Reproductive History and Pregnancy incidence of Malian and Beninese Female Sex workers before and During Sex Work Practice

Aim/Background: To reduce maternal mortality (MM), access to family planning and reproductive health care services are key strategies. Access to and use by marginalized populations pose a substantial challenge. The objective of this study was to describe the reproductive history of female sex workers (FSWs) before and during sex work. Materials and methods: FSWs aged ≥18 years were recruited in Benin, and Mali, to answer a questionnaire during a faceto-face interview. Descriptive analyses were carried out and comparisons made between countries (Pearson chi-square) and between the periods before (BSW) and during sex work (DSW) practice within women in each country (McNemar chi-square). In addition, multiple imputations were used to estimate and compare the incidence rate of pregnancy BSW and DSW calculated with a generalized linear model for count data with a Poisson distribution and a log link. Results: Mean age was 26 years in Mali (n=322) and 35 years in Benin (n=330). More women had at least one pregnancy BSW compared to DSW in both Mali (62.1%-vs-33.5%) and Benin (91.2%-vs-32.7%). The pregnancies occurring DSW had lower livebirth rates (57.9%-vs-74.7% Mali, 17.6%-vs-60.6% Benin) and ended more often with a therapeutic abortion, DSW compared to BSW, especially in Benin (65.2%-vs-25.6%). The level of complications associated with therapeutic abortion was high, both DSW (23%) and BSW (20%). The incidence rate of pregnancy was about twice lower DSW compared to BSW [incidence rate ratio (IRR): 0.49; 95% confidence interval (95%CI): 0.37-0.66-Mali and IRR: 0.45; 95% CI: 0.32-0.63-Benin]. Conclusion: In both Benin and Mali, FSWs had more pregnancies during the period preceding sex work practice, about twice more than during sex work when considering the differences in incidence rates. Single mothers need to be supported to avoid sex work as a financial solution. On the other hand, the reproductive needs of FSWs need to be acknowledged to reduce maternal mortality within this marginalized population. It is of paramount importance that interventions remain focused on reproductive health and prevent unwanted pregnancies, answer contraceptive needs and provide safe therapeutic abortions.