Maternal suicide rate high among sex workers

Researchers have found that suicide accounted for 1 in 10 deaths among female sex workers in eight low- and middle-income countries. The study is thought to be the first of its kind. 

“This finding was a surprise, though it probably shouldn’t have been since death by suicide is a leading cause of maternal mortality in the U.S.,” said Dr. Ian Bennett, professor of family medicine and of psychiatry and behavioral sciences, and an adjunct professor of global health at the University of Washington School of Medicine in Seattle and senior author. “The expectation was that these women would be dying of things like HIV and AIDS. No one was thinking that there would be such a high rate of suicide.”

The study was conducted by Global Health Promise, a Portland, Oregon-based nonprofit organization established to help pregnant trafficked teens and mothers in sex work gain access to maternal healthcare, housing and alternate sources of income as well as food and education for their children.

The paper’s lead author was Dr. Wendy Macias-Konstantopoulos, associate professor of emergency medicine at Harvard Medical School. 

“Our findings underscore the calls for urgent evidence-based interventions to address the social vulnerabilities and mental health needs of this marginalized population of women,” Macias-Konstantopoulos said.

The researchers reported their findings Nov. 12 in the Cambridge University Press journal, Cambridge Prisms: Global Mental Health. 

In the study, researchers surveyed 1,280 female sex workers in Angola, Brazil, Democratic Republic of the Congo, India, Indonesia, Kenya, Nigeria and South Africa. 

The researchers worked with organizations trusted in the female sex worker community to help enroll women in study. Potential participants were identified at bars, brothels and other locations and told about the research. News about the study then spread through the community by word of mouth. Female sex workers who joined the study were then surveyed in group sessions. 

Gathering health information  in this way is called the community knowledge approach.

In the group sessions, women were asked about deaths they knew of among female sex workers in the preceding five years. Those who reported a death were asked additional details, including the decedent’s age, the cause of death, whether the woman was pregnant at the time, and the number of children left behind. If the death was due to suicide, they were asked about details such as potential contributing factors.

The women reported 2,112 deaths among other female sex workers occurring during the preceding five years. Of these deaths, 288 (13.5%) were said to be [BD1] due to suicide. Of these, 178 (61.8%), occurred either during pregnancy or within the 12 months following delivery. And unlike what is seen in high-income countries, where  maternal suicides usually occur after the baby is born, more than half (58%) of  these suicides occurred during pregnancy.

“In the United States, we have assumed that pregnancy provides a protective effect against depression, and we tend to focus on postpartum depression and suicide,” Bennett noted. “But women in the U.S. have many more resources available. They may actually be severely depressed before or during their pregnancy, but often they can manage until the postpartum period, when they may become overwhelmed. But among these female sex workers who have few resources, depression can often lead to suicide during pregnancy.”

The findings, he added, indicate that reducing the suicide risk among these women requires their depression to be identified and treated sooner. 

Factors that were thought to have influenced the suicides included financial distress, not being able to provide for their children, being diagnosed with HIV infection, which in some countries is considered a death sentence, and abuse by clients and intimate partners.

These deaths are not only a catastrophic event for these women but their children as well, Bennett added.

“These 288 suicides left 504 children without a mother,” he said. “Funding and action are needed quickly to prevent these deaths and the impact on their children.”

This work was supported by the New Venture Fund and the Bill & Melinda Gates Foundation (INV-049925). 

Written by Michael McCarthy

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