On Sex Work
A critical examination of claims surrounding the issue of sex work, like age at first entrance and the supposed connection to sex trafficking; along with other issues.
Sex work is considered one of the world’s oldest professions, and is an area of work full of controversy ranging from empirical issues with sex work and moral panics about sex work. This article seeks to examine the evidence surrounding the effects of sex work instead of relying on hyperbolic claims with no evidence. Chapters for easier access through CTRL+F can be seen below.
I. Age At First Entrance
II. Sex Work And Sex Trafficking
III. Reasons for Going into Sex Work
IV. Mental Health
I. Age At First Entrance
Oftentimes, it’s said that the average age of first entrance into sex work is 13 years old, sometimes even younger. For example, the Washington State Office of Attorney General says that “12 is the average age of entry into pornography and prostitution in the U.S.” Shared Hope International echoes a similar age, saying that “The AVERAGE age a child is first exploited through prostitution is 13 years old.” World Without Exploitation says that the average age of entry into the sex trade is 14. Still, their cited study (Carpenter and Gates 2016) makes no such claim, instead saying that the average age of entry into sex trafficking (not the sex trade, per se) is 16.1 years of age, not 14.
Catharine McKinnon, the infamous anti-pornography and anti-sex work feminist, also argued that the average age of entry into sex work was below the age of 18. However, instead of saying what the average age is, McKinnon instead cites multiple studies showing the age at first entry to range, but always stays below 18. As McKinnon notes, “Another global commonality of prostitution—another that no one contests—is that people typically enter prostitution when they are young, often well below the age of majority.”
The first cited study by McKinnon is Boyer et al. (1993), found in Survival sex in King County, helping women out. I am unable to find a copy of the book online, but as McKinnon notes, “reporting 15 of 16 subjects interviewed entered prostitution between ages 12 and 14.” Very small sample size to support such a bold claim on McKinnon’s part, but small samples can still be useful if they fit the trend found in more rigorous studies, but this also assumes McKinnon’s other studies are rigorous and not of poor quality; especially since stacking poor data onto more poor data does not make the data better.
The 2nd study is the Report of the Committee on Sexual Offences Against Children and Youths (1984); 229 juvenile prostitutes from 8 cities across Canada were interviewed through a quota and snowball method. Using such sampling methods would often be an issue since it leads to biased sampling, but considering sex workers are a hard population to contact, the use of this sampling only slightly weakens the quality of the data, but not by much given the circumstances. According to this study, the average age of males and females was comparable, and the majority were 17 and older.
However, the report believes that “a number of these youths were in fact younger than their reported age.” Of course, this is a study on juveniles, so why should we expect them not to be young? It’s like doing a study on high school students and being surprised when many of those in our sample are young. Even as the report notes, this is not supposed to constitute a sample [referring to the 229 people]. A proper study would have been to get older sex workers, ask them the age when they first entered sex work, and get the average age from there — not ask a group of young people how old they are while working in sex work and being surprised the young people are young.
McKinnon then cites Høigård & Finstad (1992), finding that the average age of going into prostitution was 15 1/2, based on their sample of 25 people from Norway. A pretty small sample gauged throw snowballing. McKinnon then cites James, who she says it’s a “sample of 136 prostituted girls in Seattle area whose mean age of entry was 15, with 36% being 14 or younger.” The source itself is James’ “Entrance into Juvenile Prostitution”, but I have been unable to find an online copy of this study.
The study is mentioned in Silbert and Pines (1982), with Silbert and Pines being cited by McKinnon, but seems to be cited in passing. Anyway, Silbert and Pines’ 200 juvenile and adult prostitute sample is gauged through “Public service announcements and distribution of leaflets and cards were the major methods of recruitments of subjects, who came to the study primarily through informal word of mouth.” The average age of entrance into prostitution was 16.1; the average age of entering prostitution was 13 for juveniles, and for adults, it was 18. So, it seems for juveniles it’s 13, but for adults, it’s 18 — this certainly isn’t very consistent with McKinnon’s argument that the average age of entry into prostitution, in general, is below 18. It also certainly isn’t consistent with what anti-trafficking organizations have said of it is between 13 and 14, even younger than that sometimes.
The next study is Bagley and Young (1987), who surveyed a staggering sample of 45 women who had previously been prostitutes. As Bagley and Young note, “All of the women were interviewed by women associated with various helping agencies in Calgary and Edmonton with whom the former prostitutes were in contact.” I am not sure how good of a sample this would be if these women knew people from helping agencies, and it’s possible those that wanted help would have been more likely to seek and come in contact with those who could help. Moving on, 51% started prostitution before age 16, meaning that 49% did not. Barely a difference, but it’s significant for McKinnon.
Farley et al. (2003) are then cited, showing data from nine countries. All those in the study were prostitutes, with some regions having higher samples than others.
The average age for entering prostitution was above 18 for 8/9 countries, but almost everything was unknown for Turkey. The majority of people did not enter prostitution before 18, except for Columbia and Canada, where the average age of entry was 17 for the former and 18 for the latter.
Data from Columbia and Canada support McKinnon’s assertion, but when McKinnon takes such a broad take on the issue, i.e. “many start when young”, lots of data can support her. However, when it supports her depends on the region, and the threshold McKinnon would use to consider a percentage < 50% important for her cause. The final study cited is Farley et al. (1998). No data was given on the average age of entry into prostitution.
McKinnon’s assertion is supported by her data but also doesn’t when broken down by region. Of course, when such a broad position on the issue is taken, anything below 18 is in support of McKinnon — however, concerning those who argued for average age, the data does not support them since many studies give ages above 13. This does not mean these are the only studies on the issue.
Dalla (2010) found that the range of ages of people who went into prostitution ranged from 11 to 31, but the average was 19.4 (N = 43). Sanders (2005) found that among female prostitutes (N = 50) in Birmingham, UK, “The mean age of their entering prostitution was 23 years.” Bagley (1999) found that for their Canadian sample (N = 45) the average age of entering prostitution was 15.4 and for the Manila sample (N = 81) it was 15.2. Lyon (2014: archived version) offers a wealth of data examining the average age one enters sex work by region. Unsurprisingly, the data is inconsistent, and many studies from Europe and the United States show that the age at the first entrance to sex work is higher than the assumed low age of 13, give or take a few years. For example, one UK study found it at 19.6 for outdoor sex work ad 22.7 for indoor sex work. Another UK study said that the majority entered between the ages of 20-29.
The data on the issue is poor, as the sampling is poor and the sample sizes are often very small for an issue like this. Because of this, I do not think a true value will ever be found given the methodological issues in the available research, and because of this, confidence in saying what the average age of first entry in sex work is does not follow. We may never get a true value as studying sex workers leads to many significant issues, but the currently available evidence does not suggest any clear age. I am not alone in saying this as others have also noted issues with the data on age at first entry into sex work (see Har 2013; Hall 2014). An issue also arises with the “average” being 13. As Hall notes,
Even by mathematical standards, the numbers don't add up. In order for 12 or 13 to represent the national average age of entry, there would need to be a significant number who enter at ages younger than that. "The vast majority of young people who are 'rescued' by the law enforcement during Operation Cross Country sweeps are 16- and 17-year olds," Koyama says, "and there are rarely any under the age 13... For the average age to be around 13, there needs to be many more 5-12 year olds that are forced into prostitution than are empirically plausible." If the massive numbers of children exist in quantities enough to offset those who enter in their late teens or as adults, they’re not showing up in the arrests made by the Federal government, even high-profile ones like Operation Cross Country.
For the average age of entry to be 13 or younger, or slightly older (14, for example), that many there would be many people below the age of 13 working in sex work — but we see no such numbers to the point where they drive the average down. Some have varied the argument saying that the average age a minor enters sex work is 13, but again, this argument still runs into the issue of the average calculation.
Cunningham and Jacquin (2018) echo criticisms levied against the Canadian report cited by Mickelwait: If one interviews juveniles, of course, they’ll find the average age to be below 18, what else would they expect? Studies provided by Cunningham and Jacquin find the average to be higher than what’s assumed.
The authors repeat what is already known, “Research to address the age of entry into the sex trade has not yet been constructed and faces design challenges.”
II. Sex Work And Sex Trafficking
When discussing sex work, it’s often claimed that sex work and sex trafficking are linked to one another. Leidholt (2003) argues that “…prostitution and sex trafficking were closely related phenomena.” Leidholt also says that “While prostitution may be characterized as an expression of sexual freedom or as a form of labor, the reality is that it bears a much closer relationship to–indeed it incorporates–practices of gender-based violence, especially the sexual abuse of girls, rape, and intimate partner violence.” Leidholt takes the same position as McKinnon and Dworkin (1998), arguing that sex work—in McKinnon and Dwokin’’s case, pornography, specifically—is a form of violence against women from men, a way to degrade women, and seeing sex work through the oppression paradigm rather than something that can be consensual.
Weitzer (2011) remarks how the “oppression paradigm” refers to the monochromatic lens through which individuals view sex work. Supported of this view see sex work as a form of seeing women as lower class, essentially. Women are sex objects, and sex work is a way to dominate and exploit women, according to this view. Indeed, this is how commentators like McKinnon, Dworkin, and Leidholt view sex work through their monochromatic lens on the issue. On the contrary, another view sees sex work as not something that only seeks to dominate and exploit women, but rather sees sex work as a construct with many variations. Some see sex work as oppressive towards women if forced, harmful in some ways if a woman has no other offer to take except sex work, but also positive if the woman herself decides to do sex work based on their own accord.
An example of the oppression paradigm is given by Weizter. As Weitzer’s example remarks, Donna Hughes, an American academic and feminist, says that “most ‘sex workers’ are or originally started as trafficked women and girls.” This accusation is important as the idea that sex work and sex trafficking are linked rests on this assumption.
On her Substack, Aella (2022) notes significant issues with the data about how many sex workers are trafficked, to begin with. As Aella goes in-depth with the data, the issue has come to inconsistent values that do not align with one another. Of course, we should not expect estimates from one source to perfectly align with another when estimating things like sex trafficking, but the large discrepancy certainly casts doubt on the validity of values relating to how many people are trafficked into sex work—because of this issue, some numbers might be overestimated, which certainly wouldn’t help with Hughes’ assertion that" “most” sex workers started as victims of trafficking.
One government report found that in 2001 and 2002, 50,000 women were trafficked per year in the U.S. (Clawson, Layne, and Small 2006). However, in 2003 and 2004, this number decreased from 50,000 to 14,500-17,500. This is a significant decrease from the 50,000 number originally said. As Weitzer notes,
Apart from the lack of transparency in how officials arrived at these figures, when we compare the 2000 figure (50,000) with the lower figure for 2004 (14,500), we see an astonishing 71% decrease in the estimate in just five years. Such dramatic downscaling should give pause to researchers and policymakers alike. More recent reports have substituted vague language for numerical estimates of the domestic situation. The 2008 Trafficking in Persons report, for instance, simply declared that “thousands” of people are trafficked into the U.S. every year.
This high value of 50,000 has been repeated by multiple anti-trafficking organizations (e.g. Do Something; Child Liberation Foundation). Even the GAO (2006) has criticized the government’s number since the data behind it was flimsy, at best.
The U.S. government estimates that 600,000 to 800,000 persons are trafficked across international borders annually. However, such estimates of global human trafficking are questionable. The accuracy of the estimates is in doubt because of methodological weaknesses, gaps in data, and numerical discrepancies. For example, the U.S. government’s estimate was developed by one person who did not document all his work, so the estimate may not be replicable, casting doubt on its reliability. Moreover, country data are not available, reliable, or comparable. There is also a considerable discrepancy between the numbers of observed and estimated victims of human trafficking.
Government publishing bad data which has led to an argument now clung onto by multiple anti-sex work activists and anti-trafficking activists is certainly not what we would have expected. These numbers pushed by activists are certainly scary, but the issue of sex trafficking does not warrant the use of bad data since sex trafficking is already an issue on its own. Even 500 people being sex trafficked is an issue, but there is no need for bad data to inflate the issue to become more of an issue than it already is.
According to people like McKinnon, children would also be the victims of sex trafficking. Indeed, children are often victims of sex trafficking, but how bad is the issue? Is there a discrepancy between what activists have claimed about children in sex trafficking and the data itself? Avila (2014) says how “between 300,000 to 400,000 American children every year in some form of sex-trafficking.” Moms in Prayer International echo the same argument, saying that “Between 300,000-400,000 minors will be human trafficked in the United States this year.” When discussing this number, McNeil (2014) says,
“That number is a distortion of a figure from a 2001 study by Richard Estes and Neil Weiner of the University of Pennsylvania, which estimated that number of ‘children, adolescents and youth (up to 21) at risk of sexual exploitation.’ (Emphasis added.) ‘Sex trafficking’ was the least prevalent form of ‘exploitation’ in their definition. Other forms included stripping, consensual homosexual relations, and merely viewing porn.”
How sex exploitation was defined, then, also seems to be an issue since in what world would one consider “viewing porn” a form of sexual exploitation? Unless you’re Liala Mickelwait, this seems like a far fetch.
Kessler (2015) also remarks how “The ‘300,000’ figure also relied on a series of guesses on the part of the researchers, such as the assumption that 35 percent of runaway youth away from home at least a week were “at risk” or that one-quarter of one percent of all youth ages 10-17 were ‘at risk.’” The National Academies of Science, Engineering, and Medicine (2013) found that in their report on minors and sex trafficking, “No reliable national estimate exists of the incidence or prevalence of commercial sexual exploitation and sex trafficking of minors in the United States” and, “Despite a growing literature on commercial sexual exploitation and sex trafficking of minors in the United States, reliable estimates elude the field. When estimates are presented, they are generally accompanied by qualifiers and caveats.”
Some examples given by the National Academies highlight the issues of studies examining minors and prostitution. One 2008 study had a range of 1,400 to 2.4 million, and arrest records estimate 1,400, but using arrest records runs into multiple issues, like counting people multiple times because they might have been arrested multiple times.; and, for example, “arrest numbers cannot convey the number of minors being prostituted who escaped detection from police.” (See Tiffany 2022 for more.) While even one child being sex trafficked is bad, the number often thrown out by activists is unwarranted. No need to make up numbers about an issue that is already bad in itself through the use of inflated numbers and bad data.
Another way to estimate the amount of people sex trafficked into sex work is to see how many people were rescued from this. This fits both adults and minors, but there is a large discrepancy between how many people are estimated to be trafficked into sex work and how many people are identified. As Weitzer notes,
A related issue is the discrepancy between the claimed magnitude of the problem and the number of victims identified and assisted by authorities. No one would claim that the latter should roughly match the former, given the obstacles to locating victims in black markets, but a huge disparity between the two should at least raise questions about the alleged scale of victimization. The State Department recently reported that only 0.4% of the estimated number of victims worldwide have been officially “identified.” And domestically, the Justice Department took issue in 2005 with the “stark difference” between the estimated number of victims trafficked into the U.S. for that year (14,500–17,500) and the number of victims located (611 over the four years from 2001 to 2004).74 The 2008 Trafficking in Persons report provides updated figures: between 2001 and mid-2008, 1,379 trafficking victims in the U.S. were identified. This figure remains but a tiny fraction of the number of persons allegedly trafficked into the U.S. during this time period (14,500 x 7.5 years = 108,750; 17,500 x 7.5 years = 131,250).
Weitzer echoes similar criticisms like GOA towards the government estimates. Of the 42 reporting agencies, only 18 “engaged in what analysts at the U.S. Bureau of Justice Statistics considered “high-quality” data collection and reporting; confining the analysis to these eighteen agencies, 31% of the alleged sex trafficking incidents (consisting of 218 cases) were confirmed as bona fide trafficking, 37% were not confirmed, and the remainder were pending.” Unfortunate facts are also given by Weizter when he says that
Unfortunately, many scholars recapitulate the NGO and government numbers, ignoring the standard caution against uncritical acceptance of official statistics. A review of over 100 academic journal articles found that the claims of government agencies (especially American) and global organizations (such as the United Nations) were treated as evidence, even though most of these agencies had failed to reveal their data sources or methods. The most quoted source was the annual Trafficking in Persons report by the State Department; very few of the academic articles were based on independently collected data.
More examples of bad data can be seen in a hearing in congress. Deborah Richardson, CPO of Women’s Funding Network, told the government that “An independent tracking study released today by the Women’s Funding Network shows that over the past 6 months, the number of underage girls trafficked online [reffering to the site Backpage] has risen exponentially in three diverse states” (Hearing Before the Subcommittee on Crime, Terrorism, and Homeland Security of the Committee on the Judiciary, House of Representatives, One Hundred Eleventh Congress, Second Session, September 15, 2010). It certainly sounds like damning evidence, but the methodology was flawed from the start. This was not a study examining how many were minors, but rather asked people how old they thought they were and took their estimates at face value. They used how old someone was according to someone else’s guesses and ran with it (Pinto 2011). This is not the first time activists have used bad data or hyperbole to push their message (see Sullum 2015, 2012).
As a quote in Weizter’s paper notes,
[I]t is in the best interests of groups and NGOs, both national and international, to push these unreliable and most likely vastly overstated estimates . . . . Once the problem has been presented and accepted to be on a certain scale, new information that does not support this notion is dismissed. The estimates have become the “received wisdom”
The data on sex work and sex trafficking is thus not based on good data, but this has not stopped anti-trafficking activists from repeating claims which seem can’t be verified by quality data. However, the central tenant that “most” sex workers are trafficked can still be true even if the data on sex trafficking estimates are unreliable, but the lack of reliability in sex trafficking statistics certainly weakens Hughes and others’ arguments.
As Aella notes when combining data on how many sex workers there are, “given my estimated sex trafficking prevalence, I estimate about 3.2% of active, in-person sex workers in the US are currently being sex trafficked.” This estimate can be wrong since getting data on how many sex workers there are runs into issues on its own. However, taking the 3.2% estimate as face value, and Aella estimates that 0.29% of the U.S. population are sex workers, this does not seem as if “most” sex workers are trafficked. Rossler et al. (2010) found that in their sample of 193 sex workers derived from different locations, only 3 (1.6%) were forced to do sex work.
Even if most sex workers aren’t trafficked, the oppression paradigm still lives on because it can still view sex work as a form of dominance and oppression, and this can be true regardless if most sex workers aren’t sex trafficked. Because some women have to go into sex work because of financial needs, for example, this is still oppression. The issue of if sex work fits within the line of the oppression paradigm has been discussed in other works (see Weizter’s paper and Gerassi 2015). That topic is far beyond the scope of this article, but the idea that sex work and sex trafficking are strongly linked doesn’t seem to stand under scrutiny. The relationship is weak, at best, and most sex workers do not seem to be trafficked into it. One should also keep in mind that this data tends to relate to prostitutes most of the time, but sex work has evolved to things like Onlyfans, pornography, etc., so the estimate of how many women are sex trafficked into sex work may be a little bit higher, but not by much, and it certainly doesn’t seem as they represent a significant majority.
III. Reasons for Going into Sex Work
The reason people go into sex work can vary for a lot of reasons, and it certainly isn’t as binary as some people would want it to be. This section goes over the reasons people go into sex work. Many of these studies will be recited in Chapter IV.
Rossler et al. looked at 193 sex workers who worked “outdoors, in studios, bars, cabarets, parlors, brothels, and escort services” (3).
Most people who went into sex work (55, 37.3%) went into sex work because they liked the job. This was followed by not being able to find another job, which isn’t necessarily bad in itself as those who went into sex work because of may or may not have positive/ negative feelings about sex work); needing to support a family through financial means; paying debts; buying drugs, and financing a professional education, and a minority of women went into sex work to help a partner and only 3 were forced to do sex work. While not shown in the table above, 55.4% of sex workers wished to quit, but they did not break this down by where the sex worker worked.
Krumrei-Mancuso (2017)’s sample of 88 prostitutes “from the Netherlands (60.2%), with 6.8% from another Western European country, 4.5% from Asia, and 3.3% from other parts of the world” found that 48.9% did it for financial reasons (making money, financial needs, no other jobs available, desiring a luxurious lifestyle, and wanting easier work and fewer hours). For those who made explicit reasons for going into sex work, 15.9% reported doing prostitution for financial reasons, and 14.8% did it for a nicer lifestyle. The second most common reason was for fun/ and or excitement (22.8%).
As was said above, sex work is more than just prostitution, but also includes things like going into the pornography industry. Data on reasons for entering the pornography industry and sparse and oftentimes not rigorous. Griffith et al. (2012) measured the reasons for entering the pornography industry among its sample of 176 female performers.
The majority of performers went into the pornography industry for money, sex, attention, and fun. Reasons like coercion, which one would expect to be high given the recent claims that the pornography industry is riddled with trafficking, were the minority at 1% (1 person). We should expect people entering the pornography industry to do it for reasons related to money and sex given it seems as if it’s a better option than going into prostitution.
Sausa, Keatley, and Operario (2007) looked at transgender individuals (N = 48) who engaged in sex work. Not much data is given in this paper, but it does offer valuable insight into why transgenders entered sex work. According to the responses, it was seen as a way into a community of sex workers. This community “provided many young transgender women of color feelings of community and social support, which they often lacked in their family contexts” (772). Focusing on structural and economic barriers, the authors say that,
Participants reported systemic and institutionalized mechanisms of oppression (transphobia, sexism, and racism) that limited their employment opportunities and encouraged sex work as means of financial support. Some attributed a reliance on sex work to inadequate transgender-sensitive.
Lack of social inclusion can lead transgender individuals to go to sex work as it offers a mattress of support for them.
Vanwesenbeeck (2001) review of the research from 1990-2000 found that older work has found childhood sexual abuse was associated with entering sex work, but this data largely restricted itself to samples of prostitutes only, women in jail who were prostitutes, and ex-prostitutes recruited through agencies. Much of the data at the time was not representative. Being pushed into sex work because of drugs and pimps also became less important as more research accumulated.
Ernst et al. (2021) focused on college students who were in sex work (N = 227). Sex work included escort services, erotic massages, or working as an actor in the pornography industry.
Most people went into sex work because they considered things like wanting a higher income, followed by having financial problems, followed by enjoying the adventure, and having fun as the most important reasons. Another motivation was the lowest at 9.7%.
Benoit et al. (2017) looked at 209 sex workers from sex census metropolitan areas in Canada. There was overlap in why people went into sex work, but the most reported reason was needing or desiring money. The 2nd most reported reason was because of critical life events, followed by the personal appeal of the work.
Critical life events included things like needing to take care of kids, having to survive because of family abandonment, etc. Needing or desiring money was not separated and instead lumped in together. 1/3 of the sample considered their financial situation as acute or desperate; for a quarter of participants, “sex work was described as the best way to make money among several options available that consumed more time, were considered to be less attractive and offered less flexibility" (10).
One-quarter of participants entered sex work because of the personal appeal of the work. “Participants specifically described the desire to use their skills and strengths, satisfy curiosity, increase confidence or independence and meet sexual or emotional needs” (11). One person said, for example, “‘I’ve always been very sexually open. So I was like, “well, I need money, I don’t have a sex life, why don’t I do this and then I can kind of satisfy both those needs?’”
Cobbina and Oselin (2011) conducted interviews with 40 prostitutes, which included people who entered the trade before the age of 19 and people who entered when they were 19 or older.
For some reason, the 19 and up category did not present a “normal” entrance, or how they measured how these women went into prostitution, exactly. Instead, since it’s qualitative data, they do not give much information on this, so this study should be taken with someone caution.
46 gay and bisexual men who offered sexual services on the internet in New York were interviewed by Uy et al. (2004). 63% of men said they went into sex work for monetary gain and benefits. One person said that,
I really enjoy it because I get to … see all that money, or like, you know, all these rich apartments in New York. And I’ve been taken to … [the] New York Palace Hotel one night, and I’ve stayed at the Astoria. So I get to see, you know, a lot of glamorous New York but also just all kinds of people that I wouldn’t have met if I’d just been filing day after day in an empty room. So it really has entertained me for the past year, and … I really enjoy it.
Other reasons for going into sex work include having an increase in one’s sense of self, like an increase in ego (28.3%), and having positive changes to their personality (26.1%); going in because they want to have sex (39.1%).
Mayhew and Mossman (2007) say that,
Briefly, most writers accept a combination of ‘push’ and ‘pull’ factors in entering sex work. Push factors – particularly for young street workers – can include abuse and neglect, a breakdown in caregiving, school exclusion, homelessness, and lack of money. Pull factors can include excitement, encouragement from others involved in sex work, and a way of seeking affection. Freedom to work one’s own hours to accommodate childcare or study responsibilities is another pull, particularly for off-street workers (Plumridge, 2001)
Of most importance, though, seems to be that sex work can offer more money than from ‘square jobs’ (for New Zealand studies, see Robinson, 1987; Jordan, 1991; Turvey, 1999; and Saphira and Herbert, 2004). For young sex workers in particular, money allows immediate gratification (see it, do it, buy it). For others, too, the economic motive is strong. In a study of sex workers in Australia, most had entered the sex industry to support families, pursue higher education, pay off debts and buy cars, houses and/or other large expensive items (Perkins, 1991).
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There is no single reason why people enter sex work. This is in contrast to claims made by people like McKinnon and Walsh, who argue that most people go into sex work because they are forced into it—and deny that people can go into sex work for reasons beyond force. Reasons for entering sex work differ by who is being surveyed, where they work, where they live, etc. Some do it for money, some do it for fun, and it seems a minority are forced into the job.
IV. Mental Health of Sex Workers
In recent years, the site Onlyfans, which caters to sex workers and non-sex workers has boomed as a way to start sex work and sell services. These services range from things like nude photos, sex videos, selling used undergarments, etc., and have been a new way to do sex work with a partner or just do solo work. Evidence on the mental health of these sex workers is sparse and the quality of the work ranges.
The Avery Center, which is an anti-sex trafficking organization that works with victims, surveyed 53 Onlyfans creators and found that
Thirty-four percent of the respondents said they had experienced negative physical or mental health outcomes as a direct result of content creation on OnlyFans. The negative effects creators experienced included anxiety, depression, low self-esteem, fear and shame. The constant demand to create new content from all stakeholders was a primary cause of the anxiety and depression.
The study wasn’t very rigorous and was biased as they put a large emphasis on sex trafficking, but their criteria for sex trafficking are obscure as they have no clear definition. They considered creators getting messages of people offering to run their account as sex trafficking, and asked creators if they know of any minors who had their Onlyfans, but this is not what we consider sex trafficking, to begin with.
A more rigorous study comes from Civic Science (Wilson 2022), which got a sample of creators and subscribers, both current and no longer current ones, and weighed it by the U.S. census.
Current creators and past creators were doing well when asked how happy they were, along with people who weren’t contributing but planned to be, and those who did not plan to be contributing and were not interested.
Bosworth et al. (2022) surveyed 19 Onlyfans creators and found that they scored at a moderate level on the Rosenberg Self-Esteem Scale, and some saw an increase in traits associated with psychological well-being.
As of now, these are the only studies available on the psychological well-being of sex workers on Onlyfans. I hope researchers study these groups more in the future, but due to the nature of creators and how hard it would be to get in contact with them, I doubt new work on this population would be very rigorous.
Pornography actors have also had their mental health studies, but much like the data on Onlyfans, the data is sparse. Plenty of anecdotal evidence arguing pornography is associated with lower psychological well-being because of how harsh the industry is, but these stories often come from biased anti-pornography sites like Fight The New Drug, for example. This anecdotal evidence is not data, and actual data suggests a different picture.
Griffith et al. (2012) consisted of 105 male pornography actors and a matched sample of non-actors and compared them on mental health.
There was no statistically significant difference in psychological well-being between the two groups, except for sexual satisfaction, body image (higher in the pornography actor group), and physical safety. If the industry was harming the well-being of its performers, we should expect this to reflect in the data by showing lower well-being among actors, but this is not what we see. Griffith et al. (2013) found similar results, but they only compared actors to actors.
Griffith et al. (2013b) looked at 177 female pornography actresses and compared them to a matched sample, too, and measured their psychological well-being.
There were no significant differences in well-being between the pornography actresses and the matched sample, except in sexual satisfaction, positive feelings, social support, and spirituality, where the pornography cohort scored higher.
Grudzen et al. (2011) find differing results, instead finding lower mental health among their sample (n = 134) of adult film performers and a sample of non-performers of similar ages (n = 1,773). Performers scored lower on psychological well-being than non-performers.
However, this seems to reflect demographic variables unrelated to adult performer status, as shown in both regressions for mental health in the past 30 days and current depression.
Why Grudzen et al. found different results are unknown, but it has been picked up by critics of sex work. For example, Farley and Donevan (2021) say that “Compared to women who were not in the sex trade, Grudzen and colleagues (2011) found that women in porn had significantly worse mental health and more severe depression.” However, no mention of Griffith et al.’s work is mentioned anywhere.
Farley and Donevan also cited Donevan (2019), work done on Swedish performers as another study finding lower well-being among performers. However, this study interviewed 9 women! This can not be taken as serious work of scholarship and reflects the bias of people like Farley and Donevan for citing bad data with no mention of contradicting data. The authors also go as far as to say that because pornography actors are more likely to do drugs, this must reflect the horrors of the industry leading its actors to abuse drugs to cope with their lower psychological well-being. No mention is given of the possibility of a spurious correlation: those that do porn just happen to do drugs, too, and this may have come before entering the industry and is unrelated to anything.
Overall, it seems like the majority of the evidence (2/3) does indicate good psychological well-being among pornography stars, and one study found opposing results. However, even Grudzen et al.’s work suggests this is not related to whether one is a performer or not.
Balint and Senn (2021) interviewed 150 female student sex workers (cam sex, streets, etc.) and found that when women can maintain distance between themselves and clients during sex work through digital technology, it led to more positive attitudes. When women scored higher on things like hostile sexism, sexual agency decreased’ and “There was also a significant positive relationship between women who have previously considered sex work and enjoyment of sexualization, r = 0.17, p < .05, indicating that as enjoyment of sexualization increases, previous consideration of sex work was more likely.|
Focusing on the psychological well-being of sex workers, Rossler et al. found that it differed by clusters relevant to where sex workers worked at. Cluster 1 had Swiss sex workers working outdoors, those of whom experienced violence at a higher rate outside the red light district; cluster 2 had women who worked in brothels, salons, and cabarets, and who did not experience much violence; cluster 3 was primarily with women of European origin, and who work mostly in studios with little to no violence, and the 4th cluster consisted of women who were mostly non-European, who worked in studios, and who experienced the highest violence in the red light districts and highest burden (i.e., the burden from sex work).
Women in cluster 3, who worked mostly in studios, presumably outside the red light district, experienced higher psychological well-being than those in clusters 1,2, and 4. This is to be expected since the other clusters tend to have people working in more dangerous areas. Cluster 2, though, also showed better psychological well-being than clusters 1 and 4, but slightly higher than 3.
Many variables were not associated with either increases or decreases in the odds of diagnosis with any psychiatric disorder (specifically focusing on 1-year prevalence rates). For example, age at first sex work and none of the different workplaces were not associated with a diagnosis. Having nobody to thrust, lower family support, feeling excluded by society, working days per week, customers per weak, lower auxiliary income, violence in the right light and rape in the red line, rape outside the red light, and a higher burden were all associated with increases in being diagnosed with lower psychological well-being.
Thus, the issues that come with sex work, like violence, and stigma, are associated with lower psychological well-being, but it’s not as clear as simply saying “sex workers” have lower mental health — the relationship depends on violence experienced, stigma faced being a sex worker, and other issues that differ by where different sex workers work at. No sex worker is the same.
Krumrei-Mancuso (2017) had a sample of 88 sex workers who engaged in prostitution. Most of the women in the study were “from the Netherlands (60.2%), with 6.8% from another Western European country, 4.5% from Asia, and 3.3% from other parts of the world.” There were significant group differences in PTSD, intrusion, avoidance, and hyperarousal when where sex researchers worked were compared to.
Those who worked in windows scored higher on PTSD, those in brothels scored higher on avoidance, those working as escorts scored higher on intrusion, and those who worked at home scored higher on intuition, too. According to the authors, “those who worked in a combination of settings including outdoors experienced higher levels of post-traumatic stress, including higher levels of intrusion, avoidance, and hyperarousal, than those who worked in brothels, from home, or in a combination of settings that did not include working outdoors (p < .05).”
When asked for reasons why those in the sample entered prostitution, 48.9% did it for financial reasons (making money, financial needs, no other jobs available, desiring a luxurious lifestyle, and wanting easier work and fewer hours). For those who made explicit reasons for going into sex work, 15.9% reported doing prostitution for financial reasons, and 14.8% did it for a nicer lifestyle. The second most common reason was for fun/ and or excitement (22.8%). When conducting a MANCOVA on differences in psychological well-being between those who went into prostitution for financial reasons and fun/ and or excitement, or both combined.
Those who went into prostitution for fun or excitement scored lower on depressive symptoms than those who went into prostitution for financial reasons and fun/ excitement, while those who went in for financial reasons scored higher than both other groups on depressive symptoms. Table 3 shows their regression when looking at intentions to remain in prostitution, finding that “the longer participants intended to remain in prostitution, the lower their levels of depressive symptoms were” and “Intentions about how long to remain in prostitution were not predictive of levels of post-traumatic stress (β = -.21, p = .32).” When looking at those who wanted to leave prostitution, “Table 3, Panel B shows that a greater desire to leave prostitution was associated with higher levels of depressive symptoms, even after controlling participants’ levels of education (β = .34, p < .01)”, and “a greater desire to leave prostitution was also associated with higher levels of post-traumatic stress (β = .51, p < .001).”
Some barriers stopping those from leaving sex work were
“financial, including not having a source of income to pay bills, not having as much money to spend, and difficulty finding other work. Several commented on being in debt, pressure from debt collectors, the state of the economy, and the cost of healthcare. Besides financial reasons, a smaller number of participants commented on not wanting to leave the excitement or fun of prostitution, finding their personal worth in prostitution, or not wanting to give up the freedom of setting their own work hours.”
Being confident in being able to find a new job was associated with better psychological well-being. Focusing on those who had experienced violence and those who didn’t, the author says that.
“Consistent with hypotheses, those who had experienced violence in prostitution reported significantly higher levels of symptoms of intrusion (M = 1.29, SD = .99) than those who had not (M = .75, SD = .85), F(1, 54) = 4.14, p < .05, η² = .08. However, no significant group differences were observed in overall levels of posttraumatic stress, F(1, 54) = 2.97, p = .09, avoidance, F(1, 54) = 1.86, p = .18, hyperarousal, F(1, 54) = 2.00, p = .16, or depressive symptoms, F(1, 54) = .63, p = .44.”
A hierarchal regression analysis found that higher fair treatment, higher self-transcendence, and higher achievement were associated with lower depressive symptoms. Only higher self-acceptance was associated with lower PTSD.
The author also ran hypothetical models finding that achievement and fair treatment mediated the relationship between the desire to leave prostitution and depressive symptoms; “as desire to leave prostitution increased, levels of self-acceptance among women in prostitution decreased, resulting in higher levels of post-traumatic stress”; “desire to leave prostitution did not mediate links between achievement or fair treatment and depressive symptoms”; and “As levels of self-acceptance among women in prostitution increased, the desire to leave prostitution 21 decreased, thereby being associated with less post-traumatic stress.”
A systemic review by McCann, Crawford, and Hallet (2021) on 95 papers found that the psychological well-being of sex workers depended on their area’s legal status concerning sex work.
As the authors note,
Studies reported a range of health outcomes. Mental health issues were most frequently reported [29,41–46,48–50,52–54,56–61,64–86,88–112,115–117,120–124,126–131,133]. This included: higher distress levels compared to non-sex workers in the USA (n = 176) [115], social isolation reported by Asian sex workers in Western Australia (n = 94) [63] and high rates of mental health disorders experienced by sex workers in Switzerland (n = 193) [133]. Experience of violence [41,46,47,77,98,108,114,133], stigma [27,44,51,63,118], drug use [29,41,56,66,80,98,110,123,129,131], rates of sexually transmissible infections (STIs) and bloodborne viruses (BBVs) [41–44,48,49,52,53,57,61,64,67,69,73,75,78–80,82–86,88,89,91–97,100–102, 104–107,109–113,116,117,120–124,126–128,130,132] and use of health services [27,29,45,47,48,55,65, 71,72,76,77,102,113,116,117,119,125] were also reported. Two of the five studies that reported experiences of stigma as a health outcome also noted experience of stigma as a risk factor for reduced usage of health services by sex workers [27,118]. For example, the study by Abel found that sex workers frequently did not disclose their profession to health care providers due to fears of stigmatization, leading to less comprehensive health reviews [118].
Studies from settings where sex work was criminalized and partially criminalized frequently reported epidemiological data such as prevalence of STIs and BBVs, vaccination rates and drug use [78–80,82–86,109,111,112,122,123]. However, it was noted that epidemiological data for partially criminalized studies was more often reported in the context of social influences such as experience of violence [41,46], stigma [44] and sexual risk behaviours [66,67,69,88,89,101,105,121,127]. Studies in settings where sex work was legalized commonly reported on legislation effects upon the improvement of sexual health [52,61] and mental health outcomes [60,103]. Studies in settings where sex work was decriminalized showed sex workers were likely to engage in health service seeking behaviour [18,29,57]. These findings were contrasted by a number of studies which identified issues of access to and usage of health services in the other contexts including partially criminalized [45,72,116,117,119], criminalized [113,114] and “Nordic model” settings [65]. A study explicitly comparing health service access between decriminalized, legalized and partially criminalized jurisdictions in Australia found that sex workers in partially criminalized settings experienced the poorest health and safety outcomes, with greater availability of public sexual health clinics in legalized jurisdictions and most significant investment in health promotion programs and occupational health and safety measures in decriminalized and regulated settings [27,102].
Drug use was more frequently reported in studies from criminalized and partially criminalized settings [80,102,108,110,115,131]. One study from NSW in Australia (decriminalized), reported a reduction in drug use [29]. Studies from decriminalized and legalized locations mostly displayed consistent and improved condom usage [29,50,57,58,106], in comparison with studies from criminalized and partially criminalized settings that showed higher rates of poor condom usage [46,62,90,108,132]. The study from a Nordic model setting found higher prevalence of unmet health care needs, including poor mental health [65], Studies in partially criminalized settings noted both high STI prevalence [73,86,93,94,124] and low STI prevalence [79,97]. However, a study of multiple jurisdictions in Australia including legalized, decriminalized and partially criminalized settings, found significantly greater gonorrhea diagnoses in partially criminalized settings; attributed to increased policing of condom use [53].
Very long. But as the authors show, sex workers “in legalized and decriminalized contexts demonstrated greater awareness of health conditions and health risk behaviours, in comparison with criminalized jurisdictions.”
Do sex workers have lower mental health? Yes. And No. It depends on who is being studied, factors surrounding their work, and the legal status of sex work in their area. The data doesn’t suggest one binary answer, but rather it depends on a lot of factors that do not allow for a single yes or no response to the question.
The question that follows from all of this is: Should sex work be decriminalized or criminalized? Much of this debate should revolve around empirics, but many people put moral arguments into the scene. Since some people consider sex work to be immoral, it should be criminalized — but this gets us nowhere as arguments about morality are useless as two people with differing views on morality would never agree. Thus, I reject these arguments in favor of empirics and I believe they better suit an answer to the question rather than enforcing morality onto others.
Based on the evidence in Chapter IV, the evidence does indicate that the removal of stigma and legalization of sex work does positively impact mental health and sexual health. Some critics, though, won’t care for these effects, and instead argue that legalizing sex work would increase sex trafficking. For example, one of the most cited studies used to support this claim comes from Cho, Dreher, and Neumayer (2012) finding that “On average, countries with legalized prostitution report a greater incidence of human trafficking inflows.”
As Weitzer (2014) comments about the paper, the authors used UNODC data from 161 countries which consisted of information from 113 different sources (government, NGOs, etc.). According to Weitzer,
The UNODC, however, expressly cautioned against using its report to measure the number of victims within countries—“the report does not provide information regarding actual numbers of victims”—and identified myriad problems including the lack of a uniform definition of trafficking across countries; the lack of transparency in data collection and reporting in many nations; the hodgepodge nature of the 113 sources; and the mix of smuggling, trafficking, and irregular migration numbers in some country figures (UNODC 2006, 37, 44–45). Cho, Dreher, and Neumayer noted these problems and acknowledged that their figures did “not reflect actual trafficking flows” and that it is “difficult, perhaps impossible, to find hard evidence” of a relationship between trafficking and any other phenomenon (Cho, Dreher, and Neumayer 2012, 70), but they proceeded to use the UNODC report anyway.
The authors used UNDOC data anyways but also lumped in sex trafficking with other forms of trafficking. Their attempt to see if sex work decriminalization decreases or increases sex trafficking is flawed from the start, but this has not stopped the study from being spread in the media, according to Weitzer.
Another European report which found similar results as the prior study also ran into similar issues: “but relied on information drawn from different kinds of agencies in each nation and based on unstandardized definitions and methods. Some nations reported the number of officially “identified” victims while others reported a dubious category of “presumed” victims who had not been identified, and nations differed in their definitions of trafficking, their means of identifying victims, and in their reporting procedures.”
It does not seem as if legalizing sex work would increase sex trafficking. More steps should be taken to legalize sex work, in my opinion, to make the job and well-being of sex workers better. However, even legalization alone won’t help much and thus requires extra steps. Sex workers must be involved in legal policies to make the job better for them, as current legal processes about sex work often do not involve sex workers and good intentions could backfire.
What does the research on women who use sex workers look like?