Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility based survey
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
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.
Description
Keywords
Maternal health, Pregnancy planning, Female sex workers, Uganda, Sub-Saharan Africa
Citation
Bukenya, J., Barrett, G., Kaharuza, F., Guwatudde, D., & Wanyenze, R. K. (2019). Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility-based survey. https://doi.org/10.21203/rs.2.12740/v1