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Our study documents the correlates of barriers to pregnancy and mothering among sex workers in Vancouver, Canada. Our findings highlight a critical need for tailored and non-judgmental services and supports, including improved programs to address intersecting aspects of poverty, health literacy, stigma and substance use. However, due to the criminalized nature of sex work in most settings, the prevalence of sex workers globally remains unknown.
This is particularly true for lost connections with non-drug using family and friends, who may represent an important resource for families e. Researchers studying mothers who use drugs found that both drug use, as well as factors related to drug use i.
This includes qualitative research documented that many homeless mothers feel a sense of powerlessness and loss Meadows-Oliver,and reported their authority as parents were undermined when staff interfered with disciplining their children Kissman, Despite high rates of pregnancy and live births among sex workers Duff et al.
Therefore, we undertook the current analysis to describe the barriers that pregnant and parenting sex workers face, and elucidate factors associated with experiencing the impact of these barriers.
Researchers developed AESHA based on well- established partnerships with sex work and community agencies dating back to Shannon et al. Participant were recruited through day and night times outreach at off-street sex work venues i. Interviews were conducted at one of the project offices or a safe place as located by participants. Following informed consent, participants completed an interviewer-administered questionnaire by trained community interviewers both experiential and non-experientialand brief nursing questionnaires.
The main questionnaire asked questions related to: socio-demographics, e. Macro-structural factors such as migration status born in Canada versus abroadhomelessness and education were also included. This included asking sex workers questions on pregnancy history, contraceptive usage and barriers to pregnancy and mothering.
We had extensive protocols in place for addressing reports of violence and abuse safely and ethically for participants, including supports and referrals. As ly in this study Shannon et al.
This heurisitc posits that the macro-structural factors e. Given high levels of drug use among street-involved sex workers in our setting, we also considered history of injection and non-injection illicit drugs excluding cannabis.
While cannabis use is not legal in Canada, its use is highly prevalent and relatively tolerated, with over half of the population in the province of BC using cannabis. Macro-structural factors included: English as primary language, education completed high school versus less than high school educationlifetime homelessness, having removed by child protection services. A of interpersonal variables were included, such as intimate and partner-violence. In total, biologically female sex workers completed baseline interviews.
Of these, sex workers reported a history of pregnancy and provided a valid response to our dependent variable and were considered eligible for our cross-sectional analysis. We checked the final model for multicollinearity. Of the sex workers who reported a history of pregnancy, just over one third of our sample Just over half The median age of participants reporting barriers while pregnancy and mothering was The most common barriers cited were lack of financial support Please see Table 3.
Specific barriers to pregnancy and mothering among sex workers in Vancouver who reported prior pregnancy. Unadjusted and Adjusted odds ratios ORs for the association between individual, interpersonal, work environment, and macro-structural-level factors and barriers to pregnancy and mothering services among a sample of sex workers in Vancouver, Canada. Participants reported a wide range of social and structural barriers, with social i. Sex workers parenting in shelters may face the additional risk of being identified as sex workers, and having their children apprehended by child protection services, given child welfare laws and regulations that conflate parental sex work with poor parenting Barnett, Given we found that lower levels of education were associated with experiencing barriers, we suggest there is an urgent need for services to better address the health literacy needs of women with lower education; together with improved income and educational policy and programming supports.
There is also a need to expand access to safe and affordable child-friendly housing options, ranging from low-threshold Women wants sex Newell shelters to supportive housing models Wolitski et al. Staff of existing shelters and supportive housing should provide parenting services e. These high rates of child apprehension may be owing to the multiple vulnerabilities faced by sex workers e. Despite this unique window of opportunity for intervention, we found there to be a lack of access to appropriate services and supports for sex workers who use drugs.
We interpret these findings to demonstrate a shortage of accessible and appropriate drug treatment services and supports for sex workers who are mothers, and protection program that falls short of adequately protecting children or supporting the integrity of families. Stepping Stones involves couples including women involved in transactional sexpromoting gender equity in relationships and improved communication skills with partners. The program also targets behaviours associated with ideas of masculinity e. Interventions to address the male partners of sex workers warrant consideration.
The hidden nature of sex work poses challenges in terms of sampling frame selection and population representativeness, however, time-space sampling and social mapping were used to temper this limitation. Social desirability bias cannot be excluded from this study, given the sensitive nature of sex work while parenting, including fear of reporting to child protection services. Despite this, we obtained a high response rate, likely due to the good rapport of the study and interviewers both experiential and non-experiential and long history of community collaboration.
Finally, given the cross-sectional nature of this data, temporality cannot be inferred. We found that sex workers face a range of barriers in their roles as mothers, underlining a critical need for shifts in policy and programming to better support their needs as mothers. Additionally, decriminalization would foster the collectivization and empowerment of sex workers, and decrease exposure to workplace and partner violence and improving peer social support networks and access to care Abel et al.
The collectivization of sex workers could potentially offer the possibility of sharing of childcare responsibilities among sex workers, or the availability of more formal childcare for the children of sex workers. An example of such a service is Vancouver-based Shewaya women-centred, harm reduction model that delivers addiction treatment services, food, parental support, health care and links women to external services e. While Sheway has been hailed an effective model by sex workers, lack of funding for the program has resulted in cramped quarters and age-cutoffs for child services e.
There is a need for increased of and funding for effective services such as these, to provide enabling environments for women to exercise their rights to raise their children. AIDS Society. National Center for Biotechnology InformationU. Health Care Women Int. Author manuscript; available in PMC Sep 1.
Author information Copyright and information Disclaimer. Copyright notice. See other articles in PMC that cite the published article. Abstract Our study documents the correlates of barriers to pregnancy and mothering among sex workers in Vancouver, Canada. Statistical Analyses In total, biologically female sex workers completed baseline interviews. Open in a separate window. Table 2 Specific barriers to pregnancy and mothering among sex workers in Vancouver who reported prior pregnancy.
TABLE 3 Unadjusted and Adjusted odds ratios ORs for the association between individual, interpersonal, work environment, and macro-structural-level factors and barriers to pregnancy and mothering services among a sample of sex workers in Vancouver, Canada. Limitations The hidden nature of sex work poses challenges in terms of sampling frame selection and population representativeness, however, time-space sampling and social mapping were used to temper this limitation.
Conclusion, policy and programming implications We found that sex workers face a range of barriers in their roles as mothers, underlining a critical need for shifts in policy and programming to better support their needs as mothers. Taking the crime out of sex work. Bristol: Policy Press; Ottawa: Women Health. Children of female sex workers and drug users: a review of vulnerability, resilience and family-centred models of care.
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