A cross-sectional study of contraception and abortion utilization among female sex workers in the democratic Republic of Congo, Kenya, and Nigeria: preferences, access, and barriers

Female sex workers (FSW) report high rates of unintended pregnancy and unmet need for contraception. Using convenience sampling, this cross-sectional study included 853 FSW recruited from eight cities in the Democratic Republic of the Congo (DRC), Kenya, and Nigeria, where proportionate mortality from unsafe abortion is high. The study examined contraceptive prevalence, preferences, access, and barriers, and abortion history, methods and complications. Non-condom modern contraceptive prevalence was higher among FSW in Kenya (73.2%) than in the DRC (40.8%) and Nigeria (26.9%). A greater proportion of FSW in Kenya reported no abortion in the past five years (82.8%) compared with the DRC (54.0%) and Nigeria (33.9%). Among those reporting abortion, the mean number was lower in Kenya (1.5) than in the DRC (1.7) and Nigeria (2.2). Cost was a common barrier to accessing contraceptives in the DRC and Nigeria (approximately one-third of respondents) but less common in Kenya (9%). Contraceptive preferences differed. The majority of FSW in Kenya preferred long-acting reversible contraception (LARC). Although the majority of FSW in the DRC and Nigeria preferred condoms, client dynamics in criminalized settings may limit consistent condom use making them ineffective. Improving access to free or affordable non-condom modern contraceptives, particularly LARC, is critical to reducing unintended pregnancies and preventing morbidity and mortality from unsafe abortion among FSW. Increased education and counseling on LARC methods may further support uptake.