In an interview a few years back, Canadian feminist and pro-choice activist Joyce Arthur drew a convincing parallel between the movement for women’s right to access safe and legal abortion and sex workers’ movements for their rights and decriminalisation of sex work. Both movements, at their core, are about women having control over their own bodies, sexuality, and choices, unclipped and free from interference by the State.[1] The comparison isn’t perfect, as Ms. Arthur cautioned, but it is well worth exploring the complex, dynamic relationship shared by these movements, especially when situated within the framework of reproductive justice.
Ensuring bodily autonomy for all people, regardless of any “stipulations and caveats”[2] is the cornerstone of the reproductive justice framework. Reproductive justice offers a critical paradigm shift from approaching and thinking about abortion and reproductive health merely in terms of “choice” to locating these issues within the broader context of “well-being and health of women, families and communities” while also taking into account “issues of population control, bodily self-determination, immigrants’ rights, economic and environmental justice, sovereignty, and militarism and criminal injustices that limit individual human rights because of group or community oppressions”. This intersectional framework and movement enables a space for marginalised identities and groups to fight collectively against reproductive oppression, defined as “control and exploitation of women, girls, and individuals through their bodies, sexuality, labour, and reproduction.”[3]
The framework of reproductive justice, therefore, serves as an excellent avenue to bring together the issue of abortion and sex work, in order to explore the commonalities and intersections between these fields of advocacy, which are geared towards challenging patriarchal norms around (women’s) sexuality(/ies). Abortion and sex work also share the distinction of being topics on which even feminist activists sometimes find it difficult to remain non-judgmental, confronting feminists with the question: to what lengths are we really willing to go to respect and enable women’s choices and bodily autonomy? Though reproductive justice encompasses all genders of sex workers, for the purpose of this essay we’ll be focusing on female sex workers (FSWs) and abortion. Similar barriers could be experienced by individuals with different gender identities and gender expressions as well.
Barriers to sex workers’ reproductive freedom – including means and access to prevent pregnancy, options to terminate pregnancy, and the choice and resources to raise children – haven’t been thoroughly explored because SRHR (Sexual and Reproductive Health and Rights) has been applied in a limited fashion to sex workers. It is telling that the majority of studies concerning FSWs in the Global South address their sexual health but narrowly, focusing on prevention and treatment of HIV/AIDS. This assumption elides the fact that FSWs are not responsible for the majority of the transmission of HIV, and are hence wrongly characterised as vectors of disease to the extent that both Rs in SRHR are often overlooked.[4] Most outreach to sex workers does not seriously consider their sexual autonomy or reproductive lives, part of an implicit marginalising of FSWs even among activists, leading them to classify FSWs as a separate category at arm’s length from “other” women.
Interesting things happen when we examine how FSWs approach obtaining abortions. In many ways, FSWs in India, Brazil, Uganda, and other locales where abortion is stigmatised and frequently difficult to access, face the same barriers as abortion-seekers who are not involved in sex work. Both face a possible breach of confidentiality or judgmental attitude of medical providers (to the point of sometimes refusing abortion or contraception services). Because of this, many abortion-seekers end up availing private medical care, which is costlier and thus harder for many to access.
Furthermore, for many women the ‘basket of choices’ isn’t realistically available when it comes to contraception, meaning a lack of access to resources that help them exercise their bodily integrity and sexual autonomy in choosing when and if they want to become pregnant. There is also a clear need for dual methods of contraception – not condoms alone, which are only “medium effective” at preventing pregnancy.[5] Like adolescents and unmarried women, FSWs are typically excluded from so-called “family planning” initiatives. As Swati Ghosh notes in her study of sex workers in Kolkata, their consistent exclusion from contraceptive services leads many to believe modern contraceptive methods don’t apply to them as these are designed for married people within normative families.[6] All of these groups face barriers to non-stigmatised, affordable contraceptive care given underlying assumptions that they either don’t have control over their own bodies or shouldn’t be using them for sex of their own volition – whether for income or for personal pleasure.
Another common barrier among abortion seekers has more to do with exercising their reproductive freedom to decide on their own terms when and with whom to have children. The stigma and risk associated with having an abortion is still less than going through with an unplanned pregnancy, especially if it happens outside of marriage. The social barrier is such that even when a woman might otherwise want to continue a pregnancy, she feels abortion is her only option – that is, if she can access one.
These barriers to accessing safe and legal abortion are sometimes intensified for FSWs because of their marginalised position in society. However, research indicates that because of the relatively high frequency of unplanned pregnancies FSWs face, they may differ from other abortion seekers with regard to their own attitudes toward termination of pregnancy, and how information, resources, and support related to abortion circulate within sex worker communities. Sex workers in Uganda report that because of the nature of their work, abortion information is readily available within their communities, in which women are an active support network for each other with regard to unplanned pregnancies and other issues.[7] In Kolkata, Ghosh asserts that having an abortion is such a common occurrence among FSWs that it doesn’t carry the same “inhibition” as it does for women in a “family setting”.[8]
At the same time, it would be a mistake to assume that there’s a homogeneous narrative around FSWs’ lived experiences of abortion. In Laos for instance – where both sex work and abortion are illegal – a more complicated ethical stance of FSWs emerges, challenging the idea that sex workers lack an ethical and/or emotional response to abortion and are merely annoyed by it as a work-related hazard. Though many interviewees had experienced abortion before or after entering sex work, about 70% thought that abortion should remain illegal in Laos, should not be culturally accepted, and that women who terminated pregnancies were immoral.[9] Yet, 70% also strongly agreed that abortion is the best option they have when facing unintended pregnancy. Instead of positioning FSWs as a separate category, the authors of this study show that, of course, sex workers’ sense of morality is affected by broader social mores, even as they might intentionally or implicitly subvert norms by participating in a marginalised form of work.
This is a fascinating finding: in the majority of literature on FSWs accessing abortion, their narratives are reduced to numbers. 70% of Laotian sex workers seem to have a deep conflict about the morality of abortion, but we have none of their statements telling how they really feel and what challenges they faced in going ahead with termination. In spite of the emphasis on storytelling in the abortion rights movement, and the imperative for intersectional inclusivity on which reproductive justice hinges, there is a troubling lack of dialogue with FSWs regarding their experiences of abortion. As their experiences encapsulate (on one hand, the multiple marginalisation of being abortion seekers involved in sex work, and on the other the cultivation of communities where women openly support each other and share resources about abortion and other services) abortion rights activists stand to learn a lot from how FSWs understand, address, and access abortion. In the Indian context, moreover, given that our movement to expand safe abortion access and secure abortion as a right for all women is still emerging and growing, we can learn a lot from the strategies surrounding organising and movement building that sex workers’ movements have developed and advanced over the last two decades.
Despite histories of rifts in feminist movements over both abortion rights and sex workers’ rights, it is our belief that reproductive justice can help suture these rifts, because it aims to make ‘choice’ realistic for everyone by addressing comprehensive intersecting inequalities. But these efforts will work only if we apply the principles of reproductive justice consistently and with healthy doses of self-critique. For abortion rights activists, this means reaching out to sex workers to share their experiences (of abortion, and otherwise) instead of assuming it’s enough to implicitly include them in the category of ‘other marginalised groups’. Only then can we ensure a mutual enabling of ownership and space for diverse identities, stories and experiences around abortion within the reproductive rights movement, and inch a step closer towards our mutual goal of ending reproductive oppression for all.
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[1] Smith, Charlie. Why Feminist Joyce Arthur Supports Sex Workers’ Rights. The Georgia Straight. September 28, 2011.
[2] Kapp-Klote, H. Beyond Birth Control: Recent Reproductive Justice Stories That Fewer People Are Talking About. Rewire. July 18, 2014.
[3] Ross, Loretta. Understanding Reproductive Justice. Trust Black Women. November 2006 (Updated March 2011).
[4] See for example: Madeiro, Alberto and Debora Diniz, “Induced Abortion Among Brazilian Female Sex Workers”, Ciência & Saúde Coletiva 20.2 (2015): 587-593.
Marlow, Heather M. et al, “Abortion Services for Sex Workers in Uganda: Successful Strategies in an Urban clinic”, Culture, Health & Sexuality 16.8 (2014): 931-943; Todd, Catherine S. et al, “Contraceptive Utilization and Pregnancy Termination Among Female Sex Workers in Afghanistan”, Journal of Women’s Health 19.11 (2010): 2057-2062.
[5] Feldblum, Paul J. et al, “Pregnancy Among Sex Workers Participating in a Condom Intervention Trial Highlights the Need for Dual Protection,” Contraception 76 (2007): 105-110.
[6] Ghosh, “‘Professional’ Abortion Seekers: The Sex Workers of Kolkata,” CEHAT (2003): 1-18.
[7] Marlow Op Cit, p. 935.
[8] Ghosh, Op Cit, p. 2.
[9] Cleeve, Amanda et al, “Attitudes and Experiences Regarding Induced Abortion Among Female Sex Workers, Savannakhet Province, Laos,” Sexual & Reproductive Healthcare 5 (2014): 137-141.
