A qualitative exploration of menstrual management practices and the impact of menstruation on the livelihoods of female sex workers in a peri-urban area of western Kenya

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Background Little is known about female sex worker (FSW) experiences with menstruation and its impact on their economic livelihood and health. To support a future intervention aimed at improving menstrual hygiene management (MHM) for FSW, this study sought to explore FSW's views of MHM, its impact on work, and related practices during client engagement. Methods This qualitative study conducted seven focus group discussions among 57 FSWs in Kisumu, western Kenya, between June and September 2023. Semi-structured guides assessed current MHM practices, the impact of menstruation on work and livelihood, and clients' perceptions of sex during menses. The data were analysed using thematic analysis. Results Outside of sex work, FSWs primarily reported using disposable sanitary pads, with tampons, reusable pads, cloths, cotton wool and tissue also reported as methods used to absorb menstrual flow. Many FSWs described continuing sex work during menstruation out of financial necessity. Needing to hide menstrual blood flow when engaging in sex work was customary and women resorted to unsafe practices, including intravaginal cleansing or inserting cotton or tissue high into the vagina to stem bleeding. Most FSWs spoke of losing income during their menses from stopping work entirely or reducing the number of clients seen. Women reported a range of client attitudes towards sex during menstruation, from indifference to disgust, with most reporting negative views. FSWs discussed that clients frequently refused services if they became aware of menstruation and that non-payment or physical abuse from clients could occur upon discovering menstruation. Conclusions The use of harmful practices to conceal menstrual blood during sex work underscores a critical need for safer menstrual management solutions for this population that can be used discreetly and comfortably during sex, such as menstrual discs that can be worn during sex. Negative perceptions of menstruation contribute to increased financial instability in this population. Clinical Trial Registration : Clinicaltrials.gov NCT05666778; Pan African Clinical Trials Registry 202305912778108.

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