Selected national and international studies, research projects and various women’s programs have begun to address the health burden of violence against women. Such projects have especially focused on the health consequences to women of battering or domestic violence, **** and sexual assault, child sexual abuse and incest, and female genital mutilation (See, for example, World Bank Discussion Papers 255, Violence Against Women: the Hidden Health Burden). In depicting the health effects of such forms of violence against women, these projects attempt to make the violence, harm and human rights violation to women visible.
When violence against women is considered, prostitution is often exempted from the category of violence against women. However, a consideration of the dire health consequences of prostitution demonstrates that prostitution not only gravely impairs women’s health but firmly belongs in the category of violence against women.
The health consequences to women from prostitution are the same injuries and infections suffered by women who are subjected to other forms of violence against women. The physical health consequences include: injury (bruises, broken bones, black eyes, concussions). A 1994 study conducted with 68 women in Minneapolis/St.Paul who had been prostituted for at least six months found that half the women had been physically assaulted by their purchasers, and a third of these experienced purchaser assaults at least several times a year. 23% of those assaulted were beaten severely enough to have suffered broken bones. Two experienced violence so vicious that they were beaten into a coma. Furthermore, 90% of the women in this study had experienced violence in their personal relationships resulting in miscarriage, stabbing, loss of consciousness, and head injuries (Parriott, Health Experiences of Twin Cities Women Used in Prostitution).
The sex of prostitution is physically harmful to women in prostitution. STDs (including HIV/AIDS, chlamydia, gonorrhea, herpes, human papilloma virus, and syphilis) are alarmingly high among women in prostitution. Only 15 % of the women in the Minneapolis/St. Paul study had never contracted one of the STDs, not including AIDS, most injurious to health (chlamydia, syphilis, gonorrheal, herpes). General gynecological problems, but in particular chronic pelvic pain and pelvic inflammatory disease (PID), plague women in prostitution.. The Minneapolis/St. Paul study reported that 31% of the women interviewed had experienced at least one episode of PID which accounts for most of the serious illness associated with STD infection. Among these women, there was also a high incidence of positive pap smears, several times greater than the Minnesota Department of Health’s cervical cancer screening program for low and middle income women. More STD episodes can increase the risk of cervical cancer.
Another physical effect of prostitution is unwanted pregnancy and miscarriage. Over two-thirds of the women in the Minneapolis/St. Paul study had an average of three pregnancies during their time in prostitution, which they attempted to bring to term. Other health effects include irritable bowel syndrome, as well as partial and permanent disability.
The emotional health consequences of prostitution include severe trauma, stress, depression, anxiety, self-medication through alcohol and drug abuse; and eating disorders. Almost all the women in the Minneapolis/St. Paul study categorized themselves as chemically-addicted. Crack cocaine and alcohol were used most frequently. Ultimately, women in prostitution are also at special risk for self-mutilation, suicide and homicide. 46% of the women in the Minneapolis/St. Paul study had attempted suicide, and 19% had tried to harm themselves physically in other ways.
More succinctly, women in prostitution suffer the same broken bones, concussions, STDs, chronic pelvic pain, and extreme stress and trauma that women who have been battered, ***** and sexually abused endure. In fact, the case can be made that women in prostitution -- because they are subject to being battered, ***** and sexually abused all at the same time over an extensive period of time -- suffer these health consequences more intensively and consistently. For example, in another survey of 55 victims/survivors of prostitution who used the services of the Council for Prostitution Alternative in Portland, Oregon, 78% were victims of **** by pimps and male buyers an average of 49 times a year; 84% were the victims of aggravated assault and were thus horribly beaten, often requiring emergency room attention and hospitalization; 53% were victims of sexual abuse and torture; and 27% were mutilated (Documentation available from the Council for Prostitution Alternatives).
In developing countries, it has also been estimated that "70 percent of female infertility... is caused by sexually transmitted diseases that can be traced back to their husbands or partners (Jodi L. Jacobson, The Other Epidemic, p. 10). Among women in rural Africa, female infertility is widespread from husbands or partners who migrate to urban areas, buy commercial sex, and bring home infection and sexually transmitted diseases. Women in prostitution industries have been blamed for this epidemic of STDs when, in reality, studies confirm that it is men who buy sex in the process of migration who carry the disease from one prostituted woman to another and ultimately back to their wives and girlfriends. In what becomes a vicious cycle, infertility leads to divorce and, in some cases, the ex-wife who is cast aside herself turns to prostitution to survive. "The movement of abandoned or rejected ‘barren’ women to urban prostitution has been documented in Niger, Uganda, and the Central African Republic. Numerous studies in Africa and Asia by the World Bank and a number of international research organizations have found that divorced or separated women comprise the great majority of prostitutes or ‘semi’ prostitutes’ (Jacobson, p. 13)." Thus, a major health effect of the mass male consumption of commercial sex and the expansion of sex industries in developing countries, is not only a rampant increase in sexually transmitted diseases but an exponential increase in infertility. The further effects of this vicious cycle insure that a whole new segment of women who are abandoned by their husbands due to infertility, are propelled into prostitution for survival.
Anti-AIDS groups have largely focused on negotiating "safe sex" by promoting condom usage. In both developing and industrialized country contexts, current campaigns to control the spread of HIV/AIDS by advocating "safe sex" for women in prostitution fail to address the blatant inequities between women who are bought for sex and the men who pay for it. Any AIDS strategy based on negotiating condom use between the purchaser of sex and the woman who must supply it assumes a symmetry of power that does not even exist between women and men in many personal consensual relationships. If AIDS programs are serious about eradicating AIDS, they must challenge the sex industry.
Women in prostitution are targeted as the problem instead of making the sex industry problematic and challenging the mass male consumption of women and children in commercial sex. This is institutionalized when governments and NGOs argue for the medicalization of prostitution when they propose laws on prostitution which subject women to periodic medical check-ups. It is stated that women in the sex industry would be better protected if they submitted, or were required to submit, to health and especially STD screening. The way in which sex industries are responsible for the widespread health problems of women and children is mystified with proposals to implement health checks of women in the industry. No proposals have been forthcoming, from those who would propose both mandatory and voluntary medical surveillance for women in the sex industry, to medically monitor the men who would purchase sex.
On the other hand, proposals to medicalize female genital mutilation have been soundly rejected by women’s groups. Women’s human rights organizations have refuted arguments that girls and women undergoing genital cutting would be better protected from its health risks and physical trauma if it was performed in hospitals under trained medical supervision. Although policies and programs that medicalize female genital mutilation may reduce some injury and infection, women’s groups have stressed that these policies and programs do not address or end the abuse of women’s human rights represented by the very institutionalization of this unnecessary and mutilating surgery in a medical context.
The same is true with current attempts to medicalize prostitution. No action will stabilize the sex industry more than legitimating prostitution through the health care system. If medical personnel are called upon to monitor women in prostitution, as part of "occupational health safety," we will have no hope of eradicating the industry. Furthermore, from a health perspective alone, it is inconceivable that medicalization of women in the industry will reduce infection and injury without concomitant medicalization of the male buyers. Thus medicalization, which is rightly viewed as a consumer protection act for men rather than as a real protection for women, ultimately protects neither women nor men.
As with other forms of violence against women, eradicating the health burden of prostitution entails addressing but going beyond its health effects. To address the health consequences of prostitution, the international human rights community must understand that prostitution harms women and that in addition to needing health services, women must be provided with the economic, social and psychological means to leave prostitution. Until prostitution is accepted as violence against women and a violation of women’s human rights, the health consequences of prostitution cannot be addressed adequately. Conversely, until the health burden of prostitution is made visible, the violence of prostitution will remain hidden.
