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Peer-reviewedCC BY 4.0Frontiers in Reproductive Health

A cross-sectional study of contraception and abortion utilization among female sex workers in the democratic Republic of Congo, Kenya, and Nigeria: preferences, access, and barriers

  • Regan A. Moss1,2
  • Isabella Danel1,3
  • Grace Kamau4
  • Wendy L. Macias-Konstantopoulos1,5
5 affiliations
  1. 1Global Health Promise, Portland, OR, United States
  2. 2Social, Behavioral, Population Health Sciences, Weatherhead School of Public Health, Tulane University, New Orleans, LA, United States
  3. 3Adjunct Assistant Professor, Community Health Sciences, School of Public Health, University of Illinois, Chicago, IL, United States
  4. 4African Sex Workers Alliance
  5. 5Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Abstract

Female sex workers (FSW) report high rates of unintended pregnancy and unmet need for contraception. Using convenience sampling, this cross-sectional study included 853 FSW recruited from eight cities in the Democratic Republic of the Congo (DRC), Kenya, and Nigeria, where proportionate mortality from unsafe abortion is high. The study examined contraceptive prevalence, preferences, access, and barriers, and abortion history, methods and complications. Non-condom modern contraceptive prevalence was higher among FSW in Kenya (73.2%) than in the DRC (40.8%) and Nigeria (26.9%). A greater proportion of FSW in Kenya reported no abortion in the past five years (82.8%) compared with the DRC (54.0%) and Nigeria (33.9%). Among those reporting abortion, the mean number was lower in Kenya (1.5) than in the DRC (1.7) and Nigeria (2.2). Cost was a common barrier to accessing contraceptives in the DRC and Nigeria (approximately one-third of respondents) but less common in Kenya (9%). Contraceptive preferences differed. The majority of FSW in Kenya preferred long-acting reversible contraception (LARC). Although the majority of FSW in the DRC and Nigeria preferred condoms, client dynamics in criminalized settings may limit consistent condom use making them ineffective. Improving access to free or affordable non-condom modern contraceptives, particularly LARC, is critical to reducing unintended pregnancies and preventing morbidity and mortality from unsafe abortion among FSW. Increased education and counseling on LARC methods may further support uptake.

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Cite

BibTeXRIS
BibTeX
@article{moss2026crosssectional,
  title = {{A cross-sectional study of contraception and abortion utilization among female sex workers in the democratic Republic of Congo, Kenya, and Nigeria: preferences, access, and barriers}},
  author = {Regan A. Moss and Isabella Danel and Grace Kamau and Wendy L. Macias-Konstantopoulos},
  journal = {Frontiers in Reproductive Health},
  year = {2026},
  month = oct,
  doi = {10.3389/frph.2026.1789135},
  url = {https://doi.org/10.3389/frph.2026.1789135},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A cross-sectional study of contraception and abortion utilization among female sex workers in the democratic Republic of Congo, Kenya, and Nigeria: preferences, access, and barriers
AU  - Regan A. Moss
AU  - Isabella Danel
AU  - Grace Kamau
AU  - Wendy L. Macias-Konstantopoulos
PY  - 2026
DA  - 2026/10/29
JO  - Frontiers in Reproductive Health
DO  - 10.3389/frph.2026.1789135
UR  - https://doi.org/10.3389/frph.2026.1789135
AB  - Female sex workers (FSW) report high rates of unintended pregnancy and unmet need for contraception. Using convenience sampling, this cross-sectional study included 853 FSW recruited from eight cities in the Democratic Republic of the Congo (DRC), Kenya, and Nigeria, where proportionate mortality from unsafe abortion is high. The study examined contraceptive prevalence, preferences, access, and barriers, and abortion history, methods and complications. Non-condom modern contraceptive prevalence was higher among FSW in Kenya (73.2%) than in the DRC (40.8%) and Nigeria (26.9%). A greater proportion of FSW in Kenya reported no abortion in the past five years (82.8%) compared with the DRC (54.0%) and Nigeria (33.9%). Among those reporting abortion, the mean number was lower in Kenya (1.5) than in the DRC (1.7) and Nigeria (2.2). Cost was a common barrier to accessing contraceptives in the DRC and Nigeria (approximately one-third of respondents) but less common in Kenya (9%). Contraceptive preferences differed. The majority of FSW in Kenya preferred long-acting reversible contraception (LARC). Although the majority of FSW in the DRC and Nigeria preferred condoms, client dynamics in criminalized settings may limit consistent condom use making them ineffective. Improving access to free or affordable non-condom modern contraceptives, particularly LARC, is critical to reducing unintended pregnancies and preventing morbidity and mortality from unsafe abortion among FSW. Increased education and counseling on LARC methods may further support uptake.
SN  - 2673-3153
ER  -