Are internal migrants (head porters) sexually vulnerable due to the coronavirus pandemic? A qualitative study of the situation in Ghana

Head porterage, popularly known in Ghana as Kayayei, has been an old economic venture for young girls and women who migrate from the northern to the southern part of the country. Even though Head Porters view Kayayei as a source of livelihood, conditions such as the outbreak of the 2019 coronavirus disease (COVID-19) further worsened their sexual vulnerabilities, as well as their autonomy to make decisions on contraceptive use. Head Porters, as a term defined in this study, refers to women aged 15 years or older who carry loads from one point of the town to another for a fee. The study is qualitative and used both purposive and simple random sampling in recruiting 120 Head Porters for focus group discussions. The study was planned and implemented in three zones in Kumasi, the Ashanti Regional capital of Ghana, during the lockdown period (between March and April 2020). Factors such as access to contraceptives, self-reported sexual desire, and partner desire to use condoms, sexual demands, and the impact of the COVID-19 pandemic on contraceptive access were assessed. Sexual demands increased during the COVID-19 period, with most Head Porters indicating they used fewer condoms and contraceptives during the same period. The desire to use a condom was limited among both Head Porters and their partners, and access to contraceptives was hampered by fear of getting infected by COVID-19 from a health worker at family planning clinics. The COVID-19 pandemic significantly increased the sexual and economic vulnerabilities of Head Porters in Ghana and impacted their access to family planning services. Governmental and international organizations need to start developing intervention programs for vulnerable populations such as Head Porters before future disease outbreaks.