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Assessment of the lifetime prevalence and incidence of induced abortion and correlates among female sex workers in Mombasa, Kenya: a secondary cohort analysis
  1. Anne Marieke Simmelink1,
  2. Caroline M Gichuki1,2,
  3. Frances H Ampt3,4,
  4. Griffins Manguro2,
  5. Megan S C Lim3,4,
  6. Paul Agius3,4,
  7. Margaret Hellard3,4,5,6,
  8. Walter Jaoko7,
  9. Mark A Stoové3,4,8,
  10. Kelly L'Engle9,
  11. Marleen Temmerman2,10,11,
  12. Peter Gichangi2,11,12,
  13. Stanley Luchters3,11,13,14
  1. 1Department of Population Health, The Aga Khan University, Nairobi, Nairobi, Kenya
  2. 2International Centre for Reproductive Health Kenya, Mombasa, Kenya
  3. 3Burnet Institute, Melbourne, Victoria, Australia
  4. 4Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  5. 5Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
  6. 6Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  7. 7Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Nairobi, Kenya
  8. 8School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
  9. 9School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
  10. 10Department of Obstetrics and Gynaecology, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
  11. 11Department of Public Health and Primary Care, Ghent University, Gent, Belgium
  12. 12Technical University of Mombasa, Mombasa, Kenya
  13. 13Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
  14. 14Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
  1. Correspondence to Stanley Luchters; stanley.luchters{at}ceshhar.co.zw

Abstract

Introduction Prevalence of lifetime-induced abortion in female sex workers (FSWs) in Kenya was previously estimated between 43% and 86%. Our analysis aimed at assessing lifetime prevalence and correlates, and incidence and predictors of induced abortions among FSWs in Kenya.

Methods This is a secondary prospective cohort analysis using data collected as part of the WHISPER or SHOUT cluster-randomised trial in Mombasa, assessing effectiveness of an SMS-intervention to reduce incidence of unintended pregnancy. Eligible participants were current FSWs, 16–34 years and not pregnant or planning pregnancy. Baseline data on self-reported lifetime abortion, correlates and predictors were collected between September 2016 and May 2017. Abortion incidence was measured at 6-month and 12-month follow-up. A multivariable logistic regression model was used to assess correlates of lifetime abortion and discrete-time survival analysis was used to assess predictors of abortions during follow-up.

Results Among 866 eligible participants, lifetime abortion prevalence was 11.9%, while lifetime unintended pregnancy prevalence was 51.2%. Correlates of lifetime abortions were currently not using a highly effective contraceptive (adjusted OR (AOR)=1.76 (95% CI=1.11 to 2.79), p=0.017) and having ever-experienced intimate partner violence (IPV) (AOR=2.61 (95% CI=1.35 to 5.06), p=0.005). Incidence of unintended pregnancy and induced abortion were 15.5 and 3.9 per 100 women-years, respectively. No statistically significant associations were found between hazard of abortion and age, sex work duration, partner status, contraceptive use and IPV experience.

Conclusion Although experience of unintended pregnancy remains high, lifetime prevalence of abortion may have decreased among FSW in Kenya. Addressing IPV could further decrease induced abortions in this population.

Trial registration number ACTRN12616000852459.

  • SEXUAL MEDICINE
  • PUBLIC HEALTH
  • EPIDEMIOLOGY

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Raw data are available upon reasonable request. The original data are not available in a public repository. The corresponding author is to be contacted for the consideration of any data requests.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Raw data are available upon reasonable request. The original data are not available in a public repository. The corresponding author is to be contacted for the consideration of any data requests.

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Footnotes

  • Contributors SL was the principal investigator on the study and is the guarantor of this work. SL, FHA, PG, MSCL, PA, MH, WJ, MAS, KLE, and MT contributed to the study design. CMG and GM coordinated the trial and undertook data acquisition in Kenya under the supervision of PG. AMS and SL conceptualised the manuscript. AMS and PAA conducted the statistical analyses. AMS and CG wrote the first draft of the manuscript. All authors contributed to data interpretation, provided critical input and approved the final version of the manuscript.

  • Funding This work was supported by Australia’s National Health and Medical Research Council (NHMRC), Project Grant GNT 1087006.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.