The objective of this study was to document sexual and reproductive health SRH practices among female sex workers FSWs including abortion, pregnancy, use of maternal healthcare services and sexually transmitted infections STIs with the aim of developing recommendations for action.
A total of FSWs aged between 15 and 49 years were surveyed using a stratified sampling in Dhaka, Bangladesh. A workshop with 23 participants consisted of policy makers, researchers, program Dhaka sex was Dhaka sex to formulate recommendations.
Adopting sustainable and effective strategies to provide accessible and adequate SRH services for FSWs was prioritized by workshop participants. Therefore, it is important to integrate SRH services for FSWs in the formal healthcare system or integration of abortion and maternal healthcare services within existing HIV prevention services. Female sex workers FSWs are at high risk of Dhaka sex and morbidity related to both sexual and reproductive health SRHparticularly from unsafe abortion and pregnancy-related complications including sexually transmitted infections STIs.
There is an increasing trend in the FSW population in many Asian countries, as women Dhaka sex often entering the sex trade at younger ages than in the past [ 1 ]. In Bangladesh, a small country in Asia, approximately 0. Commercial sex is not legal in Bangladesh, and as Dhaka sex result, there are limited services available in formal healthcare systems which are an important public health issue.
FSWs are at high risk of becoming pregnant because of their reproductive age, poor negotiation power for condom use, and the high number of clients they entertain.
The prevalence of consistently using condoms with new clients in the past week among brothel-based, hotel-based and street-based FSWs in Dhaka was According to the 7 th round behavioral surveillance survey, brothel-based FSWs entertained an average of 20 clients per week [ 4 ].
However, some FSWs continue their pregnancy up to 28 weeks of gestation or more. Thus, it is necessary to understand their behaviors for seeking pregnancy and delivery care. Bangladesh is committed to reduce maternal mortality and morbidities through Dhaka sex interventions and research which have been implemented targeting rural, urban slum and non-slum areas. The Government of Bangladesh also established a supportive network of abortion clinics which carried out more than one million pregnancy terminations by MR or abortion [ 7 ].
However, women in urban slum areas are less likely to seek four antenatal visits Moreover, FSWs are particularly at risk for STIs [ 10 ] and STIs have been associated with a number of adverse pregnancy outcomes including spontaneous abortion, stillbirth, prematurity, low birth weight LBWpostpartum endometritis, and various sequelae in surviving neonates [ 11 ].
There is evidence Dhaka sex FSWs face stigma and discrimination in seeking health services [ 12 ]. There are two packages of interventions that are being implemented to reach approximately 28, FSWs in 51 districts through Drop in Centers DICs and 10 outreach offices.
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The present study was conducted in DIC with the aim of understanding sexual and reproductive health behaviors of FSWs during pregnancy, delivery and symptoms related to STIs to inform the design of essential interventions to improve SRH related health outcomes.
A cross-sectional descriptive study was conducted in Dhaka sex FSWs in Dhaka city.
Dhaka, the capital city of Bangladesh is highly populated with about 15 million people living in mi 2 areas with an Dhaka sex population growth of 4. Dhaka sex study population was comprised of residence, hotel, and street-based FSWs who were working in Dhaka city during the study period. The study sample size was estimated atDhaka sex on standard parameters, such as-proportion of FSWs having SRH related experiences eg.
Three DICs were randomly selected using a stratified sampling technique for the quantitative component of the study. Data for this study were collected in two phases. Phase I included a quantitative survey with FSWs. In Phase II, a workshop was conducted to identify barriers in implementation of SRH related services for FSWs, re-examining the findings from Phase I to formulate a policy brief and program recommendations.
The data collection team included four data collectors and one field supervisor. The team was trained on the survey questionnaire which Dhaka sex been shown in S1 Table.
A literature review was undertaken by the principal investigator to formulate the questionnaire which contained questions on socio-demographic characteristics and SRH issues, such as- abortion, maternal healthcare and STIs.
Assessment of each question was carried out by a medical doctor Dhaka sex expertise on sexual and reproductive health to ensure content validity. Moreover, the questionnaire was reviewed by experts in the field of sexual Dhaka sex reproductive health at icddr,b, Save the Children in Bangladesh and Chulalongkorn University.
The data collectors conducted the interviews at the DICs. They also visited condom distribution locations, where outreach workers distribute condoms to Dhaka sex who were not available at the DIC. In Phase 2, a half-day workshop was conducted with 23 participants from the Government of Bangladesh health department, and national and international organizations and partners Table 1.
The participants were key national policy makers, FSW-based health program implementers, health system specialists, public health researchers including scientists from reproductive health and HIV fields. At first, the principal investigator prepared a list Dhaka sex key Dhaka sex involved in SRH-related interventions from her knowledge and experience.
She shared this list with the other investigators of this study and updated the list based on their feedback. All identified participants were invited through email as well as delivered printed invitation letters at their offices. One day before the workshop, participants were reminded via email and telephone. On the day of the workshop, participants from almost all organizations were present and successfully contributed to the workshop.