Abstract
BACKGROUND: Unintended pregnancies pose a significant health risk for Female Commercial Sex Workers (FCSW), a highly vulnerable population. Despite the availability of emergency contraceptives (EC) to prevent such outcomes, concerns still exist regarding potential misuse as a regular contraceptive method, and the specific factors influencing EC use among FCSWs remain underexplored. This study aimed to evaluate the prevalence and determinants of EC use among FCSWs to address this critical knowledge gap. METHODS: This analytical cross-sectional study involved 326 randomly selected female commercial sex workers in Tanzania. Data were collected using a structured questionnaire created from previous literature and analyzed using SPSS version 29. Given the sensitive nature of this population, detailed ethical procedures were followed to ensure voluntary participation and confidentiality. Our sampling approach utilized community-based outreach rather than a formalized registry. RESULTS: The study found that a significant majority of the respondents (64.4%) had never used EC. Multivariate logistic regression analysis identified several key factors independently associated with EC use. Education level showed an inverse relationship, with those having ordinary secondary education (AOR=0.37, 95% CI=0.16-0.88, P=.024) and college-level education (AOR=0.13, 95% CI=0.04-0.47, P=.002) being significantly less likely to use EC compared to those with no formal education. Furthermore, a history of drug use was strongly associated with a reduced likelihood of EC use (AOR=0.35, 95% CI=0.19-0.61, P<.001). Conversely, prior awareness of emergency contraceptives emerged as a powerful predictor of use, with those who had ever heard about EC being substantially more likely to use them (AOR=6.20, 95% CI=3.44-11.17, P<.001). CONCLUSION: The use of emergency contraceptives among FCSW is still low for various reasons including educational attainment, and drug use. While awareness is a strong facilitator of EC use, higher education levels surprisingly showed an inverse relationship. This suggests that interventions are needed to address the unique barriers faced by this vulnerable group, including misconceptions among the educated and the compounding challenges posed by drug use. Several approach combining comprehensive education, integrated health services, and sustained awareness campaigns is essential to improve EC access and utilization for FCSW.