Unmet need for contraception among sex workers in Madagascar

作者：Khan Maria R^*; Turner Abigail Norris; Pettifor Audrey; van Damme Kathleen; Rabenja Ny Lovaniaina; Ravelomanana Noro; Swezey Teresa; Williams D'Nyce; Jamieson Denise; Behets Frieda

来源：Contraception, 2009, 79(3): 221-227.

DOI：10.1016/j.contraception.2008.09.011

• Pregnancy intentions
• Contraception
• Unmet need
• Sex worker
• Madagascar

Background: The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers.
Study Design: We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months.
Results: Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having "unmet need" for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4-3.0] and low self-efficacy to negotiate condom use (age- and site-aqjusted PR: 2.0; 95% CI: 1.4-3.0).
Conclusions: Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were Substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers.

• 出版日期2009-3