FHI - High Rates of Pregnancy and Cervical Infection Signal Need for Dual Protection

Young sex workers urgently need dual protection against both pregnancy and sexually transmitted infections (STIs), according to data from a USAID-supported study of condom promotion in Madagascar.

Among some 900 sex workers that were included in the analysis, about a quarter became pregnant during the 18-month observation period. According to the results, published in the journal Contraception, the strongest predictors of pregnancy in this population were the nonuse of an effective form of contraception, self-reported unprotected sex, and young age.

Additional results in the journal Sexually Transmitted Diseases show that self-reported unprotected sex and — especially — young age were important predictors of cervical infections among sex workers. Young women, 16 to 19 years old, were 1.5 times more likely than older women to acquire a chlamydial or gonococcal infection. This increased risk remained even when any differences in sexual behavior between the younger and older women were taken into account. Several factors could account for this finding, including immature reproductive tracts, weaker immune responses, and greater gender inequities or power imbalances in the relationships of young women when compared with their older counterparts.

Future interventions should address the family planning needs of sex workers and promote consistent condom use among sex workers and their partners. Prevention efforts should also target parents and community leaders to help increase educational and employment opportunities for young women.

This research was conducted by scientists from Family Health International, the University of North Carolina at Chapel Hill, and the University of North Carolina at Madagascar. To read more, click here and/or here.

Sources
Feldblum PJ, Nasution MD, Hoke TH, et al. Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection. Contraception 2007;76(2):105-110.

Pettifor AE, Turner AN, Van Damme K, et al. Increased risk of chlamydial and gonococcal infection in adolescent sex workers in Madagascar. Sex Transm Dis 2007;34(7):375-378.