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Do female sex workers in Dhaka need family planning information and services?

November 01, 2012

To learn more about the reproductive health needs of female sex workers, FHI 360 conducted a formative assessment among street-based and hotel-based female sex workers in Dhaka, Bangladesh. Funding for the assessment was provided by the U.S. Agency for International Development (USAID) through the Preventive Technologies Agreement (PTA). This study was conducted in close collaboration with two nongovernmental organizations that provide services to female sex workers: Bangladesh Women’s Health Coalition and Durjoy Nari Shangha.

The goal of the study was to provide information to inform the development of interventions to meet the reproductive health needs of female sex workers. Data were collected May–July 12, 2011, through surveys and in-depth interviews with hotel-based and street-based female sex workers in Dhaka. Nearly 700 women were interviewed.

The survey found that about 40 percent of the female sex workers had had at least one abortion. In addition, the majority of those interviewed either did not want any more children or indicated they did not want a pregnancy within the next 12 months. Knowledge and use of contraceptive methods were high; over 95 percent reported currently using condoms, and 48 percent of hotel-based and 36 percent of street workers were using a method aside from condoms (primarily pills and injectables). These other methods were not substituting for condoms and for most, other methods were used in addition to condoms. Condoms, however, were not being used effectively or consistently. Almost half of the sex workers reported that they had a condom break in the 30 days preceding the interview, and one-fourth reported that they accepted more money in exchange for not using a condom during this same time period. Many female sex workers do not feel they can force a client to use a condom, and if they insist, the client may go to a different woman or even beat them.

When asked how many times they used a condom in their past five sex acts with clients and their past five sex acts with a steady partner if they had one, only 33 percent of the hotel workers and 25 percent of the street workers used a condom in all sex acts, although they were more likely to use them with clients than other partners. Unmet need for contraception was calculated by looking at modern method use, consistent condom use and fertility desires. More than half of the hotel workers (55 percent) and nearly two-thirds of the street workers (64 percent) had an unmet need.

On the surface, the results on knowledge and use are positive. But, more in-depth analysis reveals that, despite high-reported use of methods, family planning use is not as effective as it first appears. The results suggest that female sex workers would benefit from increased access to family planning information and services.