Digital divide and socio-economic gradients in pregnancy-, contraception-, and abortion-related knowledge among female sex workers in Colombo, Sri Lanka

Knowledge relating to pregnancy, contraception and induced abortion supports informed reproductive decision-making and timely service utilization. In marginalized settings, expanding digital information pathways may improve access while widening knowledge gaps across socio-economic strata. Pregnancy-, contraception- and abortion-related knowledge was assessed among female sex workers (FSWs) in Colombo District, Sri Lanka, and socio-economic gradients and the digital divide in “good” overall knowledge were examined. A cross-sectional survey was conducted from March to June 2025 using respondent-driven sampling (N=551). Knowledge was measured using an 18-item binary scale (0–18) and categorized as good (≥11/18) versus poor (≤10/18). Psychometric assessment supported the use of the summed score as a pragmatic composite index with adequate reliability for population-level comparisons. RDS-weighted prevalence estimates were generated using Gile’s successive sampling estimator, and unweighted logistic regression examined correlates. Access to information was digital-first but uneven: 90.5% owned a mobile phone and 62.1% used social media, yet 35.8% reported no internet use. Mean knowledge was 11.75 ± 2.87, and the weighted prevalence of good knowledge was 63.5% (95% CI 59.2–67.8). Misconceptions remained on the effectiveness of contraceptive methods, the timing of emergency contraception, abortion law and post-abortion care. A steep income gradient persisted, with suggestive effect modification by education, and not accepting unprotected sex for extra pay was strongly associated with good knowledge. Overall, moderate-to-high knowledge coexisted with pronounced within-group inequality. Digital-first strategies should be complemented with equity-sensitive offline channels and locally aligned, language-appropriate content to reach women excluded from routine internet use in a legally constrained setting.