Knowledge and Practice of Emergency Contraception among Female Sex Workers: A Global Scoping Review

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Abstract Introduction Female sex workers (FSWs) face a high risk of unintended pregnancies and abortion. Emergency contraception (EC) serves as a critical option for pregnancy prevention especially in the circumstances such as condom failure, stealthing, and sexual violence. Limited research has focused on the knowledge and practices of EC among FSWs. This scoping review aims to synthesize available evidence on the knowledge and use of EC among FSWs. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive search was conducted across four databases; Lens.org, Dimensions, PubMed, and Google Scholar. Inclusion criteria covered qualitative and quantitative journal articles published between 2000 and 2024 that examined EC knowledge and use among FSWs. Thematic analysis was performed and descriptive statistics were applied where relevant. Results The initial search yielded 735 studies, with 633 unique records after deduplication. Title and abstract screening shortlisted 34 articles for full-text review, of which 16 were excluded due to lack of relevance. An additional six studies were identified through reference screening, resulting in a final set of 24 studies. Findings revealed low awareness and usage of EC among FSWs despite a high prevalence of intentional and unintentional condom breakages, stealthing, sexual violence, and abortions. Median prevalence of life time use was 27.5%. Key barriers included misconceptions, cost, stigma, and lack of service availability. Conclusion FSWs’ experience indicated significant unmet needs for EC, yet research on this issue remains limited. Expanding access, addressing misinformation, and integrating EC into reproductive health services for FSWs are critical for reducing unintended pregnancies and associated health risks. Additionally, there is a pressing need for further research focusing on EC among FSWs in diverse settings to inform targeted interventions and policy development.

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