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Background: Little is known about female sex workers’ (FSWs) reproductive health apart from their being at higher than usual risk of sexually transmitted infections (STIs), including HIV. The aim of this study was therefore to investigate the correlates of pregnancy among FSWs in semi – urban Blantyre in Malawi. Methods: We used systematic sampling to recruit a total of 200 FSWs in four different study sites in Blantyre. Data were collected through questionnaire interviews. We calculated the mean and standard deviation for continuous covariates and proportions for categorical variables to describe the data. Logistic regression analysis was used to examine the correlates between the outcome variable (pregnancy) and independent variables. Results: Ninety one (45, 5%) FSWs were between 18 and 24 years. The prevalence of pregnancy was 61% for FSWs born in rural place as compared to 37% for those who were born in town. In multivariate analysis FSWs who reported to value being respected as mothers had 12 times the risk of pregnancy comparing to the ones who did not (AOR: 11.8, 95% CI: [4.56, 30.72] p-value < 0.001). FSWs who reported using condoms inconsistently had five times the risk of pregnancy compared to the ones who did not, (AOR: 5.26, 95% CI: [2.29, 12.08], p-value < 0.001). FSWs who had a request to bear children from steady partners had 5 times the risk of pregnancy comparing to the ones who did not (AOR: 5.07, 95% CI: [2.14, 11.99]). FSWs who reported forgetfulness of contraceptives' use had 3 times more risk of pregnancy comparing to the ones who did not (AOR: 3.49 CI: [1.29, 9.37], p-value < 0.013). Conclusion: The study documents a wide range of correlates of pregnancies among FSWs in the study sites. It is important to recognize the child bearing desires and circumstances of FSWs in order to inform health programs responsive to their needs.
The study was conducted between November 2018 and January 2019. In this cross sectional study, we used quantitative methods to collect data on the prevalence and correlates of pregnancies among FSWs, in semi-urban Blantyre. The study was conducted in four townships Chirimba, Lunzu, Kachere, Mbayani located in semi -urban Blantyre, Southern region of Malawi. FSWs aged between 18 and 49 years, who had exchanged sex for money or goods and who signed the consent were eligible for the study participation. Some FSWs were recruited as seeds in snow ball sampling. They assisted us to have access to FSWs in four purposively selected study sites. The outcome variable of the study was pregnancy. We had many hypothesized socio-demographic variables and behavioral related characteristics, for instance: missing contraceptive pills, having steady partners, inconsistence condom use, to be respected as a mother, alcohol intake, violence, rape, extension of clans, challenges in accessing contraceptive pills, mothers’ obligation, peer pressure from FSWs, condom breakage or slippage. In this study, pregnancy also known as gestation was defined as the maternal condition of having a developing of one or more offspring in the woman’s body. Female Sex Workers were defined as women who sell sex in the exchange of money or goods. Condom breakage was defined as rupture of a condom during sexual intercourse. Condom slippage is getting out of a condom from a penis during sexual intercourse. Inconsistence condom use was defined as using a condom sometimes or rarely during sexual intercourse. In heterosexual relationship a steady partner was defined as spouse or co-habiting partner or someone with a romantic relationship with for a long period of time. The sample size was calculated using single population proportion formula. We used 15% as the prevalence of FSWs trying to conceive with one of their partners [10]. Marginal error of 5%, and at 95 level of confidence. Thus the required sample size was calculated at 196. For convenient purpose we used 200 FSWs as study participants. At each of the four sites, data collection took place at neutral and confidential places mutually agreed to by the study team and research participants. Fifty FSWs from each site were systematically selected to participate in the study. A specific period was identified within which the questionnaires were completed by the research assistants through the interview process with FSWs. Female research assistants trained in data collection and research went to each site at a pre-arranged time. They explained the purpose of the study and emphasized the fact that FSWs who do not wish to participate may either leave, or remain in our study but they will not be adversely affected by their voluntary decisions not to participate. Following the explanation, study participants were given an opportunity for questions and clarifications. Each of the FSWs was asked questions by the research assistant and the survey questionnaires were completed by the data collector. Cash reimbursement of Malawi Kwacha (MK) 1500.00 (approximately 2 US$ at the time of data collection) was provided to all study participants as compensation for their time in the study. For this study we had a database for entry of quantitative data from the completed questionnaires. Data analysis were conducted in Stata 14.1 (Stata Corporation, College Station, TX, USA). Descriptive statistics were used to analyze data from socio-economic and demographic characteristics of the study participants. Logistic regression analysis was used to investigate the relationship between pregnancy (binary outcome) and explanatory variables among FSWs. The study was approved by COMREC (College of Medicine Research and Ethics Committee), University of Malawi, (certificate number P.07 / 18 / 2444, dated 08 – Sept – 2018). We got clearance from the local authorities before the study started. All study staff were carefully trained in human subjects’ protection, especially the importance of protecting privacy and confidentiality and obtaining informed consent from each study participant using the approved consent forms. Participants were informed of their right to withdraw from the study and not to answer any questions they felt uncomfortable with answering. All the information which was provided by the participants was treated with confidentiality.
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