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Sex Workers as Mothers: Correlates of Engagement in Sex Work to Support Children

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Abstract

Background

Globally, most female sex workers (FSWs) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSWs who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSWs in Baltimore, Maryland, United States (U.S.).

Methods

The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell’s theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers.

Results

Our sample included 214 FSWs with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. A total of 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p < 0.001). A total of 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p = 0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR = 2.62; 95% CI 1.18–5.82; p = 0.018), less housing instability (aOR = 0.42; 95% CI 0.20–0.89; p = 0.024), initiating sex work at age < 23 (aOR = 2.59; 95% CI 1.23–5.46; p = 0.012), less frequent intoxication during sex with clients (aOR = 0.31; 95% CI 0.14–0.67; p = 0.003), and reporting mental health as most important health concern (aOR = 2.37; 95% CI:1.09–5.17; p = 0.029).

Conclusions

FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSWs as whole social beings and center their experiences and needs as mothers.

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Funding

This work was supported by the National Institute of Drug Abuse under Grant R01DA038499-01 and the Johns Hopkins Center for AIDS Research under Grant 1P30AI094189. We thank the SAPPHIRE research staff, community advisory board, and the women who participated in the study.

Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the senior author, SGS (ssherman@jhu.edu), on reasonable request.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA

    Danielle Friedman Nestadt, Ju Nyeong Park, S. W. Beckham & Susan G. Sherman

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Noya Galai

  3. Department of Statistics, University of Haifa, Mount Carmel, Israel

    Noya Galai

  4. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Michele R. Decker

  5. Johns Hopkins University School of Nursing, Baltimore, MD, USA

    Jessica Zemlak

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Contributions

DFN analyzed and interpreted data, with input from JNP, NG, and SGS, and led writing of the manuscript, with important contributions by JNP, SWB, MRD, JZ, and SGS. SGS conceptualized and designed the SAPPHIRE study and was responsible for project administration. JNP managed/curated data. All authors provided critical feedback on the analysis, interpretation, and provided final approval for the manuscript.

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Correspondence to Danielle Friedman Nestadt.

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Ethical Approval

All study procedures were in accordance with the ethical standards of the Johns Hopkins Bloomberg School of Public Health Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Sherman is an expert witness for plaintiffs in opioid litigation.

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Voluntary, written, and informed consent was obtained from all individual participants included in the study.

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Nestadt, D.F., Park, J.N., Galai, N. et al. Sex Workers as Mothers: Correlates of Engagement in Sex Work to Support Children. Glob Soc Welf 8, 251–261 (2021). https://doi.org/10.1007/s40609-021-00213-8

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