Ensure sex workers in India have access to sexual reproductive health services
We must ensure that every woman receives SRH services she needs — without being shamed or judged. No country will be fully developed unless all its women are safe and healthy
Geeta, 18, (name changed) came to Delhi hoping to support her impoverished family, back in her village in Uttar Pradesh. She did not anticipate that the man who promised her employment would sell her into sex work. When she approached the nearest health facility for an abortion, the doctor on learning of her occupation denied her services. Although she was not a minor, he asked for her parents’ consent, citing that she was unmarried. While the abortion was eventually provided when a local community leader intervened, Geeta realised that she and other women in sex work would always struggle to access safe abortion services.
The consequences of the lack of access to sexual and reproductive health (SRH) services can be dire for women. According to the United Nations Population Fund, as of 2014, 225 million or one-fourth of women of reproductive age (15-49 years) in developing regions want to avoid a pregnancy, but are not using an effective contraceptive method. As a result, 81% of all unintended pregnancies occur in developing regions. According to The Lancet, an estimated 15.6 million abortions occurred in India in 2015. Of these, 78% were outside health facilities, increasing the risk of unsafe abortions.
Women in sex work face exclusion and abuse, experience forced sex and violence by families and partners, and are denied access to SRH services. Often, these women are unable to negotiate with clients, who refuse to use condoms in exchange for more money. In addition, traffickers and pimps do not allow usage of contraceptives, especially in cases where women are held captive.
Women in sex work may need access to HIV testing, family planning, maternal, newborn and child health (Prevention of Parent to Child Transmission), and safe abortion services. In practice, however, these women encounter significant social, structural and policy barriers – including stigma – while accessing SRH services.
Traditionally, HIV interventions and programmes in India have focused on providing testing alone. However, it may not be the immediate need for women in sex work. Evidence from ongoing projects in India suggests that the uptake of HIV services increases by addressing gender-based violence and the immediate SRH needs of women in sex work, including access to contraception, abortion and post abortion care.
In addition, over the last few years, there has been a changing pattern in the way sex work is being solicited in certain areas. Gatekeepers and women are moving from traditional soliciting to virtual networks due to easy access to technology, such as Internet and mobile applications. Often, young girls remain hidden and anonymous, and are unwilling to disclose their identities. As part of our interventions, we offer video calling and trauma counselling to address their immediate SRH needs, which has enabled us to gain their confidence as well as that of the gatekeepers.
We must ensure that every woman receives SRH services she needs — without being shamed or judged. No country will be fully developed unless all its women are safe and healthy.
Sonal Mehta is chief executive and Shamnu Rao is senior programme officer at India HIV/AIDS Alliance
The views expressed are personal