings [20–24]. Katz et al demonstrated that 32% to 53% of FSWs sought maternal and child care services; however, they did not note the childbirth rate.

This descriptive exploratory study generates firm recommendations around SRH services for FSWs. Given the high prevalence of reported post abortion complications and low rates of ANC/PNC and delivery care by skilled providers, there is a need for comprehensive SRH intervention and services. Ideally, SRH services should be easily accessible to FSWs through integration with existing DIC. The study also urges policy makers and program implementers to consider FSWs health needs during pregnancy and childbirth to reduce morbidity and mortality.

 

Source:

http://doi.org/10.1371/journal.pone.0174540

 

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