Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility based survey

Abstract

Introduction Female sex workers (FSWs) are marginalized due to social rejection and stigma, especially in countries where the practice is illegal. Many FSWs are mothers but little is known about their utilization of maternal services. This study investigated the determinants of utilization of maternal services by FSWs in Uganda. Methods FSWs were recruited from the “Most at-Risk Initiative” clinics in Uganda. We analyzed data for 318 FSWs who had given birth within two years of the study to estimate the proportion of FSWs who used all the components of maternal services (antenatal, facility-based delivery and postnatal). The outcome variable (utilization of maternal services) was categorized as “recommended package” if the women received all the three services, “moderate” if they received any two and “limited/none” if they received only one or none of the services. Multinomial logistic regression analysis was used to quantify the impact of pregnancy planning and other factors on the utilization of maternal services. Results Overall, 25.2% (80) utilized all the three services in the recommended package of maternal services, 47.5% (151) had moderate utilization, while 27.3% (87) utilized limited or no services. Factors that influenced utilization of the recommended package compared to “limited/none” use were having a planned pregnancy (adjusted RRR (aRR) = 3.87; 95% CI = 1.40-10.67), knowing four as the minimum number of ANC visits (aRR = 2.43; 95% CI = 1.22-4.87), never having been criminalized for sex work (aRR = 2.48; 95% CI = 1.30-4.74) and not believing that health providers deny services to FSWs believing (aRR = 2.63; 95% CI = 1.37-5.07). Conclusion These findings confirm the relevance of pregnancy planning in the utilization of maternal services among FSWs. However, maternal health service utilization was generally low and interventions to reduce barriers including inadequate knowledge of ANC visits, internal stigma and criminalization of sex work are required. These are necessary steps in the move towards universal health coverage.