Practitioners: Marion Stevens, Lance Louskieter and Dudu Dlamini
Project: Sex worker narratives inform the complexity ofaccess to sexual and reproductive health services
Timeline: January 2018 – June 2019
Email contact: Marion Stevens firstname.lastname@example.org
A qualitative research project using body mapping with sex workers. |Exploring access to sexual and reproductive health services. Results describe narratives of barriers posed in health systems and criminalisation to sexual and reproductive health services
At the recent Health and Humanities Interest group mini conference we presented our research reflecting on sex workers experiences of accessing sexual and reproductive health services.
Mothers for the Future (M4F) a group of sex worker mothers in South Africa which has a long working relationship with the Sexual and Reproductive Justice Coalition (SRJC). Mothers for the Future set up to support and organise sex workers who are mothers from a reproductive justice perspective. It is well documented that most of the focus on sex workers comes from a welfarist approach addressing HIV prevention within the risk group – MARPs. This is limiting in not viewing sex workers as complete persons. M4F approached Marion Stevens in setting up a programme to inform sex worker mothers with regard to their sexual and reproductive rights in 2014.
With funding from Amplify Change, the SRJC and M4F conducted a small research project to gather the narratives of sex workers accessing information on sexual and reproductive health and rights and services and in particular their experiences of accessing contraception and abortion. Ethical approval was provided by the Faculty of Humanities from the University of Cape Town. This study provides in-depth narratives regarding barriers to sexual and reproductive health services in particular abortion services. Data collection included the process of body mapping and storytelling of 45 sex workers in Cape Town, Durban and Johannesburg following day long workshops. The analysis was developed from self-reported stories noting emerging themes, narratives recorded with reflection between facilitators. During the process a range of language was used informing a deep listening and story telling process. There was a need referral to counselling, care and services. Many participants described compounded and interlinking challenges that they experienced which then informed their health. A number of themes emerged: the primary family/community not being safe, impact of criminalisation, abuse, substance abuse, mental health, poor access to health services including access to information, limited Sexual and Reproductive health services, quality of contraception services, gynaecological considerations including experiences of pregnancy and obstetric violence, poor access to abortion services, limited integration of HIV services and poor health systems.
In presenting their work Marion provided input on the background and methodology and some of the findings. Dudu reflected some of the narratives of the sex workers particularly in relation to mental health, the public health system not being welcoming and the disturbing experiences of sexual and reproductive health including contraception and abortion access and experience.
Some narratives included:
‘This is me. My first real experience in the clinics is represented here in the clinic. It was terrible. The nurses have bad attitudes towards people. At the public clinic when you explain to the nurses what you feel they treat you like you do not know your own body. Once a nurse asked me what do I know about a fallopian tube and what do I know about a uterus because I am just a patient. I had a boil inside. The nurse was angry’
‘I have moved on from using public health services. I now use private doctors because I feel that I can use the services without being questioned or treated with disrespect.’
‘Again I went to a private doctor and got help. I now use condoms. I am on the pill now and it is better. My period was so heavy I used 3 packets a week. – five pads a day.’
‘I pay for my contraceptives privately because at the clinic they say they do not have the injection. I believe the future is bright for me - that is why I drew a yellow sun
Lance reflected on the methodology used through this process as a public health and gender scholar. They noted the unique value of how this was truly a sex worker led research process and how this enabled a great depth and texture when collating the research data and doing the analysis. This could contribute to the body of decolonial, queer and feminist perspectives.
Following the presentation, a few questions were asked revealing the complexity and tension of challenging health workers on the lived experiences of sex workers accessing sexual and reproductive health services. It was suggested that services are generally poor, and the analysis of whether sex workers experience services any worse than the general population was questioned. This was firmly rebuffed by Dudu who explained how criminalisation and stigmatisation of sex work, forces sex workers to travel to clinics to ensure that they are not identified. SWEAT has a clinic specifically to deal with the fact that sex workers are discriminated against in how they present with specific needs without health workers judging them or marginalising them. It was also noted that some sex workers resort to the private sector. Another participant questioned the rights, agency and perspectives of health workers who may refuse care to sex workers as they do not approve of their work.
It was a robust and insightful discussion and clearly there is a need for more engagement and understanding to learn and listen to perspectives.