Health, Pregnancy and Prostitution

Background Women involved in street-prostitution face multiple health risks emanating from contextual and behavioral factors. These risks endanger the women's lives, and would also threaten a fetus if pregnancy were to occur. Few studies have focused on these women from a maternal health perspective. Methods Twenty women with prostitution experience were recruited and interviewed in their natural environment. Semi-structured interviews elicited responses on childhood background, prostitution history, reproductive history and outcomes, responses to outcomes, health behaviors and health care access. Results Nineteen participants had been pregnant as a result of intimate partner, rape, and prostitution encounters. Women rarely used contraception with intimate partners or prostitution clients. Although most participants attempted to reduce or eliminate harmful exposures, only 59.7% of pregnancies resulted in infants who lived beyond their first year of life. Similar proportions of pregnancies ended adversely before women entered prostitution (32.4%) and while engaged in prostitution (30%). Over 80% of pregnancies resulting from prostitution encounters ended adversely. Despite numerous health care encounters, participants lacked health insurance, had unmet physical and mental health needs and most were not receiving social services. Conclusion Participants entered prostitution with the burden of adverse childhood experiences, limited resources, and a diminished capacity for obtaining optimal health. Their chances for a healthy pregnancy were thus compromised before prostitution began. The contextual factors of prostitution and lack of resources exacerbated their poor health and increased negative health behaviors and dangerous exposures. Adopting a life course perspective that acknowledges their maternal history and reproductive capability is proposed.