an initiative to end sex-trafficking
every woman free, every child in school
Columbia University - Health impact of prostituting children 2006
A big thank you to the Columbia’s Mailman School of Public Health and ECPAT-USA for including me in the expert consultation on public health strategies to prevent and mitigate the health impact of child prostitution. It is wonderful to have such an experienced group of people meeting to address the challenges that we as NGOs have to grapple with everyday in red-light areas. However, I am troubled to be discussing only the health consequences of child prostitution. As public health practitioners and as activists if we accept child prostitution and only talk of preventing and mitigating its health impact we are already giving up before we begin on the journey of restoring human rights. I would like to reword the topic as public health strategies to prevent child prostitution and mitigate its health impact. This is more than a semantic. Prostitution is not safe and will never be safe for anyone.
The best health strategy is an exit strategy. I am neither, a public health specialist or a physician or nurse. I am a journalist who is now an activist and have been researching this issue worldwide for the last eight years. My presentation is based on my experiences working with an NGO rather than a clinical analysis.
I founded a community-based organization of women and children in prostitution in Bombay, India as a result of a documentary I had made five years ago on the trafficking of women and children from Nepal to the brothels of Bombay called, The Selling of Innocents. The organization is called Apne Aap, which literally means Self-Help in Hindi or “We can do it on our own.” We are based in the largest red-light area of Bombay- Kamathipura. Kamathipura is a criss-cross of 12 lanes with some of the most notorious brothels in the world. Some of these brothels are infamous for the jails where children are kept behind bars. Girls from age seven to 15 are sold into prostitution here. Apne Aap works among the 25,000 or so women in prostitution in this area. We have a membership of 480 adults and 55 girls.
In our work at Apne Aap we do not only address the health needs of girls but find that these girls become women very quickly and it is very hard to define when they become adults. The health impact is devastating for both women and girls.
Women and girls in Apne Aap have been treated for:
a)Insomnia
b)Repeated abortions
c)Skin diseases
d)STDs
e)Drug and alcohol dependency
f)Herpes
g)Psychological traumas like post traumatic stress disorder, claustrophobia and isolation
h)Violence to their bodies
i)Malnourishment
j)Jaundice
k)TB
l)HIV
In addition children are also treated for torn vaginas, aneamia and Vitamin A deficiency. Many of them have constant low fever and some become developmentally disabled.
These children are kept in bondage and made to service 10-25 clients a day. They are locked up in small 5 ft by 5 ft rooms with very little ventilation and light. They have only a bed for eight hours and then they must fend for themselves. They develop insomnia. They are beaten into submission every night and develop post-traumatic stress disorder. One of our members, Pushpa, is still unable to speak after being used in a brothel for 18 months.
The brothels madams only give them one meal a day and encourage alcohol and drug dependency so that the girls don’t run away. The girls too prefer to continue this dependency to block out their horrifying experiences. Madams also encourage these underage girls to have a couple of children by the time they are fourteen, so that there is no way for them to go back home. Many of these pregnancies result in miscarriages as the bodies of the children are not fully formed or as a result of the everyday violence.
And on top of this as activists we have to address the problem of discrimination in health care to women and girls in prostitution. Hospitals will not admit them, or do proper examination if they do. They are callous in their behaviour and this leads those in prostitution to go to local quacks who rip them off. Surekha developed multi-drug resistant TB as the doctor did not make her complete the full course. At Apne Aap we make sure that the women and children in prostitution are admitted, examined and follow-up treatment is done. We keep health files on all our members.
However, the impact of HIV has been a huge tax on our resources in more ways than one. More than 60 per cent of our members have HIV. Three of our founding members are dead and the fourth is declining rapidly.
Besides trying to procure a cocktail of drugs for our members we have to look for ways to make food available as the drugs are toxic. We need to assign staff members time for follow up treatment for all opportunist infections. And then we have the additional challenge of looking for ways to prevent the daughters from being pulled into prostitution when their mothers die of AIDS. These are children with no extended family structures.
Our first effort is to prolong the life of the mother. We lost one of our members, Naseem, a 14 year old to prostitution when her mother died and her foster father who was also a pimp and the brothel madam immediately pulled her into prostitution. In the case of Yasmin, who is thirteen, we have been able to buy time from the brothel madam for one more year.
To only distribute condoms is not the answer or solution. It is a mockery of the child caught in sex slavery who has no bargaining or negotiating power and also implicitly accepts the inevitability of child prostitution.
Our strategy, is therefore, to have an integrated approach to child prostitution. The first step is to prevent children from being sold or pulled into prostitution. The second is to help them exit prostitution. The third is to mitigate the circumstances through support with health care via a system of referrals, alternative skills building and finding mentors for each girl woman caught in prostitution. The fourth step is to advocate against sex-trafficking and the fifth is education and awareness of the horrors of child prostitution.
Our biggest challenge before undertaking step three which is mitigating the health impact of child prostitution- was to re-instill a desire in the woman child to live- to want to be healthy. She had been isolated, subjugated and so completely traumatized that she did not want to live. She had no stake in the future. Our approach was thus to reintroduce a sense of self, of identity. We did this through creating a safe space and by group therapy. This broke the sense of isolation. We then issued ID cards to our members. These ID cards offered protection and a sense of belonging to the children and women. We then struggled to get the children citizenship papers by issueing ration cards. This was followed by workshops based on rights around CRC and CEDAW. These processes create a strong urge to survive, to live, to access health care and our battle is half won. We then have to make sure that our system of referrals are adequate to respond to these demands.
At Apne Aap we strongly believe that the most successful interventions are community-based and led by the poor. A top-down approach handing out health is intimidating and may not be accessible for the poorest of the poor. On the other the mobilization of women and children in prostitution to demand health care should only happen if an infrastructure to deliver that health care is possible. A rights-based approach ensures that women and children will demand that such an infrastructure is in place. A strong health-infrastructure which is community-based can best address the needs of a women and children in prostitution.
I thank all of you once again in getting together to address one of the last true evils in the world today.
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