Sexual and Reproductive Health and Rights Inequities Among Sex Workers Across the Life Course

Abstract

AbstractAll individuals, including sex workers, are entitled to the full spectrum of sexual and reproductive health (SRH) and rights. Yet sex workers continue to bear significant SRH inequities and unmet needs for appropriate SRH services at every step along their sexual and reproductive lives. To illustrate the complex and nuanced barriers that currently impede sex workers’ access to SRH services, this chapter describes the current gaps in access to SRH services experienced by sex workers globally, drawing on in-depth interviews and focus group discussions with 171 sex workers and sex worker organisations from across ten countries. Interviews highlight the lack of tailored, comprehensive, and integrated SRH services. These gaps are driven by intersecting structural forces such as: the criminalisation of sex work, same-sex relationships, and gender non-conformance; harmful and coercive SRH policies; sex work and gender-based stigma; and logistical and practical barriers. To support the SRH needs and rights of sex workers, participants recommended improved access to comprehensive, integrated services addressing sex workers’ broader SRH needs, including family planning, abortion and pregnancy needs, SRH screening, hormone therapy, and other gender-affirming services. Crucial steps towards ensuring equitable SRH access for sex workers include addressing stigma and discrimination within healthcare settings, removal of coercive SRH policies and practices, and dedicating appropriate resources towards sex worker-led SRH models within the context of decriminalisation of sex work.