Evidence map›Paper›PMID 42920162›Full record

ArticleBMC public health2026

Maternal health service utilization and birth outcomes among female sex workers in the Democratic Republic of the Congo, Kenya, and Nigeria: results from a cross-sectional survey.

Isabella Danel, Regan Moss, Brian Willis, Swarna D S Weerasinghe, Heather Thompson, Kelsey Bricker, Patrick Ezie, Grace Kamau, Emily Perttu, Wendy L Macias-Konstantopoulos

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Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Isabella DanelGlobal Health Promise, Portland, OR, USA. idanel2@uic.edu.ORCID http://orcid.org/0009-0000-5686-8915
Regan MossGlobal Health Promise, Portland, OR, USA.
Brian WillisGlobal Health Promise, Portland, OR, USA.
Swarna D S WeerasingheGlobal Health Promise, Portland, OR, USA.
Heather ThompsonGlobal Health Promise, Portland, OR, USA.
Kelsey BrickerGlobal Health Promise, Portland, OR, USA.
Patrick EzieSilver Cross Hospital, Federal Capital Territory, Abuja, Nigeria.
Grace KamauAfrican Sex Workers Alliance, Nairobi, Kenya.
Emily PerttuGlobal Health Promise, Portland, OR, USA.
Wendy L Macias-KonstantopoulosGlobal Health Promise, Portland, OR, USA.

Funding

Bill and Melinda Gates Foundation INV-049925New Venture Fund 015413-2021-08-01
6 · The paper itself

Abstract

backgroundInformation on maternal health service utilization among female sex workers (FSW) in low- and middle-income countries (LMIC) is limited, with research focusing on HIV. Despite most FSW being mothers, little is known about their childbirth care or birth outcomes. To our knowledge, this is the first multicountry study to describe adverse birth outcomes among FSW in LMIC.

methodsThis cross-sectional study used a convenience sample of 853 FSW from eight cities in the Democratic Republic of the Congo (DRC), Kenya, and Nigeria to examine antenatal care (ANC) utilization, substance use during pregnancy, skilled birth attendance, and birth outcomes (stillbirth, perinatal mortality, and low birth weight). Self-reported outcomes for the five years preceding data collection were compared descriptively with national survey data for urban women to provide context.

resultsMaternal health service utilization and birth outcomes varied widely by country. FSW participants in Kenya reported high ANC utilization (95.6%) and facility delivery (97.0%), comparable to urban women. ANC utilization and facility delivery were lower among FSW participants in the DRC (ANC: 49.0%; facility delivery: 68.0%) and Nigeria (ANC: 37.5%; facility delivery: 26.1%) compared to urban women. Cost and stigma were the main barriers. Alcohol use during pregnancy was common in all countries. Stillbirth rates among participating FSW were very high (113 per 1000 births in the DRC [95% CI 85-146], 49 in Kenya [95% CI 30-75], and 85 in Nigeria [95% CI 63-111]), as was perinatal mortality. Low birth weight prevalence was high in the two countries with sufficient birthweight data (DRC: 17.1%; Kenya: 9.7%).

conclusionsIn this study sample, adverse birth outcomes-high stillbirth and perinatal mortality and low birth weight-may reflect the combined effects of limited access to quality maternal health services (MHS) and broader social, economic and health vulnerabilities documented among FSW populations. Kenya's subsidized maternal healthcare system may contribute to higher MHS utilization and better birth outcomes observed in Kenya. Improving equity in maternal and newborn health for FSW requires increasing access to quality MHS and addressing underlying social determinants of health. FSW should be recognized as a high-risk population requiring targeted maternal health interventions.

Indexed as

Maternal Health ServicesPatient Acceptance of Health CarePregnancy OutcomeSex WorkersAdolescentAdultCross-Sectional StudiesDemocratic Republic of the CongoFemaleHumansInfant, NewbornKenyaNigeriaPerinatal MortalityPregnancyPrenatal CareAlcohol useAntenatal careBirth outcomesFemale sex workersHealth equityLow birth weightMaternal health servicesPerinatal mortalitySkilled birth attendanceStillbirths

Identifiers

PMID42920162

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.