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Chuki told about selective condom and contraceptive use to try to get pregnant with a certain man: I try very hard to use condoms, but for right now You Prostitutes Mafinga not be given services without implementing this. It may be partly the result of the numerous plantations in the region, which encourage seasonal migration of workers from within and outside the regions, creating high demand for sex work.

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Really he was able to change me. IDIage 33; kilabuIringa; 2 pregnancies, 1 child. Other women did not seek pregnancy as a Prostitutes Mafinga to leave sex work but rather to gain or secure attention from a particular client. Chuki told about selective condom and contraceptive use to try to get pregnant with a certain man:.

I try very hard to use condoms, but for right now Prostitutes Mafinga spent a lot of time together Prostitutes Mafinga the Prostitutes Mafinga, and I was using the injections [Depo Provera] and condoms.

We continued to have Prostitutes Mafinga without, we went just so [hivi hivi, e. Later he said he wants a child, so I stopped getting the injections and I got pregnant with that child. He cares about my family and he said he wants a family with me. IDI Prostitutes Mafinga, age 38; kilabu and baa, Makambako; 3 pregnancies, 3 children. Such strategic childbearing did not always turn out well for the women, however.

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Several women talked about men deceiving them into thinking they would be permanent partners and sources of income, only to deny paternity and leave Prostitutes Mafinga pregnant and alone. One woman said:. There are some [who intend pregnancy], yes, like if a person has deceived you [kudanganya]. One week, two Prostitutes Mafinga, he gives you money. Yes, you bear him a child. He has deceived us.

FGDParticipant 1, Makambako. When asked about such an experience, Sofia related:. The day that I will never forget in my life is the day we planned, we Prostitutes Mafinga with each other, that I should get pregnant, and then later he turned away from me.

I will not forget Prostitutes Mafinga. IDIage 26; baa, Iringa; 2 pregnancies, 0 children. Sofia twice experienced intended childbearing with a client, followed by denial of paternity. Both times she thought she had found a man she could settle down with, only to be left with a pregnancy she had to care for alone.

In cases like these, many women consider or complete termination of the pregnancies, but sometimes, as was the case for Sofia, the pregnancy was already late term. Both times, she bore and lost premature infants. The Prostitutes Mafinga women who disclosed that they were HIV-positive related various pregnancy experiences and potential associated health risks. Serafina had a regular client who wanted her to become pregnant, though she refused to do so and used birth control but not condoms IDIage 28; baaMakambako; 3 pregnancies, 2 children.

Mlamka had recently had a child with a regular client, was breastfeeding, and was not receiving antiretroviral therapy ART ; although she believed the father infected her with HIV, she continued to see Prostitutes Mafinga IDIage 30; kilabu, Iringa; 4 pregnancies, 3 children. Finally, Mwajuma expressed a desire to become pregnant; she had one child already and Prostitutes Mafinga a second.

Before learning she was HIV-positive, she used to have unprotected sex with casual clients, hoping for another child. One of her regular clients, a married man, visited her a couple of times Prostitutes Mafinga month, and they did not Prostitutes Mafinga condoms or any other form of birth control. She worried Prostitutes Mafinga she was destined to have only one Prostitutes Mafinga but nevertheless hoped for another IDIage 34; kilabu, Iringa; 1 pregnancy, 1 child.

As sex workers and unmarried women, they sometimes faced discrimination and denial of care. Many of them also had developed strategies to surmount these obstacles to ANC services. Sofia related:. They [FSWs] are treated like regular people.

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Women dressed this way because they feared health care workers would automatically assume sex workers were HIV-positive and refer them directly to care and treatment centers, rather than provide them with ANC or determine whether they required any other health services.

One woman explained:. Straight away they direct you to the HIV [treatment clinic] Over there, they Prostitutes Mafinga not give you any services at all other than AIDS tests [e. They think straight away you are infected. Oh, Prostitutes Mafinga women who do sex work [udada poa] are separated because they Prostitutes Mafinga known as really deviant [wahuni sana].

IDIage 31; multiple sites, Ilula; 2 pregnancies, 3 children. In addition to the stigma and discrimination they potentially faced as sex workers, Prostitutes Mafinga reported being refused services Prostitutes Mafinga pregnancy, including HIV testing, if they did not bring their husbands to the ANC clinic.

A woman explained:.

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These days, you cannot carry a pregnancy with the father not Prostitutes Mafinga, because if you are pregnant and go to the clinic they do not test you [for HIV]. Sofia Prostitutes Mafinga that this difficulty led some FSWs to avoid ANC services completely, delaying care-seeking until they were in labor.

According to her, this led to substandard care and stigmatization:. Since these days the clinic does not enroll Prostitutes Mafinga without your husband when you go to be issued an [ANC] card If you are open, you are enrolled.

But if you hide [your occupation], you cannot be enrolled. You will wait until you are in Prostitutes Mafinga pains, and then you will be enrolled. Even if you are enrolled, you will not be served like if you had been issued a card at the beginning.

That is, you will be stigmatized a certain amount because you were not open from the beginning. If you are open, you will receive all services.

Prostitutes Mafinga will not be accepted like a woman who came with her husband. Meaning you will be stigmatized [ kunyanyapaliwa ] and you will not get those services.

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Not until you deliver. FGDParticipant Prostitutes Mafinga, Ilula. Some women attempted to deceive Prostitutes Mafinga care workers about their nonexistent husbands, so they could get care. As Johanna recalled:. In the past there was no asking about your husband and what not.

Maybe you find another way, saying he is traveling and went far away. IDIage 28; kilabu, Makambako; 3 pregnancies, 2 children. One explained:. When we are enrolled, we are tested and everything, and we continue Prostitutes Mafinga in care until delivery. FGDParticipant 5, Ilula.

You will not be given services without implementing this. Of particular concern are the risky circumstances in which some women reported seeking to become pregnant, including having unprotected sex with both regular and casual clients. Especially concerning is the Prostitutes Mafinga that FSWs reported Prostitutes Mafinga care and denial of care at ANC clinics, both because they were sex workers and because they were not married.

All of these circumstances have health implications for the Prostitutes Mafinga, their pregnancies, and their partners and clients.

Pregnancy is also a way to avoid the stigma of infertility, which is strong in Tanzania Kielmann ; Hollos and Larsen The women in this Prostitutes Mafinga achieved some level of respectability as mothers, which helped to overcome the stigma they faced as sex workers Beckham et al. Pregnancy was also seen as a way to secure long-term relationships or greater financial security.

Through their children, women can make claims to inheritance, property, and social capital, even long after the sexual relationship with the father Prostitutes Mafinga Guyer The women in our study may have been engaging in this kind of process whereby childbearing with multiple men was a potentially advantageous Prostitutes Mafinga.

At the time of this study, there were neither clinical services nor national guidelines in Tanzania for health care workers to Prostitutes Mafinga the specific medical needs of FSWs. Women reported only rarely disclosing their occupation to health care workers, which precluded such tailored care for this high-risk population.

This hesitancy on the part of FSWs was likely due to societal stigma against sex workers and the criminalized status of sex work. However, this four-prong model, as well as efforts to integrate HIV and reproductive health care Kennedy et al. The difficulties FSWs reported in accessing ANC care in this study highlight the need to ensure equitable access to these and other services.

Furthermore, reproductive health programs could better tailor their services Prostitutes Mafinga include women who are not married, who may have multiple partners, and who are seeking to become pregnant.

Additionally, programs for Prostitutes Mafinga could help them develop skills to discuss health risks Prostitutes Mafinga their clients and could Prostitutes Mafinga integrated family planning services.

These programs could promote a wider variety of methods, such as short-term barrier methods that could be used with some partners but not others with whom they would like to have children. According to participants, this Prostitutes Mafinga for a husband was new. It was likely a result of the policy of the Ministry of Health and Social Welfare of provider-initiated opt-out testing for all pregnant women, which includes guidelines to encourage—but not require—an accompanying partner TMoHSW When presented with this information, regional officials were Prostitutes Mafinga that the policy had been misinterpreted in this way at individual health facilities.

Evidence for the health benefits of couples-oriented services also exists Aluisio et al. In the future, guidelines should be clarified to address this issue, and practitioners should be sensitized to the specific circumstances in which couples care is or is not appropriate.

This study had limitations. Because our research included only one village Kilolowe cannot comment on differences between rural and Prostitutes Mafinga areas, which may especially affect experiences with health services.

However, the quotes presented here represent a Prostitutes Mafinga of reasons why female sex workers Prostitutes Mafinga to Prostitutes Mafinga pregnant, providing insight into complex dynamics that need not be limited to current intentions.

The cross-sectional Prostitutes Mafinga also did not allow for time to build rapport with our respondents, which can ameliorate issues such as social desirability bias. However, the interviewer was highly trained and has a degree in counseling, which helped women be open and comfortable in sharing information about stigmatized behaviors.

Another limitation is that Prostitutes Mafinga sample Prostitutes Mafinga only a small number of women who had never had children, and only three who disclosed they were HIV-positive, limiting the ability to compare differences between these subgroups. Further research could Prostitutes Mafinga target these groups. Another limitation of this study is that experiences with ANC care were self-reported by the women, and no observations were made to Prostitutes Mafinga interaction with health care workers.

Additionally, the data collection used an iterative approach to interviewing, meaning some questions were adapted and added over time and were thus not asked of all participants. Recent research examines pregnancy prevention among female Prostitutes Mafinga workers, but FSWs also seek and desire pregnancy, sometimes in ways that increase their risk of infection.

Thus, their reproductive health needs extend beyond contraception. The health system could benefit from sensitization training for health care workers and national guidelines for health care services for FSWs. Community mobilization and empowerment interventions Kerrigan et al.

The authors acknowledge Haneefa Saleem and Justin Beckham for their input on drafts of the manuscript. In general, a client pays for each individual sexual encounter, while a partner provides resources in a more generalized way, and probably but not necessarily has a romantic attachment as well.

Hutapewa huduma bila kutekeleza hili. Sarah W. Catherine R. Peter J. Deanna L. National Center for Biotechnology InformationU. Stud Fam Plann. Author manuscript; available in PMC Apr BeckhamCatherine R. KerriganProstitutes Mafinga Professor. Find articles by Sarah W. Find articles by Catherine R. Find articles by Chris Beyrer.

Find articles by Deanna L. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Stud Fam Plann. See other articles in PMC that cite the published article. Abstract Understanding the pregnancy experiences of female sex workers FSWsespecially in the context of high rates of HIV and sexually transmitted infections STIs Prostitutes Mafinga, is essential to tailoring Prostitutes Mafinga to meet their needs.

Open in a separate window. NOTE: Percentages may not sum to due to rounding. Characteristic n Percent Mean Median Lifetime pregnancies 2.

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NOTE: Percentages may not total due to rounding. Experiences with Intended Pregnancy The experiences and comments presented below demonstrate a variety of circumstances in which FSWs might choose to become pregnant. She explained: My other [child], the boy—truly I just decided myself IDIage 34; multiple Prostitutes Mafinga, Ilula; 3 pregnancies, 2 children Mlamka, a mother of three, explained how other FSWs sought pregnancy for a chance to have families: Some [FSWs] just wanted to have children.

IDIProstitutes Mafinga 24; kilabu, Iringa; 2 pregnancies, 2 children Several women referred to the status and Prostitutes Mafinga women gain as mothers. Naiwa, a mother of three, elaborated: When you are called Mama, it is great praise.

Chuki told about Prostitutes Mafinga condom and contraceptive use to try to get pregnant with a certain man: I try very hard to use condoms, but for right now

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As Johanna recalled:. Foi um momento Mafinga na minha sexualidade e que repercutiu para outras esferas da minha vida. Open in a separate window.