Sex Workers' Experiences of Violence Are Associated with Contraceptive Choices, Study Finds

WASHINGTON, DC (November 16, 2021)—Many sex workers use contraception and experience violence from clients and intimate partners, but are different kinds of violence associated with different contraceptive choices among women sex workers? In a study selected as the Editor's Choice for the November/December issue of Women's Health Issues, authors found that women sex workers who experience violence by intimate partners were more likely to select contraceptive methods they could use without the involvement or knowledge of partners.
 
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
 
Jessica L. Zemlak, currently an assistant professor at the Marquette University College of Nursing, was a doctoral student at the Johns Hopkins University School of Nursing when she conducted the research along with colleagues from the Johns Hopkins Bloomberg School of Public Health. The team used data from the SAPPHIRE study, a research project focused on women sex workers in Baltimore. In the current study, the researchers asked 250 participants aged 18 to 49 about contraceptive use, and categorized methods as being partner-controlled (e.g., condoms) or woman-controlled (e.g., birth control pills, contraceptive implants or injections, or tubal ligation). They also inquired about lifetime experiences of physical or sexual violence and found that 52 percent of women reported intimate partner violence and 58 percent violence from clients. Participants who experienced violence by intimate partners had more than twice the odds of using woman-controlled contraceptive methods, compared to those who did not experience intimate partner violence. They did not find a significant relationship between experiences of client violence and woman-controlled contraception.
 
“Clinicians screening for interpersonal violence should consider adding detailed questions regarding relationship context given that this study found perpetrator type is associated with women’s contraceptive use,” the authors advise. They also recommend policies “supporting access to integrated, holistic reproductive care including woman-controlled contraception and HIV/sexually transmitted infection prevention services.”
 
“Sex workers are an important population to study, given their health risks and unique circumstances,” said Amita Vyas, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “These findings can support stronger services and policies to empower sex workers to control their lives and health.”
 
“Interpersonal Violence and Contraceptive Method Use by Women Sex Workers” has been published in the November/December 2021 issue of Women’s Health Issues.