Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka city, Bangladesh

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Abstract

Objectives

This study aimed to identify the barriers female sex workers (FSWs) in Bangladesh face with regard to accessing sexual and reproductive health (SRH) care, and assess the satisfaction with the healthcare received.

Methods

Data were collected from coverage areas of four community-based drop-in-centers (DICs) in Dhaka where sexually transmitted infection (STI) and human immunovirus (HIV) prevention interventions have been implemented for FSWs. A total of 731 FSWs aged 15–49 years were surveyed. In addition, in-depth interviews (IDIs) were conducted with 14 FSWs and 9 service providers. Respondent satisfaction was measured based on recorded scores on dignity, privacy, autonomy, confidentiality, prompt attention, access to social support networks during care, basic amenities, and choice of institution/care provider.

Results

Of 731 FSWs, 353 (51%) reported facing barriers when seeking sexual and reproductive healthcare. Financial problems (72%), shame about receiving care (52.3%), unwillingness of service providers to provide care (39.9%), unfriendly behavior of the provider (24.4%), and distance to care (16.9%) were mentioned as barriers. Only one-third of the respondents reported an overall satisfaction score of more than fifty percent (a score of between 9 and16) with formal healthcare. Inadequacy or lack of SRH services and referral problems (e.g., financial charge at referral centers, unsustainable referral provision, or unknown location of referral) were reported by the qualitative FSWs as the major barriers to accessing and utilizing SRH care.

Conclusions

These findings are useful for program implementers and policy makers to take the necessary steps to reduce or remove the barriers in the health system that are preventing FSWs from accessing SRH care, and ultimately meet the unmet healthcare needs of FSWs.

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Most cited references 20

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Estimates of the number of female sex workers in different regions of the world.

F Crabbé, J Vandepitte, R Lyerla … (2006)

To collect estimated numbers of female sex workers (FSW) and present proportions of FSW in the female population (FSW prevalence) in different regions of the world. Subnational and national estimated numbers of FSW reported in published and unpublished literature, as well as from field investigators involved in research or interventions targeted at FSW, were collected. The proportion of FSW in the adult female population was calculated. Subnational estimates were extrapolated to national estimates if appropriate. Population surveys were scanned for proportions of adult women having sex in exchange for money or goods. In sub-Saharan Africa, the FSW prevalence in the capitals ranged between 0.7% and 4.3% and in other urban areas between 0.4% and 4.3%. Population surveys from this same region yielded even higher proportions of women involved in transactional sex. The national FSW prevalence in Asia ranged between 0.2% and 2.6%; in the ex-Russian Federation between 0.1% and 1.5%; in East Europe between 0.4% and 1.4%; in West Europe between 0.1% and 1.4%; and in Latin America between 0.2% and 7.4%. Estimates from rural areas were only available from one country. Although it is well known and accepted that FSW are a highly vulnerable group in the scope of the HIV epidemic, most countries in the world do not know the size of this population group. The estimates of the prevalence of FSW presented in this paper show how important this hard-to-reach population group is in all parts of the world.

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Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study

Rishan Weldegebreal, Yohannes Melaku, Mussie Alemayehu … (2015)

Background Unintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia. Methods A community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05. Results The magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn’t. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn’t use. Sex workers who had 60–96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). Conclusions High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1366-5) contains supplementary material, which is available to authorized users.

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Knowledge of, attitudes toward, and preventive practices relating to cholera and oral cholera vaccine among urban high-risk groups: findings of a cross-sectional study in Dhaka, Bangladesh

Tasnuva Wahed, Sheikh Shah Tanvir Kaukab, Nirod Chandra Saha … (2013)

Background In endemic countries such as Bangladesh, consequences of cholera place an enormous financial and social burden on patients and their families. Cholera vaccines not only provide health benefits to susceptible populations but also have effects on the earning capabilities and financial stability of the family. Community-based research and evaluations are necessary to understand perceptions about and practices of the community relating to cholera and oral cholera vaccines. This may help identify the ways in which such vaccines may be successfully introduced, and other preventive measures can be implemented. The present study assessed the knowledge of, attitudes toward, and preventive practices relating to cholera and oral cholera vaccine among an urban population residing in a high cholera-prone setting in Dhaka, Bangladesh. Methods This cross-sectional study was conducted in an area of high cholera prevalence in 15 randomly-selected clusters in Mirpur, Dhaka city. A study team collected data through a survey and in-depth interviews during December 2010–February 2011. Results Of 2,830 families included in the final analysis, 23% could recognize cholera as acute watery diarrhea and 16% had ever heard of oral cholera vaccine. About 54% of the respondents had poor knowledge about cholera-related issues while 97% had a positive attitude toward cholera and oral cholera vaccine. One-third showed poor practice relating to the prevention of cholera. The findings showed a significant (p < 0.05) association between the respondents’ knowledge and sex, education, occupation, monthly overall household expenditure, attitudes and practice. In the adjusted model, male sex, having a lower monthly overall household expenditure, and having a less positive attitude toward cholera were the significant predictors to having poor knowledge. Conclusions The findings suggest the strengthening of health education activities to improve knowledge on cholera, its prevention and treatment and information on cholera vaccination among high-risk populations. The data also underscore the potential of mass cholera vaccination to prevent and control cholera.

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Author and article information

Contributors

Tasnuva Wahed:

ORCID: http://orcid.org/0000-0002-6819-8370

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Anadil Alam: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draft

Salima Sultana: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administration

Monjur Rahman: Role: Data curationRole: Formal analysisRole: Software

Nazmul Alam: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – review & editing

Monika Martens: Role: Writing – original draftRole: Writing – review & editing

Ratana Somrongthong: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Iratxe Puebla: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 31 July 2017

Publication date Collection: 2017

Volume: 12

Issue: 7

Electronic Location Identifier: e0182249

Affiliations

[1 ] College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

[2 ] Research to Policy Limited, Mirpur, Dhaka, Bangladesh

[3 ] Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh

[4 ] HIV/AIDS Sector, Save the Children, Gulshan, Dhaka, Bangladesh

[5 ] University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada

[6 ] Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands

Public Library of Science, FRANCE

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: ratana.so@ 123456chula.ac.th (RS); tasnuva.wahed@ 123456gmail.com (TW)

Author information

Tasnuva Wahed http://orcid.org/0000-0002-6819-8370

Article

Publisher ID: PONE-D-16-24568

DOI: 10.1371/journal.pone.0182249

PMC ID: 5536311

PubMed ID: 28759575

SO-VID: d55d1a52-189e-4769-9f46-b83aa169ee20

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 19 June 2016

Date accepted : 14 July 2017

Page count

Figures: 1, Tables: 5, Pages: 19

Funding

The first author received partial PhD fund from the USAID's Next Generation of Public Health Experts (NGPHEP), and the PhD Scholarship Program implemented by James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University. She also received research scholarship “THE 90TH Anniversary of Chulalongkorn University Scholarship” from Chulalongkorn University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability To maintain participants’ confidentiality, data can’t be made publicly available. Data can be accessible after publication from Graduate School Chulalongkorn University, Bangkok, Thailand (Web site: http://www.grad.chula.ac.th/eng/about-us and contact: Chaloem Rajakumari 60 Building (Chamchuri 10 Building), M1 Floor, Soi Chula 12, Phayathai Road, Phatumwan, Bangkok, 10330 Thailand Tel. (662)218-3501 press 0, Fax. (662)218-3522 E-mail: grad@ 123456chula.ac.th ).

Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka city, Bangladesh

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Abstract

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Conclusions

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Most cited references 20

Estimates of the number of female sex workers in different regions of the world.

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study

Knowledge of, attitudes toward, and preventive practices relating to cholera and oral cholera vaccine among urban high-risk groups: findings of a cross-sectional study in Dhaka, Bangladesh

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