Unveiling reproductive choices: Knowledge and practices of emergency contraceptive pills among the female factory workers in Sri Lanka.

BACKGROUND: In Sri Lanka, the Emergency Contraceptive Pill (ECP) is categorized as a Schedule 2A medication, allowing it to be purchased over-the-counter without a prescription, but exclusively from licensed pharmacists. It is estimated that around 3 million ECPs are consumed by Sri Lankan women each year. This study aims to assess the knowledge and practices of Female Factory Workers (FFWs) on ECP and to unearth the association with unintended pregnancy and unsafe abortion. METHODS: After receiving written informed consent, a structured interview schedule was administered among 585 FFWs attached to eight factories in a selected Export Processing Zone (EPZ). Data analysis was performed using SPSS software. RESULTS: Only 26 % of FFWs were aware of the effective time period to take an ECP to prevent a pregnancy. Most (67 %) had the impression that a valid prescription is required to purchase ECP from the pharmacies. Around one-tenth of the FFWs (11.3 %, n = 66) had used ECP during their lifetime. Among the 65 respondents who reported having experienced unintended pregnancies, only 26.2 % (n = 17) had utilized ECPs. In contrast, among the 22 respondents who disclosed a history of abortion, only two women had ever employed ECPs. CONCLUSION: The study highlights the low knowledge and use of ECP among FFWs in Sri Lanka, contributing to unintended pregnancy and unsafe abortion. Results call for targeted interventions to improve knowledge and access to ECP, helping to reduce unintended pregnancy and improve reproductive health outcomes.

Unmarried Sri Lankan youth: sexual behaviour and contraceptive use.

BACKGROUND: Youth are at high risk for casual and unprotected sexual activities even before marriage. The objective of the study is to describe the sexual behavior, and contraceptive use among unmarried youth of Sri Lanka and to assess the factors associated with sexual behaviour. METHODS: An observational descriptive cross-sectional study was conducted in three selected districts in Sri Lanka from 1st March 2019 to 31st January 2020 among 1057 never-married youth using a self-administered questionnaire. Both stratified cluster sampling and snowball sampling were used to select the eligible never-married youth. Factors associated with sexual intercourse were assessed using logistic regression. RESULTS: Compared to boys (26%), more girls (35%) were engaged in unprotected sexual intercourse. Among sexually active unmarried youth aged less than 20 years, 10% had sexual intercourse with an unknown person. Unmarried Tamil and estate sector youth displayed significantly lower chances of sexual intercourse compared to Sinhala and urban counterparts (OR = 0.390, CI = 0.213-0.715, p = 0.002 and OR = 0.807, CI = 0.709-0.978, p = 0.020 respectively). Youth in the rural (69.5%) and urban sectors (87.3%) tend to use contraceptives during intercourse compared to the youth in the Estate sector (51.1%). CONCLUSIONS: A significant portion of youth are exposed to sexual risk behavior including unprotected sexual intercourse even before marriage which can contribute to many social and health consequences. Focus interventions are needed to address the issue.

With early puberty and late marriage, Sri Lankan youth are more susceptible to unprotected and casual sex. The physical, psychological, and sociocultural impact of resulting pregnancies and Sexually Transmitted Diseases including HIV could be detrimental. In Sri Lanka, significant variation in sexual intercourse and concurrent use of contraceptive use was observed among different ethnic groups and sectors. Increased popularity for emergency contraceptive pills was observed among never-married female youth. Younger youth (teenagers) tend to engage in more unprotected sexual intercourse compared to older youth in Sri Lanka. Concentrating on reducing barriers to contractive access for younger youth in Sri Lanka is important. To prevent unwanted pregnancies, and Sexually Transmitted Diseases including HIV, targeted interventions are required especially for Tamil ethnic groups and estate sector youth populations in Sri Lanka.

Factors associated with clinic escorts in peer-led HIV prevention interventions for men who have sex with men (MSM) in Sri Lanka.

BACKGROUND: Sri Lanka has recently completed an HIV prevention project for most-at-risk populations (MARP) under the Global Fund. The intervention includes delivery of a HIV prevention package (HPP) to men who have sex with men (MSM) that includes provision of: (1) knowledge about sexually transmitted infections (STI); (2) HIV knowledge; (3) MSM-tailored leaflets; (4) condom/dildo demonstration; (5) provision of condoms; and (6) clinic escorts. MSM who received services 1-5 in the HPP are defined as 'reached'. The final step is to escort the reached MSM to an STI clinic, and they are then defined as 'escorted'. This HPP was delivered to MSM through peer educators (PE) scattered in four highly populated districts in the country. Each PE has contact with another 15 peers forming a peer group (PG). However, in this model, a significant number of MSM do not take up the escorting step of the HPP. Therefore, the purpose of this paper is to analyse the factors associated with clinic escorts among MSM peers in the HIV prevention project. METHODS: All the MSM peers (699 MSM) registered and retained during the project period had been reached in 2013, 2014 and 2015 and were chosen from the web-based Monitoring and Evaluation information management system (MEIMS) for analysis. The sample was divided in to two groups based on escort status (escorted peers vs non-escorted peers). Variables were compared between the two groups for the hypothesis of difference to identify significant factors associated with clinic escorts. RESULTS: The study sample (699 MSM) represented four districts: Galle (37%), Colombo (35%), Gampaha (14%) and Kalutara (14%). Escort status depended on the district (P<0.001), age group of MSM (P=0.008), level of education (P=0.007) and urban/rural status (P<0.001), duration of MSM behaviour (P=0.018), experience of an HIV test during previous 12 months (P=0.050), and recent receptive anal sex (P=0.050). CONCLUSIONS: Older MSM (>25 years), MSM living in urban and semi-urban areas, Nachchi MSM (effeminate males), MSM with receptive behaviours as well as less-educated MSM were less likely to be escorted and needed some extra effort to improve escort rate among MSM. In addition, performance of PEs, field supervisors and coordinators was observed to be a major factor in improving escort rate.