Reproductive Health Needs of Female Sex Workers 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 FSWs. The evaluation involved survey interviews with 354 hotel-based and 323 street-based FSWs in Dhaka, as well as in-depth interviews (IDIs) with both groups, NGO service providers, peer educators, and key informants. The survey was conducted between May 24 and July 12, 2011, and the IDIs took place between July 6 and July 25, 2011. The study found that hotel-based workers were younger (average age 22 years) than street-based workers (average age 26 years) and were more likely to have at least some schooling (68% compared to 47% of street-based workers). Hotel-based workers were also more likely to have a higher average number of clients each day (22 compared to 6) and had a higher average number of living children (1.3 compared to 1.7). The majority of both groups reported that they did not want any more children or did not want a pregnancy within the next 12 months, with 84% of hotel-based workers and 86% of street-based workers citing this as their preference. In-depth interviews highlighted the problems associated with becoming pregnant, including the inability to care for a baby and the impact on their ability to work. Knowledge of family planning (FP) methods was high among FSWs, with condoms and pills being the most widely known methods. Over 90% of FSWs reported using condoms, and 48% of hotel workers and 36% of street workers were using a method aside from condoms. Pills and injectables were the methods most commonly used, with hotel workers using pills more than injectables. However, consistent condom use was a concern, with 42% of FSWs reporting that they had a condom break in the 30 days preceding the interview, and one-fourth reporting that they had accepted more money in exchange for not using a condom during this time period. Many FSWs did not feel they could force a client to use a condom, and that if they insisted, the client may go to a different woman or even beat them. The study also found that sexual and physical violence can affect condom use, fertility desires, and pregnancy risk. Fifty-four percent of street workers and 28% of hotel workers reported that they had been forced to have sex when they did not want to in the past year, and 80% of street workers reported that they had been beaten or received an injury in the past year compared to 43% of hotel workers. Unmet need for contraception was calculated by looking at modern method use, consistent condom use, and fertility desires. Despite the high reported use of contraception, 25% of hotel workers and 36% of street workers had an unmet need for contraception. Twenty-nine percent of hotel FSWs and 25% of street FSWs reported that they wanted to use a method other than condoms in the future, with injectables followed by pills being named most often. The study highlights the need for comprehensive family planning services that address the reproductive health needs of FSWs, including access to modern contraceptive methods, education on safe sex practices, and support for those who have experienced violence or trauma.