By Shubhi Agarwal from Amity University, Noida
‘No woman suffers more discrimination in access to services, whether for healthcare, fertility regulations or safe abortions as much as women in sex work’. – National Commission for Women
In India, the conversation around sex work or prostitution is always hushed. There is so much taboo and misinformation around this area of work that the people involved in it are looked down upon, grossly mistreated and dehumanised. Prostitution is regarded as an illegal profession in the country. Whereas in theory, prostitution is legal under the Immoral Traffic (Prevention) Act, 1956 while pimping, owning and managing a brothel is illegal. Though being a legal profession under the law, people involved in it are neither recognised and treated as normal citizens nor given access to basic rights and entitlements. One of the saddest things is that their existence is not even acknowledged in the country. This group of people is one of the most marginalised groups in India.
Prostitution is believed to be the oldest professions in the world. It is practiced in all the countries and every type of society. In India, the references to this practice can be found in the Vedas, one of the earliest known Indian literatures. The Vedas describe prostitution as an organised and established institution. There are mentions of high class prostitutes in the form of celestial demigods having unmatched beauty and feminine charms. Some more mentions and references have been found in some famous Indian literatures, namely Kalidas’s Abhiguan Shakuntalam and Kautilya’s Arthasashtra. In Indian history from Guptas to the Mughals, all kings had dancers who used to entertain the courtesans and even held important positions in the court. They were known as ‘tawaifs’ during the Mughal Era. These ‘tawaifs’ also used to accompany soldiers during war times to release their stress and provide sexual services.
In the Mughal courts, the ‘tawaifs’ held positions of prominence and were known to excel in arts and the Urdu literary tradition. After the downfall of the Mughal Empire and start of the British colonial rule, these women who held important positions and were respected, had to turn to enter into the trade of sex due to economic problems. During that time, they were hired to please the British rulers and soldiers and were even forced in bed by them. This is when the commercialization of prostitution gained prominence. Even though prostitution has always been there in one or the other form, the proper dehumanisation and mistreatment of women started during the British period.
Definition and Causes of Prostitution
The word prostitute is derived from the Latin word ‘prostituta’ meaning ‘to offer up for sale’. According to an encyclopaedia of social science, prostitution is defined as the practice in which a female offers her body for promiscuous sexual intercourse for hire, etc.
The Immoral Traffic (Prevention) Act, 1956, amended the definition of prostitution as ‘the sexual exploitation or abuse of persons for commercial purposes’.
There are various factors conducive to prostitution, but one of the most important and identified one is the socio-economic exclusion and subordination of women by men in the society. Other prevalent factors include poverty, unemployment, abduction, rape, incest, etc.
Poverty is one of the most prevailing driving factors for poor helpless women to get into prostitution. Economic constraints in the family and a migration to urban place drive young women into prostitution to fulfil their own and the family’s needs. Unemployment in the urban cities and a poor education is also a major factor. Due to a lack of proper education amongst the lower classes of the society, there is a lack of employment opportunities which forces them to get into the sex trade. Abduction of young girls from their homes/ villages by taking advantage of their innocence and selling them into sex trade is also very prevalent. It is estimated that around 6% of the girls enter prostitution after rape as they are shunned by their families and the society because of the social stigma. Due to delayed justice and no good future perspectives, they find their ways to the brothels. Incest drives around 8% girls into prostitution.
Though it’s true that most women are forced into this line of profession, there are women who enter it by choice. In 2016, UNAIDS estimated that there are around 657,829 prostitutes in the country.
Healthcare Accessibility for Prostitutes
In India, even though prostitution is legal as long as it’s being carried out in private and not within a distance of 200 yards from a public place, the basic human rights of sex workers are not acknowledged in the country. In the case of Budhadev karmaskar v State of West Bengal, a prostitute’s right to life and dignity under Article 21 was recognized. Even after this recognition, this particular section of the society is not given access to healthcare, freedom of labor, reproductive and sexual rights, etc.
Sex workers basically want easy access to healthcare for themselves and their children, dependable contraception, protection from sexual violence within the profession and protection from STDs and AIDS. With such a large proportion of sex workers in India prone to so many health problems, healthcare is still not easily accessible to them. Due to lack of awareness and sensitisation towards this specific group, they are exploited and mistreated when they try to access healthcare or visit a hospital. Such exploitation and inaccessibility result in a distrust for healthcare system amongst the sex workers.
Due to the line of work, prostitutes are prone to many kinds of STDs and with little knowledge and awareness available to them, most of the times they don’t even realise that something is wrong with their health. Prostitutes usually suffer from sexually transmitted infections or similar diseases, tobacco, alcohol or other substance abuse, and even psychiatric co-morbidity. It is also believed that the sex workers and their children suffer from mental health problems.
Some government initiatives and NGOs working towards healthcare accessibility for the sex workers like National AIDS Control Organisation (NACO), Sonagachi Project in West Bengal and Avahan Project in South India have done some remarkable work. The NACO provides counselling services for STDs and de-addiction among other things and the Sonagachi Project and Avahan Project have succeeded in providing both preventive and curative healthcare deliveries.
Even with these efforts, there is still a huge gap in the accessibility of healthcare services for people in this profession.
Some factors which affects the accessibility of healthcare services for the prostitutes is the behavior and treatment by the healthcare personnel, economic status, facility problems, literacy level, etc.
In the surveys and studies conducted, prostitutes have complained about mistreatment by the healthcare providers like asking for sexual favours, charging a hefty amount or being forcibly asked to get tested for HIV. Also it’s been observed that the medical physicians prescribe an HIV test for a patient when they have a recurring fever, diarrhoea or sexually transmitted infections but in the case of a prostitute they prescribe a HIV test even in case of common cold or fever which is discriminatory. Moreover, in a hospital in Bombay which is often frequented by prostitutes, the healthcare providers draw blood from each person without providing them any adequate reason or information which is in direct violation of their right to information and right to privacy.
Mostly, prostitutes are not economically well off which prevents them from accessing healthcare services. Literacy level of the prostitutes is also a determent in accessing healthcare as half the time they are not able to figure out if a problem is serious which might need medical supervision.
With all these factors affecting the healthcare accessibility of a very vulnerable group, there is an urgency that their basic human right to life, freedom of labor, healthcare, reproductive and sexual rights are provided to them.
Some steps or solutions which can be considered for better accessibility of healthcare for sex workers are:
- To review the Immoral Traffic (Prevention) Act, 1956 which de facto criminalizes prostitution and ensures that the measure to combat human trafficking doesn’t ignore the need for the protection of human rights of sex workers.
2. To decriminalise sex work and all related activities.
3.The UN Organisations and International agencies have also suggested to recognize the trafficking in persons for sexual exploitation and sex work as two different concepts and make laws accordingly.
4. To recognise sex work as a legit profession under the labour legislation and provide them legal protection and rights available under labour laws.
5. States should recognise that the unlawful recognition of sex workers make them more prone to exploitation and violence and should be provided with equal protection from other kinds of violence.
6. Educate and organise sex worker sensitisation workshops for healthcare professionals.
7.Government may offer health insurance policies at subsidised rates to the prostitutes for making healthcare more accessible to them.
8. Set up rehabilitation centres which can conduct classes for book keeping, computing, sewing, etc., so that the prostitutes have something to fall back on if they wish to leave this profession. The centres can also provide therapy and routine check-ups for prostitutes.
9. Provide social security to the prostitutes to ensure their child’s future which would encourage them to leave the profession if they choose to.
10While devising/ amending laws or policies concerning sex workers or prostitutes, sex work organisations should be consulted and their participation should be ensured in devising such policies.
11. Sensitivity training concerning sex workers and issues faced by them should be made a part of training concerning police personnels, medical professionals, public prosecutors and the judiciary.
It can be inferred from the above analysis that the healthcare status of the prostitutes in India needs urgent notice from policy and law makers of the country. It’s high time that their basic human rights are recognized and policies concerning them are formulated accordingly. Proper policies and laws in place will help in regulating the spread of STDs, and keep health of the people involved in the profession in check, while also ensuring protection of the sex workers and their children from exploitation. It’s also important that the people start recognising them as a part of the society and not treat them as outcasts as prostitution as a profession is here to stay.
1) Immoral Traffic (Prevention) Act, 1956