Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

Feldblum, Paul J.; Nasution, Marlina D.; Hoke, Theresa H.; Van Damme, Kathleen; Turner, Abigail N.; Gmach, Rebecca; Wong, Emelita L.; Behets, Frieda

doi:10.1016/j.contraception.2007.04.009

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Volume 76, Issue 2 , Pages 105-110, August 2007

Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection

Paul J. Feldblum
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA
- Corresponding author. Tel.: +1 919 544 7040; fax: +1 919 544 7261.
Marlina D. Nasution
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA
Theresa H. Hoke
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA
Kathleen Van Damme
- UNC-Madagascar Enceinte INSPC, Ex-Ecole de Médecine, Befelatanana, Antananarivo 101, Madagascar
Abigail N. Turner
- Department of Epidemiology, School of Public Health, University of North Carolina-Chapel Hill, Campus Box 7435, Chapel Hill, NC 27599-7435, USA
Rebecca Gmach
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA
Emelita L. Wong
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA
Frieda Behets
- Department of Epidemiology, School of Public Health, University of North Carolina-Chapel Hill, Campus Box 7435, Chapel Hill, NC 27599-7435, USA

Received 11 December 2006; received in revised form 27 March 2007; accepted 22 April 2007. published online 25 June 2007.

Abstract

Background

Little is known about pregnancy rates among sex workers (SWs) or the factors that predispose SWs to this risk. We aimed to estimate the pregnancy incidence rate among Madagascar SWs participating in an intervention trial promoting use of male and female condoms and assess the influence of various predictive factors on pregnancy risk.

Methods

SWs from two study clinics in Madagascar participated in a randomized trial to assess the effect of peer education and clinic-based counseling on use of male and female condoms and prevalence of sexually transmitted infections (STIs). Women were seen every 2 months for up to 18 months; they received structured interviews at every visit, and physical exams at baseline and every 6 months thereafter. Site staff recorded information on pregnancies during interviews; pregnancy data were then merged with trial data for this analysis.

Results

Of 935 SWs in the analysis population, 250 became pregnant during follow-up. The cumulative probability of pregnancy was 0.149 at 6 months and 0.227 at 12 months. Comparable proportions of nonpregnant and pregnant SWs reported using highly effective contraception at baseline (∼16%); these users were younger and were more consistent condom users. Method switching and discontinuation were frequent. In multivariate analysis, nonuse of effective contraceptives and any self-reported unprotected sex were associated with higher incidence of pregnancy. Approximately 51% of women delivered, 13% reported a spontaneous abortion, 13% reported an induced abortion and 23% had missing pregnancy outcomes.

Conclusions

Women traditionally targeted for STI/HIV preventive interventions need more comprehensive reproductive health services. In particular, SWs could benefit from targeted family planning counseling and services.

Keywords: Pregnancy rate, Sex workers, Contraception, Dual protection, Cohort study, Poisson regression