Access and Barriers to Health Care
Many people who live in the United States struggle to gain access to basic health care. Prostitutes face their own set of barriers in regards to accessing medical services, and prostitutes who are also mothers face the added challenge of getting themselves and their children care.
Just like any pregnant person, it is important that prostitutes receive prenatal care during pregnancy and also have access to assisted childbirth. Studies have shown that, “Infants whose mothers fail to receive prenatal care are more likely to have low birth weight or be premature and show a greater incidence of nutritional deficiencies”. [1] In her journal article written based off an “ecological framework”, Rochelle Dalla claims that “ Prostitution-involved women often are reluctant to seek medical attention when pregnant because they lack information on the benefits of and access to services (e.g., transportation, finances), and/or because they fear that their children will be removed from their care by social services”. [2] Coupled with lack of information, fear, and transportation barriers, Susan Dewey delves deeper into the financial hurdles that prostitute mothers face. She explains that because many women who are prostitutes or dancers work “under the table” they do not get benefits like health insurance with their full-time employment. As a result, many prostitutes end up paying full-price when they (or their children) need to visit emergency rooms. Prostitutes often rely on asking one another for advice on “giving birth without health insurance”, [2] and either pay out-of-pocket for traditional medical care or visit free clinics, when possible.
Along with seeking care for themselves and for their children, because of the environmental and social circumstances of their work, prostitutes often need care for mental health issues, substance use and abuse, and sexual health and STI treatment. [3] In thinking about potential health care strategies for parenting prostitutes, Dalla notes that, “medical attention to inform, treat, and prevent STDs and related health complications must be addressed in interventions”. She also writes, “Community outreach, through providing information and direct services, is necessary to access populations that will not likely seek services on their own. If resources were not an issue, a “roaming” medical unit could directly provide services to those in need or transport individuals to clinics specializing in the needs of sex workers”. [1]
One clinic that strives to meet the needs of prostitutes where they’re at is the St. James Infirmary in San Francisco, California. With the mission to, “provide non-judgmental and compassionate healthcare and social services for all Sex Workers while preventing occupational illnesses and injuries through a continuum of care”, the St. James Infirmary was started by and is now run and staffed by entirely male, female, and transgender current and former prostitutes. The St. James Infirmary is, “Grounded in principles of harm reduction because we understand that sex work in itself is not harmful, but is shaped and influenced by the political, legal and social context in which we live and engage in sex work”. [4] This clinic can and should serve as a model for other similar clinics across the country, and even across the world. Perhaps if more clinics, mobile or stationary, such as this one existed, prostitute mothers might be better able to access fair, affordable, and consistent health care.
[1] Dalla, R. (2004). "I Fell Off [the Mothering] Track": Barriers to "Effective Mothering" Among Prostituted Women. Family Relations, 53(2), 190-200.
[2] Dewey, Susan. Neon Wasteland. Berkeley, US: University of California Press, 2011. ProQuest ebrary. Web. 3 March 2016.
[3] Dodsworth, J. (2014). Sex worker and mother: managing dual and threatened identities. Child & Family Social Work, 19(1), 99-108
[4] Akers, Naomi, and Cathryn Evans. Occupational Health & Safety Handbook. St. James Infirmary. Print.