What happens to women who sell sex?

In my previous post I reviewed Modern Slavery by Kevin Bales and a couple of other people. I was interested in Chapter 4 because it is about prostitution. There is something interesting in Chapter 7 too. They write about a study that followed 130 prostitutes in London (I don't know why they write 'nearly 150', the number is precisely 130). The study is called "What happens to women who sell sex? Report of a unique occupational cohort" by Helen Ward and Sophie Day.

The title is misleading, because it is suggesting that if a woman begins to sell sex certain things will happen to her. Such as higher rates of murder, death through AIDS, death through alcoholic liver disease and intravenous drug overdose. As Kevin Bales et al state, this cohort did suffer from a higher mortality rate. They also had other health problems such as STIs.

What Bales et al don't point out though is that the authors of the study state quite clearly that 'The women followed up are not representative of sex workers in general or even the baseline cohort.' When you consider that '46 (of 72, 64%) reported previous or current addiction', it is obvious that they cannot be representative of sex workers generally. Only about 20% of sex workers are addicts.

There are two paragraphs in the study that put sex work in a completely different light from that which Bales et al intended. This takes some explaining, but it seems to me that we are talking about two different groups of women, the drug addicts and the non-drug addicts. The outcomes for sex workers in these two groups are very different.

Two points. 48% of the women owned their own homes, for women where household details were available. They found no major difference in health outcomes between those who left and those who remained in the sex industry. This suggests that structural factors (like addiction, housing, and social support) may be more predictive of long-term health than sex work itself.

I have quoted these two paragraphs below, adding emphasis for the most important points.

"The most significant problems related to mental ill health and substance misuse. The relation between these health problems and sex work is complex, and despite the longitudinal nature of this study, we are not able to determine causation. Multiple factors predispose sex workers in general to chronic ill health, including poverty and poor education. We were unable to control for these because of the relatively small numbers followed up, and limited baseline information on chronic health problems. However, it is clear that prejudice towards the sale of sex and legal penalties marginalised sex workers both during and after their time in the industry, and the majority of respondents attributed their symptoms to this burden of disrespect and the difficulties they faced in hiding what they did."

"Women also combined jobs within the sex industry with work, education, and training outside. Research participants reported that sex work created the opportunities for such initiatives (qualitative data not shown). However, on completing training, many women stayed in the industry. Given the new possibilities offered by higher education and vocational training, sex work must therefore be considered a positive choice, preferable to alternatives. In other words, sex work is not simply a form of social exclusion but a conduit to social mobility and opportunities such as home ownership and a family wage. Therefore, policies that emphasise ‘‘exiting’’ strategies are likely to have limited impact. Governments may sponsor training schemes for sex workers, but as we have shown women may well train but then combine new skills with sex work in order to retain the economic advantage and flexibility that the occupation can offer. In this study, sex work was a choice for the majority who were followed up, and for many a route out of poverty rather than a vicious circle of social exclusion."