EP7.08 Predictors and consequences for unintended pregnancies for female sex workers in Mombasa-a mixed methods study

Introduction: It is estimated that 0.7–4.3% of women in SubSaharan Africa exchange sex for money, favours or goods. Despite public health interventions to provide family planning, unintended pregnancies in female sex workers (FSWs) continue to be common. Access to safe pregnancy terminations is difficult, and women who continue a pregnancy are faced with substantial health risks and the increased socio-economic burden of raising a child. This study assessed the rates, predictors and consequences of contraceptive use and unintended pregnancies among FSWs in Mombasa, Kenya. Methods: Our mixed-methods study consisted of a prospective cohort study with serial qualitative enquiries. To be eligible, FSWs had to be HIV negative based on laboratory testing, aged 16 years or older, and not currently pregnant as assessed by self-report and negative pregnancy testing. Convenience sampling was used and eligible participants were recruited in their homes, guesthouses and streets. Participants were followed over 12 months, with quarterly visits to assess sexual behaviour, family planning, pregnancy intention, and relationship characteristics. HIV and pregnancy testing was performed at each visit. In-depth interviews (IDI) and focus group discussions (FGD) were held with FSW experiencing an unintended pregnancy during cohort follow-up. Results: In total, 400 FSWs were followed up for 12 months between 2006 and 2007. The majority (96%) of women reported having ever used contraception, with about half (57%; 228/399) currently using modern contraception. Only 5.3% (12/228) of these women were using long-acting reversible contraception and 10% were using dual contraception. Unintended pregnancies occurred in 24.4% (94/386) of participants. FSWs of younger age, those using condoms alone, and those having an emotional partner (husband or boyfriend) were significantly more likely to have an unintended pregnancy. Qualitative inquiries reported generally positive views towards family planning, but many were careless in regard to consistent usage. In particular, participants reported difficulties in using contraception with their emotional partners, with domestic violence and low relationship control identified as key factors. Qualitative data highlighted the personal burden of an unintended pregnancy on loss of income and social discrimination. Conclusion: Despite having good knowledge of modern contraception, the unintended pregnancy rate amongst FSWs remained very high. Important associations for unintended pregnancies are younger age, having an emotional partner, and the use of condoms alone. Unintended pregnancies were reported to have lasting consequences on their socio-economic vulnerability. Future interventions need to address the role of emotional partners, particularly relationship control, and improve access and acceptance of dual contraception use to prevent unintended pregnancies and sexually transmitted infections