Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010
November
Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010
Mohammad Karamouzian 0 1
Ali Mirzazadeh 0 1
Mostafa Shokoohi 0 1
Razieh Khajehkazemi 1
Abbas Sedaghat 1
Ali Akbar Haghdoost 1
Hamid Sharifi 0 1
0 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman , Iran , 2 School of Population and Public Health, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada , 3 Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco, CA , United States of America, 4 Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, ON , Canada , 5 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman , Iran , 6 Center for Disease Control (CDC), Ministry of Health and Medical Education , Tehran , Iran
1 Editor: Susan Marie Graham, University of Washington , UNITED STATES
Unintended pregnancies and abortion may be considered as occupational hazards for female sex workers (FSWs). As our understanding of contraceptive and abortion practices of Iranian FSWs is very limited, this study tries to assess the dynamics of contraception and abortion among this sub-population.
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OPEN ACCESS
Competing Interests: Abbas Sedaghat has
contributed to the development of HIV programs in
Methods
Results
This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 14 cities in Iran. Data were collected through face-to-face interviews using a pilot-tested standardized risk assessment questionnaire. We applied the logistic regression model to investigate the correlates of induced abortion among FSWs.
Of the 863 participants with valid responses to the abortion variable, 35.3% (95% CI: 32.1±
38.6) acknowledged ever induced abortion and the annual rate of abortion was estimated at
20.7 per 1000 women. Around 31.2% of FSWs reported no usual contraceptive use, 32.6%
barrier method, 23.6% non-barrier modern contraception methods, and 12.5% dual
protection. In our multivariable model, older age (Adjusted Odds Ratio (AOR) = 1.74, 95%
Confidence Interval (CI): 1.02, 2.96), group sex (AOR = 1.92, 95% CI: 1.10, 3.35), history of
travel for sex work (AOR = 1.55, 95% CI: 1.09, 2.20), sexual violence (AOR = 1.77, 95% CI:
1.25, 2.50), STIs in last year (AOR = 1.53, 95% CI: 1.09, 2.14), and accessing family
planning services (AOR = 1.76, 95% CI: 1.24, 2.49) were significant predictors of lifetime
abortion.
Iran and is supported by the Ministry of Health. The
rest of the authors have no competing interests.
This does not alter our adherence to PLOS ONE
policies on sharing data and materials.
Conclusions
The reproductive health needs of Iranian FSWs are unmet and around one-third of FSWs reported induced abortion. Scaling-up comprehensive family planning services and empowering FSWs to have safer sex practices may help them to prevent unintended pregnancies and further risk of HIV transmission.
Introduction
Female sex workers' (FSWs) sexual and reproductive health needs are complicated given their
vulnerability to sexually transmitted infections (STIs) and unintended pregnancies [
1
].
However, due to the sensitive nature of sex work, they remain underrepresented in fertility-related
research and their fertility needs are often invisible or overshadowed by their `risky'
occupation [
1
]. Several studies have reported high HIV and STIs prevalence, physical and sexual
violence, and limited access to healthcare services among FSWs; all of which have adverse effects
on their pregnancy outcomes [1±4]. Not often recognized as mothers, health risks associated
with pregnancy outcomes in FSWs remain overlooked [
2, 5
].
Recent research, however, suggests that despite complex reasons for pregnancy among
FSWs, most desire to have or have children [
3, 5, 6
]. While some FSWs may consider having
children as a way to solidify their relationship with a sex partner or leave sex work, others may
be forced into sex work to provide for their children [
1, 5, 7
]. On the other hand, unintended
pregnancies±as an occupational hazard±are very frequent among FSWs across different
settings and often lead to abortion [
1, 2
]. Evidence suggests that many abortions among this
population are unsafe, and most FSWs suffer from its complications [
1, 8
]. Unsafe practices of
abortion among FSWs are mainly driven by the criminalization of sex work and abortion [
1
].
In the context of Iran, similar to several other settings, sex work remains criminalized and
highly stigmatized [
2, 4, 9
]. Additionally, induced abortion is illegal, except for medical
indications that are life-threatening to mother or diagnoses of congenital fetal defects (e.g., Down
syndrome (...truncated)