Understanding Commercially Sexually Exploited Youths' Facilitators and Barriers Towards Contraception Use: I Didn't Really Have A Choice.

STUDY OBJECTIVE: Given the high reproductive health risks that commercially sexually exploited youth (CSEY) face, we sought to understand facilitators and barriers related to their utilization of both condoms and hormonal contraception.

DESIGN: We conducted semi-structured interviews with 21 females identified as CSEY. Interviews were audio-recorded, transcribed, and coded for emergent themes. Participants were enrolled through group homes and a juvenile specialty court serving CSEY.

RESULTS: Overall, CSEY reported relatively easy access to both hormonal contraception and condoms, expressing a strong preference for condoms as their primary form of contraception. Most respondents described an aversion towards hormonal birth control, attributed to personal experiences and peer accounts of side effects. Many also shared a common belief that hormonal methods are "unnatural," cause infertility, and have low efficacy. Although youth expressed a preference for condom use, they also reported frequent unprotected sex. Furthermore, there were notable barriers to hormonal contraception and condom use that were specific to youths' sexual exploitation, primarily due to their lack of control while trafficked.

CONCLUSION: While participants noted relatively easy access to contraception, a number of barriers to both condoms and hormonal contraceptive utilization exist. Many of these barriers align with youth identified in other at-risk adolescent populations, however, CSEY also face a number of barriers that may be attributable to their unique experience of commercial sexual exploitation. Contraceptive education that dispels prevailing myths, sets clear expectations regarding side effects, and emphasizes autonomy is most likely to resonate with their worldview and experiences.