5 Clinical and Support Services
5.7.2 Family planning and contraceptive counselling
The basic steps in effective family planning and contraceptive counselling for sex workers are:
• Provide counselling to determine the sex worker’ s pregnancy intention.
• Discuss available methods of contraception, including dual method protection.
• Determine medical eligibility for the desired family planning method.
• Provide or prescribe the family planning method.
• Promote and provide condoms.
Sex workers may use condoms less consistently with regular partners than with their clients. Many sex workers therefore need dual method protection against pregnancy as well as against STIs and HIV. This may be achieved by using a highly effective contraceptive method for pregnancy prevention, and the male or female condom for STI and HIV prevention.
The following information should be provided so that sex workers may make an informed, voluntary choice of contraceptive methods:
• relative effectiveness of each method
• correct use of the method
• how it works
• common side-effects
• health risks and benefits
• signs and symptoms that would necessitate a return to the clinic
• return to fertility after discontinuing the contraceptive method.
Emergency contraception Emergency contraception may be provided to a woman who has had unprotected vaginal sex, is not currently using a contraceptive method and is not pregnant. It should be provided as soon as possible after unprotected sex, ideally within 72 hours, with a limit of 120 hours.( Effectiveness is reduced beyond 72 hours.) Emergency contraception should be accessible to sex workers and the frequency of its use should be monitored.
Note: Since emergency contraception is not completely effective in preventing pregnancy and might not be efficient if used frequently, it is important to encourage sex workers to use a long-term family planning method.
Safe pregnancy If a sex worker plans to become pregnant, she should be provided with information about safe pregnancy, including regular antenatal care, HIV and STI prevention and testing, appropriate nutrition and safe delivery.
Abortion and post-abortion care Where abortion is legal, links to safe abortion services should be established. Where it is illegal, sex workers should be informed about the risks of informal abortion methods. Sex workers should have access to appropriate post-abortion care to reduce related morbidity and mortality, and care for postabortion complications should be provided. Sex workers should be counselled on family planning to prevent future unwanted pregnancies.
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