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, raped and sexually abused endure. In
fact, the case can be made that women in prostitution -- because they
are subject to being battered, raped 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 rape 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.

REFERENCES

Parriott, Ruth. Health Experiences of Twin Cities Women Used in
Prostitution: Survey Findings and Recommendations. Unpublished, May
1994. Available from Breaking Free, 1821 University Ave., Suite 312,
South, St. Paul, Minnesota 55104; also available from the Coalition
Against Trafficking in Women.

Hunter, Susan Kay quoting oral testimony collected by the Council for
Prostitution Alternatives. Prostitution is Cruelty and Abuse to Women
and Children." Feminist Broadcast Quarterly, Spring 1993. Available
from the Council for Prostitution Alternatives, 519 Southwest Park
Avenue, Suite 208, Portland, Oregon 97205; also available from the
Coalition Against Trafficking in Women.

Jacobson, Jodi L. "The Other Epidemic." World Watch. May-June 1992, pp.
10-17.

Author

Janice G. Raymond is Co-Executive Director of the Coalition Against
Trafficking in Women and Professor of Women's Studies and Medical
Ethics at the University of Massachusetts, USA. She is the author of
many books and articles including A Passion for Friends: A Philosophy
of Female Affection and Women as Wombs: Reproductive Technologies and
the Battle over Women's Freedom.

Published by
The Coalition Against Trafficking in Women, February 1999
Donna M. Hughes and Claire M. Roche, Editors
Donna M. Hughes, dhug...@uri.edu
http://www.uri.edu/artsci/wms/hughes

http://www.uri.edu/artsci/wms/hughes/catw/mhvhealt.htm

Science is not belief, but the will to find out.