Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

• Published in: Contraception (Stoneham) Vol. 76; no. 2; pp. 105 - 110
• Main Authors: Feldblum, Paul J, Nasution, Marlina D, Hoke, Theresa H, Van Damme, Kathleen, Turner, Abigail N, Gmach, Rebecca, Wong, Emelita L, Behets, Frieda
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Birth control; Cohort study; Condoms; Condoms, Female; Contraception; Contraception Behavior - statistics & numerical data; Dual protection; Female; Genital system. Reproduction; Gynecology. Andrology. Obstetrics; Health Education; Humans; Madagascar; Male; Medical sciences; Obstetrics and Gynecology; Other methods of contraception. Sterilization; Pharmacology. Drug treatments; Poisson regression; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Risk Factors; Sex Work - statistics & numerical data; Sex workers; Sexually Transmitted Diseases - prevention & control; Malagasy Republic; Africa; Pregnancy rate; Sex workers; Contraception; Dual protection; Cohort study; Poisson regression; Human; Condom; Incidence; Pregnancy; Prostitution; Local administration; Risk factor; Female; Contraceptive; Public health
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2007.04.009

Abstract Background Little is known about pregnancy rates among sex workers (SWs) or the factors that predispose SWs to this risk. We aimed to estimate the pregnancy incidence rate among Madagascar SWs participating in an intervention trial promoting use of male and female condoms and assess the influence of various predictive factors on pregnancy risk. Methods SWs from two study clinics in Madagascar participated in a randomized trial to assess the effect of peer education and clinic-based counseling on use of male and female condoms and prevalence of sexually transmitted infections (STIs). Women were seen every 2 months for up to 18 months; they received structured interviews at every visit, and physical exams at baseline and every 6 months thereafter. Site staff recorded information on pregnancies during interviews; pregnancy data were then merged with trial data for this analysis. Results Of 935 SWs in the analysis population, 250 became pregnant during follow-up. The cumulative probability of pregnancy was 0.149 at 6 months and 0.227 at 12 months. Comparable proportions of nonpregnant and pregnant SWs reported using highly effective contraception at baseline (∼16%); these users were younger and were more consistent condom users. Method switching and discontinuation were frequent. In multivariate analysis, nonuse of effective contraceptives and any self-reported unprotected sex were associated with higher incidence of pregnancy. Approximately 51% of women delivered, 13% reported a spontaneous abortion, 13% reported an induced abortion and 23% had missing pregnancy outcomes. Conclusions Women traditionally targeted for STI/HIV preventive interventions need more comprehensive reproductive health services. In particular, SWs could benefit from targeted family planning counseling and services.