Women engaged in sex work on a street in Nairobi. Those interviewed were all above 18 years, biological mothers to at least one child aged less than five years, and engaged in full-time sex work in the past three years.
One young mother from Nairobi’s Huruma estate recalled
losing her baby just weeks after birth.
“He was sick for three days vomiting and stooling; he did
not go to the hospital and died in the brothel,” she said.
She has many colleagues, all female sex workers, who have
also lost babies in different ways.
This is the disturbing pattern now being observed in Nairobi
and other Kenyan cities. Babies born to female sex workers are dying more often
than those of other women.
In fact, a new study indicates that one in every five sex workers
in Nairobi, Mombasa and Kisumu has ever lost a child.
So what is killing the babies of sex workers in Kenya?
Investigators, who have published their findings in the
Frontiers in Public Health journal, explained that there were already reports
of too many deaths among children of female sex workers.
So they interviewed 302 female sex workers in Nairobi,
Mombasa and Kisumu about how their children died.
The women were all above 18 years, biological mothers to at
least one child aged less than five years, and engaged in full-time sex work in
the past three years.
The survey actually took place in three countries and
included 302 Kenyan female sex workers (FSW), 301 Nigerians, and 250 Congolese.
Of the 188 children reported to have died, most (82) were
from Nigeria, followed by DR Congo (74) and Kenya, with 32 deaths.
“Our analysis found that nearly one in five mothers who are
sex workers had experienced the loss of a young child—a stark statistic
highlighting the need for research to understand and address preventable causes
of mortality in children of female sex workers,” the researchers said.
Children of mothers not engaged in sex work fare way better.
While there is no widely reported national statistic of Kenyan mothers who lose
a baby at some point in their lives, the national neonatal death rate is 21 deaths per 1,000 live births (one
death in every 48 newborns).
The researchers found the enemy of sex workers is closer
than you may think.
The probe was conducted by Wendy Macias-Konstantopoulos,
Revathi Ravi and Brian Willis, all from different institutions affiliated with
Harvard University.
They discovered that children of female sex workers exhibit
worse mental health functioning, report less parental monitoring, and respond
differently to parenting than other children.
This is because of the environment in which they are born
and brought up.
“Kidnapping, emotional, physical, and verbal abuse, neglect,
sexual aggression, early separation, early sexual debut, introduction to sex work, drug use,
low school enrollment, and the
psychosocial impact of witnessing mothers’ interactions with clients and
witnessing significant trauma such as murder were all experienced,” the researchers said.
These children also suffer intergenerational trauma carried
over from their mothers.
“Indirectly, trauma is transmitted intergenerationally from
mothers to their children, primarily through poor mental health outcomes and
limited parenting and coping skills,” they found.
All this makes the home of a sex worker mother one of the
most dangerous places for a baby to be born and live.
The researchers concluded that what is killing children of
sex workers in Kenya is not mysterious.
It is the same complications that affect many Kenyan
infants. These include premature birth, difficulty breathing at birth (birth
asphyxia), and infections.
The difference is that children of sex workers face both
poorer access to healthcare at birth and the harsher living conditions
mentioned earlier.
“Children reared by mothers who are female sex workers grow
up in the same high-risk, marginalised environments in which their mothers live
and work,” the authors said.
Among the deaths
recorded in Kenya, nearly half (46 per cent) occurred within the first 28 days
of life, largely linked to neonatal conditions such as labour complications and
early infections that are often treatable in a hospital setting.
“I was afraid they would take my baby away if they knew
what I did for a work,” was a common sentiment among sex worker mothers.
This stigma means many sex workers give birth in informal settings without a
skilled health worker, turning treatable birth complications into fatal ones.
Children who survived those first days found more dangers on
the way of life.
Diseases like pneumonia and diarrhoea, which are common
causes of child deaths in Kenya, appear much more deadly in this group. Crowded
housing, poor sanitation and delayed treatment make it harder for children to
recover.
The Kenya Demographic and Health Survey (KDHS) 2022
indicates a much more favourable life for children in the general population.
Only about 21 newborns in the general population die for every
1,000 live births, mostly due to prematurity, birth complications and
infections.
In the general population, thanks to massive public health
campaigns, deaths from diseases like measles have become rare.
However, this study found that measles is still a
significant killer of children of sex workers.
It suggested a breakdown in the last mile of healthcare.
While the government may have the vaccines, the children of mothers living in
brothels, transit corridors, or temporary urban settlements are often invisible
to the healthcare workers carrying out door-to-door immunisation drives.
“Compared to the general child population, children of
female sex workers may have lower vaccination rates due to limited access to
health care and higher levels of pathogen exposures and transmission due to
more hazardous, crowded living conditions,” the authors said.
Their study is titled, “Causes of death among young children of female sex workers in three sub-Saharan African countries: a cross-sectional exploratory investigation.”
The researchers recommended large-scale mortality surveillance
efforts within the hard-to-reach sex worker populations to identify and track
unique trends in cause of death.
“Such real-time data can assist government ministries,
intergovernmental bodies, non-governmental organisations, and funders in the
timely development of policies and allocation of resources for evidence-based
programmes that reduce preventable deaths, improve health and wellbeing, and
extend the lifespan of these at-risk children,” they said.