Sex Workers as Mothers: Correlates of Engagement in Sex Work to Support Children

Background Globally, most female sex workers (FSWs) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSWs who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSWs in Baltimore, Maryland, United States (U.S.). Methods The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell’s theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers. Results Our sample included 214 FSWs with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. A total of 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p \u3c 0.001). A total of 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p = 0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR = 2.62; 95% CI 1.18–5.82; p = 0.018), less housing instability (aOR = 0.42; 95% CI 0.20–0.89; p = 0.024), initiating sex work at age \u3c 23 (aOR = 2.59; 95% CI 1.23–5.46; p = 0.012), less frequent intoxication during sex with clients (aOR = 0.31; 95% CI 0.14–0.67; p = 0.003), and reporting mental health as most important health concern (aOR = 2.37; 95% CI:1.09–5.17; p = 0.029). Conclusions FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSWs as whole social beings and center their experiences and needs as mothers