Selected national and international studies, research projects and various womens
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, rape 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
womens 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 Healths
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
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 womens groups. Womens 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, womens groups have stressed that
these policies and programs do not address or end the abuse of womens 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
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 womens 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.
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,
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.