Factors associated with unintended pregnancy.

BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.

背景 女性性工作者（female sex workers, FSW）的非意愿妊娠是一项亟待解决的生殖健康议题，其诱因涵盖高危性行为、医疗保健资源分配不公以及与男性性伴侣协商能力不足。然而，当前针对女性性工作者非意愿妊娠的流行特征及影响因素的研究证据仍较为匮乏，而此类信息对于优化生殖健康服务至关重要。本分析旨在评估该群体终身非意愿妊娠的流行率及其相关关联因素。
方法 本研究于2022年9月至2023年3月在孟加拉国边境辖区杰索尔（Jashore）开展一项横断面研究，共纳入327名女性性工作者。研究采用全抽样法招募受试者，通过面对面访谈收集其终身非意愿妊娠史及其他相关变量数据。采用卡方检验比较报告非意愿妊娠与未报告该情况的女性性工作者的人口学与行为特征。为评估非意愿妊娠相关因素的净关联，本研究运用多重logistic回归模型进行分析。
结果 研究结果显示，受试女性性工作者的终身非意愿妊娠流行率为75.8%（95%置信区间：71.0–80.1）。在报告存在非意愿妊娠的群体中，37.1%（95%CI: 30.8–43.8）未接受过任何正规教育，39.9%（95%CI: 32.8–47.5）年龄处于25~34岁区间，49.6%（95%CI: 39.3–59.9）目前处于婚姻状态，且62.9%（95%CI: 49.7–74.4）的月收入不超过10000孟加拉塔卡（BDT），上述比例均显著高于未报告终身非意愿妊娠的受试者。与从未有过非交易性男性性伴侣的人群相比，报告存在非交易性男性性伴侣者的非意愿妊娠发生风险显著更高（调整后优势比[AOR]: 2.4, 95%CI: 1.1–5.3, p = 0.036）。此外，与对照组相比，报告终身曾遭受性侵犯者（AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037）以及过去一年自述存在心理健康问题者（AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045）的非意愿妊娠发生风险同样显著升高。
结论 本研究揭示了杰索尔地区女性性工作者非意愿妊娠的高流行率及其关键影响因素。上述影响因素应被纳入考量范畴，以强化针对女性性工作者的生殖健康干预措施与政策制定。若不在当前开展的干预工作中针对性解决这些问题，女性性工作者的生殖健康水平将难以得到实质性改善。