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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. Logistic regression models were used to assess factors associated with contraceptive use and unplanned pregnancy. Of women eligible for this analysis, 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.
Female sex workers FSW in sub-Saharan Africa face large barriers to accessing essential healthcare services, including stigma and discrimination, criminalization of sex work and fear of repercussions of seeking care, and challenges with logistically accessing care e.
Factors at multiple levels, including structural environments and interpersonal dynamics, potentiate this elevated risk among FSW . An unmet need for contraception has been documented in several settings in sub-Saharan Africa among FSW  ,  ,  , . Lack of access to contraceptive services may lead to unplanned pregnancies or pregnancy termination  , which can in turn lead to increased maternal mortality, continued dependence on sex work to financially support children, or HIV transmission to children if prevention of mother-to-child transmission services are not utilized.
Unsafe abortion is a major cause of maternal mortality worldwide . Despite provisions for the legality of abortion under some circumstances in Zambia, such as in the case of risk to the pregnant woman's life, physical, or mental health, in the case of child rape, or in the case of high risk of fetal impairment, abortion remains a major contributor to maternal mortality . Increasing access to contraception may reduce unplanned pregnancy and pregnancy termination, which could in turn lead to reduced maternal mortality and improved birth outcomes.