Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka city, Bangladesh

Abstract

Objectives This study aimed to identify the barriers female sex workers (FSWs) in Bangladesh face

with regard to accessing sexual and reproductive health (SRH) care, and assess the satis- faction with the healthcare received.

Methods Data were collected from coverage areas of four community-based drop-in-centers (DICs)

in Dhaka where sexually transmitted infection (STI) and human immunovirus (HIV) preven- tion interventions have been implemented for FSWs. A total of 731 FSWs aged 15–49 years

were surveyed. In addition, in-depth interviews (IDIs) were conducted with 14 FSWs and 9

service providers. Respondent satisfaction was measured based on recorded scores on dig- nity, privacy, autonomy, confidentiality, prompt attention, access to social support networks

during care, basic amenities, and choice of institution/care provider. Results Of 731 FSWs, 353 (51%) reported facing barriers when seeking sexual and reproductive healthcare. Financial problems (72%), shame about receiving care (52.3%), unwillingness of service providers to provide care (39.9%), unfriendly behavior of the provider (24.4%), and distance to care (16.9%) were mentioned as barriers. Only one-third of the respondents reported an overall satisfaction score of more than fifty percent (a score of between 9 and16) with formal healthcare. Inadequacy or lack of SRH services and referral problems

(e.g., financial charge at referral centers, unsustainable referral provision, or unknown loca- tion of referral) were reported by the qualitative FSWs as the major barriers to accessing

and utilizing SRH care. Conclusions

These findings are useful for program implementers and policy makers to take the neces- sary steps to reduce or remove the barriers in the health system that are preventing FSWs

from accessing SRH care, and ultimately meet the unmet healthcare needs of FSWs.