Reproductive Health Needs of Female Injecting Drug Users in Dhaka, Bangladesh

The study aimed to provide information to donors and local stakeholders to inform the development of interventions to meet the reproductive health needs of female injecting drug users. The study was conducted in close collaboration with two nongovernmental organizations (NGOs) that provide services to injecting drug users: Society for Community Health Rehabilitation, Education, and Awareness (CREA) and Ashokti Punorbashon Nibash (APON). The specific objectives of the study were to measure the unmet need for family planning among female injecting drug users in Dhaka, identify the best ways to provide family planning information and services, assess the health-seeking behaviors of female injecting drug users, identify other sexual and reproductive health services that would help female injecting drug users meet their greater health needs, and offer recommendations on developing interventions that provide more comprehensive services to female injecting drug users. The study team conducted survey interviews with female injecting drug users in Dhaka, as well as in-depth interviews with injecting drug users, NGO service providers, peer educators, and key informants. The evaluation was approved by the Bangladesh Medical Research Council and FHI 360's Protection of Human Subjects Committee. Respondent-driven sampling was used to identify and select the hard-to-reach population of female injecting drug users in Dhaka. The sociodemographic and reproductive characteristics of the 17 female injecting drug users surveyed were as follows: the average age was 27 years, and the majority (12) had never attended school. Four of the injecting drug users were married, and another seven reported having a boyfriend or steady partner. Sixteen of the injecting drug users said they had sexual intercourse in the past 30 days, and 15 reported that they sold sex in the past six months. Many injecting drug users reported that they sold sex to help sustain their drug use and meet basic living needs. The reproductive history of the injecting drug users was also assessed. Fourteen injecting drug users had ever been pregnant, 10 had ever given birth, and 11 reported at least one abortion or menstrual regulation. Eight had children at the time of the interview, with an average of 1.4 children among these women. Nine of the injecting drug users surveyed did not want any more children, and another five wanted to wait more than a year before they became pregnant. The study found that knowledge of modern family planning methods was very high, and all of the 17 injecting drug users surveyed could name at least one method. Pills were the most widely known, followed by condoms and injectables. Fifteen of the 17 injecting drug users reported that they were currently using condoms. Very few were using a method other than condoms. Pills were being used by three, and one injecting drug user had been sterilized. The study also found that condoms were being used more consistently with non-steady partners (sex work clients) than with steady partners. When asked how many times they used a condom in their past five sex acts with these two types of partners, eight said they used condoms in five out of five acts with non-steady partners, but only two said they used condoms this frequently with their husbands, boyfriends, or other steady partners. Four out of the 15 currently using condoms had experienced a condom breaking in the 30 days preceding the survey interview. In the in-depth interviews, the female injecting drug users who sold or exchanged sex said they faced challenges, especially violence, when attempting to negotiate condom use. Many injecting drug users reported that they were beaten in the 12 months preceding the survey, and 10 of the 17 had been forced to have sex in the past year. The study found that despite the high reported use of condoms, 10 of the 17 injecting drug users surveyed had an unmet need for contraception. Among the 13 injecting drug users who were using only condoms or no method at all, eight said they were interested in using a method other than condoms in the future. Women identified pills, female condoms, implants, and injectables as their options; one injecting drug user wanted counseling on what options were available to them, and one did not respond. The study also found that knowledge of where to get family planning counseling and methods was relatively high, with 11 of the 17 injecting drug users knowing of a location. When injecting drug users were asked where they would prefer to get family planning services, the drop-in centers (DICs) were the most commonly mentioned, followed by other NGO facilities and Marie Stopes. Most of the injecting drug users in the in-depth interviews reported that they were treated well by staff at the DICs and that they were satisfied with the services there.