Health risks for female sex workers and their children

Many female sex workers and their children have unmet needs for medical care, which puts them at risk for serious and potentially fatal health problems, some researchers argue.

In many communities around the world, mothers enter sex work primarily to feed their children, Brian Willis of Global Health Promise in Portland, Oregon, and colleagues note in a commentary in The Lancet Global Health.

Most female sex workers become pregnant, and many have unsafe abortions or lack access to prenatal care, the researchers point out. They may die in childbirth or suffer serious complications during delivery because they also have little or no access to medical care during labor and delivery.

Infants that do survive in these circumstances are often left alone or in substandard childcare facilities while their mothers work at night, and these babies are often at risk for injuries from poor supervision or illness from poor nutrition, the researchers argue.

“A common theme in all regions is that mothers enter sex work to feed their children, as well as to provide shelter and school fees,” Willis said by email.

“From a public health perspective, we want to prevent injuries and deaths the mothers experience in sex work, so anything we can do to help them find other options to feed and care for their children would help them avoid risks they may experience during sex work, such as violence, unplanned pregnancies and unsafe abortions,” Willis added.

The biggest health risks tied to sex work for mothers can also depend on where in the world they live, Willis said.

In sub-Sahara Africa, for example, the highest risk of death comes from HIV, unsafe abortions and a lack of care during labor and delivery, Willis said.

Elsewhere, though, violence is one of the leading causes of death and injury, including attacks on pregnant sex workers, Willis noted.

At the same time, many sex workers also grapple with mental health issues that increase their risk of harming themselves, he said.

Often, these health risks might be reduced by offering sex workers another reliable way to earn money, Willis added.

“While developing these alternative income programs for those who want them, we still need to reduce the risks of injury and death to the pregnant sex worker,” Willis said.

In addition, sex workers need better access to reproductive health services, said Shira Goldenberg, a gender and sexual health researcher at Simon Fraser University in Burnaby, Canada, who wasn’t involved in the essay.

“Many sex workers are also parents and yet face substantial barriers to accessing health and parenting supports due to the criminalized and stigmatized nature of sex work,” Goldenberg said by email.

Sex workers have similar pregnancy intentions to other women of childbearing age, but worse outcomes due to limited access to reproductive health services and poor treatment when they do seek care due to the stigma of their profession, Goldenberg added.

“This deeply concerning gap in supports for pregnant and parenting sex workers underscores the critical need for efforts to support reproductive rights and access to voluntary, respectful and appropriate maternal and parenting services for sex workers,” Goldenberg said.

By Lisa Rapaport