Contraception 96 (2017) 196 202

Original research article

Contraceptive use and unplanned pregnancy among female sex

workers in Zambia,,
Michael M. Chanda a , Katrina F. Ortblad b , Magdalene Mwale a , Steven Chongo a ,
Catherine Kanchele a , Nyambe Kamungoma a , Leah G. Barresi c , Guy Harling b, d ,
Till Brnighausen b, e, f , Catherine E. Oldenburg g,
a
John Snow, Inc, Lusaka, Zambia
b
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
c
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
d
Research Department of Infection and Population Health, University College London, UK
e
Africa Health Research Institute, Mtubatuba, South Africa
f
Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
g
Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
Received 5 December 2016; revised 1 July 2017; accepted 3 July 2017

Abstract

Objectives: Access to reproductive healthcare, including contraceptive services, is an essential component of comprehensive healthcare for
female sex workers (FSW). Here, we evaluated the prevalence of and factors associated with contraceptive use, unplanned pregnancy, and
pregnancy termination among FSW in three transit towns in Zambia.
Study design: Data arose from the baseline quantitative survey from a randomized controlled trial of HIV self-testing among FSW. Eligible
participants were 18 years of age or older, exchanged sex for money or goods at least once in the past month, and were HIV-uninfected or
status unknown without recent HIV testing (b3 months). Logistic regression models were used to assess factors associated with contraceptive
use and unplanned pregnancy.
Results: Of 946 women eligible for this analysis, 84.1% had been pregnant at least once, and among those 61.6% had an unplanned
pregnancy, and 47.7% had a terminated pregnancy. Incarceration was associated with decreased odds of dual contraception use (aOR=0.46,
95% CI 0.320.67) and increased odds of unplanned pregnancy (aOR=1.75, 95% CI 1.561.97). Condom availability at work was associated
with increased odds of using condoms only for contraception (aOR=1.74, 95% CI 1.212.51) and decreased odds of unplanned pregnancy
(aOR=0.63, 95% CI 0.610.64).
Conclusions: FSW in this setting have large unmet reproductive health needs. Structural interventions, such as increasing condom
availability in workplaces, may be useful for reducing the burden of unplanned pregnancy.
2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Keywords: Female sex workers; Abortion; Family planning; Sub-Saharan Africa

Funding: This study was funded by the International Initiative for Impact Evaluation (3ie). KFO was supported in part by NIAID T32AI007535 (PI: Seage). CEO
was supported in part by NIDA T32DA013911 (PI: Flanigan) and NIMH R25MH083620 (PI: Nunn). TB was supported by the Alexander von Humboldt Foundation
through the endowed Alexander von Humboldt Professorship funded by the German Federal Ministry of Education and Research, as well as by the Wellcome Trust,
the European Commission, the Clinton Health Access Initiative, and by NICHD R01HD084233 (PIs: Brnighausen and Tanser), NIAID R01AI124389 (PIs:
Brnighausen and Tanser), and D43TW009775 (PIs: Fawzi and Brnighausen).

Conflicts of ineterest: No authors have any conflicts of interest to report.

Clinical Trials Registration: clinicaltrials.gov NCT02827240; registered 30 June 2016.
Corresponding author. Tel.: +1 415 502 8843.
E-mail address: [email protected] (C.E. Oldenburg).

http://dx.doi.org/10.1016/j.contraception.2017.07.003
0010-7824/ 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
 M.M. Chanda et al. / Contraception 96 (2017) 196202 197

1. Introduction study towns. Each peer educator recruited approximately six

women who were enrolled in the trial.
Female sex workers (FSW) in sub-Saharan Africa face Women were eligible for participation in the study if they
large barriers to accessing essential healthcare services, were 18 years of age or over at the time of enrollment,
including stigma and discrimination, criminalization of sex reported exchanging sex for money, goods, or other items of
work and fear of repercussions of seeking care, and value at least once in the prior month, self-reported an HIV
challenges with logistically accessing care (e.g., difficulty negative or unknown status and had not tested for HIV in the
with transportation or clinic hours). FSW bear a dispropor- past 3 months, and reported a primary residence in one of the
tionately large burden of HIV in sub-Saharan Africa [1]. three study sites (Chirundu, Livingstone, or Kapiri Mposhi).
Factors at multiple levels, including structural environments The study was reviewed and approved by the Institutional
and interpersonal dynamics, potentiate this elevated risk Review Boards at the Harvard T.H. Chan School of Public
among FSW [2]. An unmet need for contraception has been Health in Boston, MA, USA, and ERES Converge in
documented in several settings in sub-Saharan Africa among Lusaka, Zambia. We obtained written informed consent from
FSW [36]. Lack of access to contraceptive services may all participants.
lead to unplanned pregnancies or pregnancy termination [4],
which can in turn lead to increased maternal mortality, 2.2. Measures
continued dependence on sex work to financially support
children, or HIV transmission to children if prevention of A trained research assistant collected all data in a
mother-to-child transmission services are not utilized. face-to-face interview at a location that was convenient
Unsafe abortion is a major cause of maternal mortality and private. Data were collected via tablet using the
worldwide [7]. Despite provisions for the legality of abortion electronic data capture platform CommCare (Dimagi, Inc.
under some circumstances in Zambia, such as in the case of Cambridge, MA, USA).
risk to the pregnant woman's life, physical, or mental health, Contraceptive use was measured by asking participants if
in the case of child rape, or in the case of high risk of fetal they were currently using a method for family planning to
impairment, abortion remains a major contributor to avoid becoming pregnant. We asked those who answered
maternal mortality [8]. Increasing access to contraception affirmatively what method they were using as an open-ended
may reduce unplanned pregnancy and pregnancy termina- question. Research assistants checked all that applied from a
tion, which could in turn lead to reduced maternal mortality pre-populated list, or wrote in other categories in an open text
and improved birth outcomes. field. We asked those who reported they were not currently
In Zambia, little evidence exists of contraception use and using family planning what were some reasons they were not
pregnancy outcomes among FSW. A better understanding of using family planning in an open-ended fashion. Research
contraceptive access and burden of unplanned pregnancy assistants recorded outcomes on a pre-populated list or wrote
and pregnancy termination may lead to improved contra- in other categories in an open text field. We considered
ceptive services for this population. Here, we report the participants to be using only condoms for contraception if
prevalence of and factors associated with contraceptive they reported condom use for contraception but no other
access and unplanned and terminated pregnancy among a contraceptive method. We considered participants to be
sample of FSW not known to be living with HIV in three using non-barrier methods of contraception only if they
transit towns in Zambia. reported current use of oral birth control pills, injectable
contraceptives, implant devices, intrauterine devices or
vaginal rings and did not report using condoms for
contraception. We considered participants to be using dual
2. Methods contraceptive methods if they reported using both a
2.1. Participants and procedures non-barrier method and condoms for birth control purposes.
Reproductive health outcomes, including unplanned
We used data from the baseline cross-sectional quantita- pregnancy and pregnancy termination, were measured by
tive assessment of the Zambian Peer Educators for HIV first asking participants if they had ever been pregnant. We
Self-Testing (ZEST) Study, a cluster randomized trial asked those who responded affirmatively how many times
investigating the effect of HIV self-testing provision they had been pregnant and how many living children they
among HIV testing outcomes among female sex workers had. We asked women who reported a history of pregnancy
in Zambian transit towns (ClinicalTrials.gov NCT02827240) if they had ever been pregnant when they did not want to be.
[9]. Participants completed the baseline questionnaire from We measured abortion by asking women Have you ever
September to October, 2016. Participants were recruited by been in a position where you or someone else has had to do
peer educators, who were current or former female sex something to end your pregnancy.
workers in Livingstone, Chirundu, and Kapiri Mposhi, Demographics included age, having a primary partner, if
Zambia. Peer educators were recruited through contacts with the participant could read and write, if they had a mobile
former sex worker organizations working in each of the three phone, and monthly income in kwacha.
198 M.M. Chanda et al. / Contraception 96 (2017) 196202

Structural and Interpersonal measures included arrest/ (66.6%) were currently using a form of non-barrier birth
incarceration history (measured by asking participants if they control (Fig. 1A). The most common non-barrier methods
had ever been arrested or incarcerated), age at sexual debut, included injectables (57.8%), oral birth control pills (27.5%),
experiences of sexual assault by clients and partners in the and implants (12.7%; Fig. 1B). More than half (61.7%) of
past 12 months, and condom availability while working. participants who had been pregnant at least once had had an
unplanned pregnancy, and 47.7% reported terminating a
2.3. Statistical analysis pregnancy.
Individuals who reported that they were not using Table 2 lists results of models assessing factors associated
contraception because they were trying to become pregnant with contraceptive use. Older age at sexual debut was
were excluded from all analyses. Distributions of character- associated with increased odds of using only condoms as
istics were calculated with medians and interquartile ranges contraception (aOR 1.04, 95% CI 1.021.06), but was not
(IQR) for continuous variables and proportions for categor- associated with using only non-barrier methods or use of
ical variables. We investigated factors associated with (1) use both condoms and non-barrier methods. Condom availability
of condoms only for contraception, (2) use of non-barrier at work was associated with increased odds of using only
methods only for contraception, (3) use of both condoms and condoms for contraception (aOR 1.74, 95% CI 1.212.51).
non-barrier methods for contraception, (4) history of History of incarceration or arrest was associated with
unplanned pregnancy, and (5) history of terminated decreased odds of using both condom and non-barrier
pregnancy using logistic regression models, and included methods for contraception (aOR 0.46, 95% CI 0.320.67).
sociodemographic variables (including age, having a Table 3 lists results of models assessing factors associated
primary partner, literacy, mobile phone ownership, monthly with history of unplanned and terminated pregnancy. Earlier
income) and structural-level variables (including age at age at sexual debut was associated with reduced odds of
sexual debut, arrest/incarceration history, sexual abuse from unplanned (aOR 0.91 per one-year increase in age at sexual
clients and primary partners, and condom availability at debut, 95% CI 0.880.93) and terminated (aOR 0.94 per
workplaces). We included covariates that were theoretically one-year increase in age at sexual debut, 95% CI 0.910.96)
associated with reproductive health outcomes that represent- pregnancy. Condom availability in the workplace was
ed opportunities for intervention development (e.g., identi- associated with decreased odds of unplanned pregnancy
fying subgroups of participants with whom interventions (aOR 0.63, 95% CI 0.610.64) and termination of pregnancy
could be focused or identifying potentially modifiable risk (aOR 0.68, 95% CI 0.510.91). Arrest/incarceration history
factors). Models of unplanned or terminated pregnancy were was associated with greater odds of unplanned pregnancy
restricted only to women who reported ever being pregnant. (aOR 1.75, 95% CI 1.561.97) and termination of pregnancy
Standard errors were adjusted for clustering within study (aOR 1.87, 95% CI 1.642.12).
site. All analyses were conducted in Stata 14.1 (StataCorp,
College Station, TX, USA).
4. Discussion

3. Results In this study of FSW in transit towns in Zambia with

historically high HIV prevalence, we found a high
A total of 1280 women underwent phone screening, and prevalence of unplanned and terminated pregnancy. How-
965 (75.4%) were eligible and consented to participate in the ever, nearly three-quarters of women reported using a
study. Reasons for exclusion were self-reported HIV method of contraception, which is considerably higher than
infection (N=174; 13.6%), HIV testing in the past 3 months women in the general population in Zambia (approximately
(N=163; 12.7%), not meeting the sex work definition 25%) [10]. Approximately two-thirds of participants report-
(N=157; 12.3%), not willing to participate (N=104; ed using a non-barrier method for contraception, but fewer
10.8%), under age 18 (N=85; 6.6%), and residing outside than 20% of participants indicated they were using both
of the study catchment area (N=84; 6.6%). One woman could condoms and a non-barrier method. For women without
have multiple reasons for exclusion. Of the 965 women who current pregnancy intention, access to and use of dual
enrolled in the study and participated in the baseline survey, protection (the simultaneous use of both condoms and
19 (2.0%) reported that they were trying to get pregnant and female-controlled modern non-barrier method) is an
were excluded from this analytic sample. essential component of comprehensive reproductive health
Table 1 displays descriptive characteristics for the 946 services [11,12]. Modern non-barrier methods are the most
women in the analytic sample. Median age was 25 years effective for prevention of pregnancy, but do not reduce the
(IQR 2130). Half (50.0%) were recruited in Livingstone, risk of HIV acquisition. Condom use reduces the risk of HIV
and approximately one-quarter each were recruited in acquisition and thus is complementary to non-barrier
Chirundu and Kapiri Mposhi. More than half (59.4%) methods. In the present study, it is possible that women
reported having a primary partner and most (84.1%) had at who reported using both condoms and non-barrier methods
least one lifetime pregnancy. Approximately two-thirds were not using both simultaneously, and the true prevalence
 M.M. Chanda et al. / Contraception 96 (2017) 196202 199

Table 1
Descriptive characteristics of women using and not using a non-barrier family planning method among female sex workers in Zambia
Using NB Method Not Using NB Method Overall p Value 1
(N=630) (N=316) (N=946)
Age (median, IQR) 24 (2129) 26 (2132) 25 (2130) .005
Site
Livingstone 318 (67.2%) 155 (32.8%) 473 (50.0%) .71
Chirundu 162 (67.5%) 78 (32.5%) 240 (25.4%)
Kapiri 150 (64.4%) 83 (35.6%) 233 (24.6%)
Have a primary partner 379 (67.6%) 182 (65.4%) 561 (59.4%) .48
Can read and write 489 (68.9%) 221 (60.0%) 710 (75.5%) .02
Mobile phone ownership 545 (67.7%) 260 (60.3%) 805 (85.1%) .10
Monthly income
No income 121 (61.7%) 75 (38.3%) 196 (21.1%)
b250 kwacha 2 79 (67.5%) 38 (32.5%) 117 (12.6%)
251500 kwacha 2 149 (64.0%) 84 (36.1%) 233 (25.1%)
.25
5011000 kwacha 2 174 (71.9%) 68 (28.1%) 242 (26.0%)
10011500 kwacha 2 51 (70.8%) 21 (29.2%) 72 (7.7%)
N1500 kwacha 2 48 (68.6%) 75 (38.3%) 70 (7.5%)
Number of living children 1 (12) 1 (12) 1 (12) .008
Age at sexual debut (median, IQR) 16 (1518) 16 (1518) 16 (1518) .70
Ever arrested/incarcerated 176 (64.9%) 95 (67.4%) 271 (28.7%) .49
Client sexual abuse, past 12 months 178 (67.2%) 87 (66.5%) 265 (28.0%) .88
Primary partner sexual abuse, past 12 months 126 (68.1%) 59 (66.3%) 185 (19.6%) .67
Condom availability at work
Never 11 (64.7%) 6 (35.3%) 17 (1.8%)
Seldom 30 (71.4%) 12 (28.6%) 42 (4.5%)
Sometimes 388 (65.7%) 203 (34.4%) 591 (62.6%) .88
Often 55 (70.5%) 23 (29.5%) 78 (8.3%)
Always 145 67.1%) 71 (32.9%) 216 (22.9%)
Ever been pregnant 553 (69.5%) 243 (30.5%) 796 (84.1%) b.001
Number of pregnancies (median, IQR) 3 2 (13) 2 (13) 2 (13) .10
Number of living children (median, IQR) 3 1 (12) 1 (12) 1 (12) N.99
Any unplanned pregnancy3 351 (71.6%) 139 (28.4%) 490 (61.6%) .10
Any terminated pregnancy 3 276 (72.6%) 104 (27.4%) 380 (47.7%) .07
Abbreviations: NB, non-barrier; IQR, interquartile range 1Wilcoxon rank-sum test for continuous variables or Fisher's exact test for categorical variables; 210
kwacha = approximately USD$1; 3Among women who had ever been pregnant (N=796).

of dual contraceptive use may be even lower. These results The availability of condoms in the work place was
indicate that interventions to improve access and use of associated with increased use of condoms as a family
condoms and non-barrier methods may help improve planning method and decreased unplanned pregnancy and
reproductive health outcomes among FSW in Zambian termination of pregnancy. This may be because women
transit regions and other similar regions of sub-Saharan working in venues where condoms are available may have
Africa. greater agency with condom negotiation or increased access

Fig. 1. Proportion of female sex workers reporting contraceptive use (1A) and types of non-barrier methods reported (1B) among individuals using non-barrier
contraception (N=946). Abbreviations: IUD, intrauterine device; BCP; birth control pill.
200 M.M. Chanda et al. / Contraception 96 (2017) 196202

Table 2
Association between history of unplanned and terminated pregnancy and current contraceptive use among female sex workers in Zambia with no current fertility
desire (N=946).
Condoms only Non-barrier only Condoms and non-barrier methods
Bivariate 1 Multivariable 1 Bivariate 1 Multivariable 1 Bivariate 1 Multivariable 1
OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI)
Age 1.02 (0.971.07) 1.04 (0.991.09) 0.96 (0.950.97) 0.93 (0.910.95) 1.01 (0.971.05) 0.98 (0.931.03)
Have a primary partner 0.98 (0.581.66) 1.09 (0.572.07) 1.10 (0.971.25) 1.01 (0.841.22) 1.50 (0.663.37) 1.73 (0.913.30)
Can read and write 0.90 (0.521.55) 0.96 (0.831.11) 1.48 (1.022.14) 1.25 (0.801.94) 1.73 (0.754.00) 1.86 (0.605.76)
Mobile phone ownership 1.12 (0.413.08) 1.02 (0.402.59) 1.38 (1.231.56) 1.45 (1.331.59) 1.63 (1.501.77) 1.64 (1.152.33)
Monthly income
No income 1.00 1.00 1.00 1.00 1.00 1.00
b250 kwacha 1.19 (0.612.32) 1.17 (0.672.05) 1.29 (0.921.80) 1.16 (0.861.55) 14.6 (6.5032.6) 15.2 (5.6240.9)
251500 kwacha 0.35 (0.150.81) 0.37 (0.180.75) 1.10 (0.582.09) 1.04 (0.571.90) 4.12 (1.6011.0) 3.61 (1.2310.6)
5011000 kwacha 0.27 (0.160.46) 0.24 (0.160.35) 1.59 (0.972.59) 1.48 (0.772.83) 2.95 (0.899.79) 2.68 (0.4715.2)
10011500 kwacha 0.55 (0.221.42) 0.48 (0.230.43) 1.51 (0.952.38) 1.35 (0.722.54) 2.19 (0.598.09) 1.74 (0.2810.9)
N1500 kwacha 0.39 (0.270.57) 0.31 (0.220.43) 1.35 (0.622.97) 1.16 (0.443.10) 1.18 (0.433.27) 1.05 (0.215.37)
Number of living children 0.95 (0.841.07) 0.84 (0.780.91) 1.11 (0.991.23) 1.39 (1.131.71) 1.25 (0.921.70) 1.40 (1.041.87)
Age at sexual debut 1.08 (1.061.11) 1.04 (1.021.06) 0.98 (0.921.03) 0.98 (0.951.01) 1.04 (1.001.08) 1.01 (0.931.10)
Ever arrested/incarcerated 0.79 (0.511.22) 0.79 (0.491.26) 0.90 (0.751.07) 0.95 (0.851.07) 0.46 (0.211.01) 0.46 (0.320.67)
Client sexual abuse, past 12 months 0.75 (0.461.23) 0.74 (0.321.74) 1.03 (0.731.46) 1.09 (0.841.43) 1.83 (0.754.49) 2.20 (0.925.29)
Primary partner sexual abuse, past 12 months 1.03 (0.422.51) 1.59 (0.743.41) 1.08 (0.881.33) 0.98 (0.701.38) 1.30 (0.344.93) 1.22 (0.275.57)
Condoms always available at work 1.56 (1.002.42) 1.74 (1.212.51) 1.03 (0.751.41) 1.07 (0.791.45) 0.98 (0.771.23) 1.25 (0.712.23)
OR, odds ratio; aOR, adjusted odds ratio; 95% CI, 95% confidence interval. 1Logistic regression model with standard errors accounting for clustering within
study site.

to reproductive health services. Furthermore, condom intervention to improve condom use and improve reproduc-
availability is likely a facilitator for condom use with clients, tive health outcomes for FSW.
which may increase use and thus reduce unplanned Arrest/incarceration history was also an important
pregnancies and thus termination of pregnancy. However, determinant of contraceptive use and unplanned and
overall reported condom use was low in this population, terminated pregnancy. Women who have a history of
which likely increases risk of acquisition of HIV and incarceration may be further marginalized and have reduced
potentially mother-to-child transmission. Increasing avail- access to reproductive health services. Incarceration is
ability of condoms in the work place may be a low-cost hypothesized to be associated with HIV acquisition [2,13].

Table 3
Factors associated with a) unplanned pregnancy and b) pregnancy termination among female sex workers in Zambia who reported being pregnant at least once
with no current fertility desire (N=796).
Unplanned Pregnancy Pregnancy Termination
1 1
Bivariate Multivariable Bivariate 1 Multivariable 1
OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI)
Age 0.97 (0.940.99) 0.94 (0.930.96) 0.98 (0.961.01) 0.98 (0.970.98)
Have a primary partner 1.37 (0.772.47) 1.09 (0.671.80) 1.65 (0.992.74) 1.46 (0.942.23)
Can read and write 1.08 (0.691.67) 1.04 (0.591.85) 1.37 (1.081.74) 1.57 (1.321.85)
Mobile phone ownership 1.34 (1.021.76) 1.78 (1.572.02) 0.99 (0.651.52) 1.14 (0.821.58)
Monthly income
No income 1.00 1.00 1.00 1.00
b250 kwacha 0.58 (0.191.76) 0.64 (0.202.10) 0.59 (0.162.24) 0.64 (0.182.26)
251500 kwacha 1.44 (0.523.97) 1.32 (0.493.56) 1.69 (0.565.12) 1.42 (0.504.05)
5011000 kwacha 2.09 (1.283.41) 2.24 (1.174.31) 1.92 (1.252.97) 1.81 (1.292.55)
10011500 kwacha 2.47 (1.943.15) 3.01 (1.456.23) 2.21 (1.064.60) 2.49 (1.733.60)
N1500 kwacha 1.57 (1.122.20) 1.88 (0.963.68) 1.02 (0.372.85) 1.06 (0.462.43)
Number of living children 1.06 (0.901.24) 1.30 (1.161.45) 1.07 (0.861.34) 1.18 (0.961.45)
Age at sexual debut 0.88 (0.860.90) 0.91 (0.880.93) 0.92 (0.890.94) 0.94 (0.910.96)
Ever arrested/incarcerated 1.75 (1.541.99) 1.75 (1.561.97) 1.96 (1.482.59) 1.87 (1.642.12)
Client sexual abuse, past 12 months 1.54 (0.902.64) 1.47 (0.723.00) 1.75 (0.714.29) 1.69 (0.624.60)
Primary partner sexual abuse, past 12 months 1.76 (1.182.63) 1.44 (0.982.12) 2.15 (1.293.57) 1.73 (0.943.20)
Condoms always available at work 0.61 (0.420.88) 0.63 (0.610.64) 0.63 (0.420.95) 0.68 (0.510.91)
OR, odds ratio; aOR, adjusted odds ratio; 95% CI, 95% confidence interval. 1Logistic regression model with standard errors accounting for clustering within
study site.
 M.M. Chanda et al. / Contraception 96 (2017) 196202 201

Pathways that lead from incarceration to increased HIV ing condom availability in work places and decriminalizing
acquisition may be similar to those for pregnancy outcomes, sex work, may improve reproductive health outcomes for
and include marginalization and reduced access to health- FSW in Zambia.
care. Although there has been much discussion of the impact
of decriminalization of sex work on HIV incidence among Acknowledgements
FSW, the effects of decriminalization on sex worker health
will likely extend beyond HIV. We thank the participants of the ZEST study for their time
More than half of women who reported a lifetime and dedication to participating in this study. We also thank
pregnancy also reported a history of unplanned pregnancy, the research assistants who collected data for the ZEST
which may indicate a large unmet need for family planning. study: Ruth Chisenga, Comfort Habinda, Leakey Hantumbe,
Previous work has shown a high incidence of pregnancy Alice Kabinda, Milimo Kalonga, Lucky Mambwe, Brian
among FSW [12], and a large proportion of FSW may have Manyando, Douglas Mashowo, Earnest Musonda, Phenet
positive pregnancy intentions [14]. However, in our study, Muunga, Michael Mwamba, Oxcellia Nkoloma, Moono
few (less than 2%) reported that they were currently trying to Shankley, Austine Simfukwe, Precious Tilimboyi and
get pregnant as a reason for not using birth control. Although Trevor Zimba.
we did not specifically measure pregnancy or fertility desires
in this study, this may be indicative that overall pregnancy
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