Among women from key populations in Myanmar, contraceptive and condom use were determined by structural factors and risk contexts, with drug use associated with lower contraceptive uptake while experience of selling sex and work-provided housing were linked to higher use, likely reflecting differential access to outreach-based services.
Key Findings
Results
Women reporting drug use only had significantly lower contraceptive uptake compared with women with no personal experience of selling sex or drug use.
Adjusted prevalence ratio (aPR) for drug use only: 0.68 (95% CI 0.48–0.95)
Analysis was conducted among 336 women of reproductive age (15–49 years) from key populations
Participants were recruited through community-based organizations across four sites in Northern and Eastern Myanmar
Contraceptive use was assessed over the past 12 months via standardized questionnaires
Multivariable Poisson regression models were used to estimate adjusted prevalence ratios
Results
Women who had never used drugs were more likely to use contraception than either opioid users or stimulant users.
Opioid users had an aPR of 0.64 (95% CI 0.43–0.95) compared to never-users of drugs
Stimulant users had an aPR of 0.72 (95% CI 0.57–0.92) compared to never-users of drugs
Both opioid and stimulant use were independently associated with lower contraceptive uptake
These findings were derived from multivariable analyses controlling for selected covariates
Results
Work-provided housing was associated with higher contraceptive use among women from key populations.
aPR for work-provided housing and contraceptive use: 1.43 (95% CI 1.01–2.05)
This association was described as strongest among individuals selling sex
The authors suggest work-provided housing may represent brothel environments that facilitate access to contraceptives
Housing insecurity was identified as a structural factor affecting reproductive health outcomes
Results
Experience of selling sex was associated with higher condom use with casual partners, while drug use only or neither experience was associated with lower condom use with casual partners.
Condom use with partner types was assessed over the past 3 months
Women with drug use only or neither selling sex nor drug use experience showed lower condom use with casual partners
The authors characterize this as highlighting 'prevention gaps outside sex-work-focused outreach'
Different partner types were distinguished in the analysis (e.g., casual partners)
Methods
The study recruited women from three key population groups across four sites in Northern and Eastern Myanmar.
Key populations included women who sell sex, women who use drugs, and sexual partners of men who use drugs
Recruitment was conducted through community-based organizations
The analysis focused on women of reproductive age (15–49 years)
The study used a cross-sectional survey design with descriptive, bivariate, and multivariable analyses
Total analytic sample in multivariable analyses: 336 women
Conclusions
Scaling up reproductive health and HIV-prevention services within harm reduction and outreach programs while addressing housing insecurity was identified as essential to improve outcomes.
Drug use was associated with lower contraceptive uptake, indicating a gap in services reaching women who use drugs
Sex-work-focused outreach appears to facilitate contraceptive and condom access, but leaves women who use drugs without similar support
Housing insecurity was highlighted as a structural barrier to be addressed
The authors call for integration of services across harm reduction and outreach platforms
What This Means
This research examined how selling sex, drug use, and housing conditions relate to contraceptive and condom use among women in marginalized communities in Myanmar. The study surveyed 336 women aged 15–49 who either sold sex, used drugs, or were sexual partners of men who used drugs, recruiting them through community organizations in four locations in Northern and Eastern Myanmar. Researchers analyzed data using statistical models to understand what factors predicted whether women used contraception and condoms.
The study found that women who used drugs—whether opioids or stimulants—were significantly less likely to use contraception than women who did not use drugs. In contrast, women who sold sex were more likely to use condoms with casual partners, and women living in work-provided housing (likely brothel settings) were more likely to use contraception overall. This suggests that existing outreach and health services connected to sex work environments are reaching women with reproductive health tools, but similar services are not effectively reaching women who use drugs. Women who used drugs but did not sell sex also showed lower condom use with casual partners, pointing to a prevention gap for this group.
This research suggests that structural factors—particularly where women live and what communities they are connected to—shape their access to reproductive health services more than individual choices alone. Programs focused on harm reduction for people who use drugs may need to more explicitly include contraceptive services and condom distribution, and efforts to address housing insecurity could also improve health outcomes. The findings highlight the importance of tailoring HIV prevention and family planning outreach to reach women in drug-using communities, not just those involved in sex work.
Maxim Kan, Carl Fredrik Sjöland, K. W. Y. Kyaw, Ruby Killingsworth, Sai Phyo Zarni, M. Kåberg, et al.. (2026). Contraceptive and condom use among women from key populations in Myanmar. Harm Reduction Journal. https://doi.org/10.1186/s12954-026-01520-z