Contraceptive decision-making through the lens of social determinants of health among female sex workers: A qualitative descriptive study.
Jessica L Zemlak, Kamila A Alexander, Deborah Wilson and 1 others
PMID 36946262WHAT IT FOUND
Women in street-based sex work said they wanted to avoid pregnancy, but drugs, violence, clients refusing condoms and healthcare barriers made that hard.
Ask about partner type and violence, not just a pregnancy-intention question.
Key findings
01Women described using condoms with clients but not always with intimate partners because childbearing intentions differed by partner type.
02Drug use, the need to earn money for drugs, and healthcare access barriers made it hard for women to carry out their intention to avoid pregnancy.
03Women described using female-controlled contraception to avoid pregnancy with violent intimate partners, while client violence did not influence decisions in the same way.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an interview study of 22 women, so it gives themes and experiences, not proof that any service changes pregnancy rates. Most participants identified as white and were from one city, so findings may not transfer to other groups. Telephone interviews required a phone and a private space, which may have missed women with the least stability. 16 women had exited sex work in the previous 2 weeks to 2 years, so many were recalling past decisions. The questions did not explore pregnancy coercion or reproductive coercion directly. The study did not test a counselling model, mobile service or integrated harm reduction and contraception service.
Declared interests
The provided text reports no funding source. It declares that Dr Susan Sherman is an expert witness for plaintiffs in opioid litigation.
The easy way to misread this
Do not conclude that mobile services, integrated harm reduction and contraception, or violence screening reduce unintended pregnancy. The study described women's experiences and barriers; it did not test an intervention or report pregnancy outcomes.