“PROFESSIONAL” ABORTION SEEKERS: THE SEX-WORKERS OF KOLKATA Swati Ghosh Abortion Assessment Project - India First Published in October 2003 By Centre for Enquiry into Health and Allied Themes Survey No. 2804 & 2805 Aaram Society Road Vakola, Santacruz (East) Mumbai - 400 055 Tel. : 91-22-26147727 / 26132027 Fax : 22-26132039 E-mail : [email protected] Website : www.cehat.org © CEHAT/HEALTHWATCH The views and opinions expressed in this publication are those of the author alone and do not necessarily reflect the views of the collaborating organizations. Printed at Chintanakshar Grafics Mumbai 400 031 TABLE OF CONTENTS ○○○○○○○○○○○○○○○○○○○○○○○○○ PREFACE ○○○○○○○○○○○○○○○○○○○○○ v ○○○○○○○○○○○○○○○○○ ABSTRACT ○○○○○○○○○○○○○○○○○○○○○○○○○○○○ vii ○○○○○○○○○○○○○○○○○ ACKNOWLEDGEMENTS ○○○○○○○○○○○○○○○○○○○ viii ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ I. INTRODUCTION ○○○○ 1 ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ II. METHODOLOGY ○○○○ 3 ○○○○ III. OBSERVATION AND INFERENCE○○○○○○○○○○○○○○○○○○○○○○○ 5 A. ABORTION ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 5 ○○○○○○○○○○○○○○○○○○○○ B. NATURE OF ERVICES VAILABLE ○○○○○○○○○ S A 5 ○○○○○○○○○○ C. RATIONAL FOR CHOICE ○○○○○○○○○○○○○○○○○○○○○○○ 6 ○○○○○○○ D. INDUCED ABORTION ○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 6 E. N ON-SEEKERS OF ABORTION ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 9 IV. CHILDBIRTH ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 9 ○○○○○ A. FAMILY ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 10 ○○○○○○○○○○○○○○○○○○○○○○○○ V. CONTRACEPTIVES ○○○○○○○○○○○○ 11 A. TRADITIONAL MODES ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 11 ○○○○○○○○○○○○○○○○○○○○○○○○ B. MODERN METHODS ○○○○○○○○○○○ 11 ○○○○○○○○○○○○○○○○ C. OTHER PRACTICES ○○○○○○○○○○○○○○○○○○○○ 12 VI. EFFECT OF WORKER’S MOVEMENT ○○○○○○○○○○○○○○○○○○○○○○○ 13 ○○○○○○○○○○○○○○○○○○○○○○○○○ VII. CONCLUSION ○○○○○○○○○○○○○○○ 14 ○○○○○○○○○○○○○○○○○○○○○○○○ VIII. END NOTES○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○ REFERENCES ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 16 ○○○○○○○○○○○○○○○○○○○○○○ ANNEXURE ○○○○○○○○○○○○○○○○○○○○○○○ 17 ANNEXURE I - SELECTION DESIGN FOR THE STUDY ON ○○○○○○○○○○○○○○○○○○○○○○○○○○○○ SEX-WORKER WOMEN ○○○○○ 17 iii PREFACE Abortions have been around forever. But studies. These would attempt to under- at different points of time in history it has stand the abortion and related issues received attention for differing reasons, some from the women’s perspective. in support of it, but often against it. Abortion IV. Household studies to estimate incidence is primarily a health concern of women but of abortion in two states in India. it is increasingly being governed by patriar- V. Dissemination of information and litera- chal interests which more often than not ture widely and development of an advo- curb the freedom of women to seek abortion cacy strategy as a right. This five-pronged approach will, hope- In present times with the entire focus fully, capture the complex situation as it is of women’s health being on her reproduction, obtained on the ground and also give policy infact preventing or terminating it, abortion makers, administrators and medical profes- practice becomes a critical issue. Given the sionals’ valuable insights into abortion care official perspective of understanding abortion and what are the areas for public policy in- within the context of contraception, it is im- terventions and advocacy. portant to review abortion and abortion prac- tice in India. The present publication is the Eighth in the AAP-I series of working papers. This The Abortion Assessment Project India paper looks at abortion and contraceptive (AAP-I) has evolved precisely with this con- practice amongst sex workers in Kolkatta. It cern and a wide range of studies are being is based on a fiscal study done by the author. undertaken by a number of institutions and We thank Ms. Sunanda Bhattacharjea for researchers across the length and breadth assisting in the language editing of this pub- of the country. The project has five compo- lication and Mr. Ravindra Thipse, Ms. Muriel nents: Carvalho for timely publication of this entire I. Overview paper on policy related issues, series. series of working papers based on exist- This working paper series has been sup- ing data / research and workshops to pool ported from project grants from Rockefeller existing knowledge and information in Foundation USA and The Ford Foundation, order to feed into this project. New Dehli. We acknowledge this support II. Multicentric facility survey in six states gratefully. focusing on the numerous dimensions We look forward to comments and feed- of provision of abortion services in the back which may be sent to [email protected] public and private sectors Information on this project can be obtained III. Eight qualitative studies on specific is- by writing to us or accessing it from the sues to compliment the multicentric website : www.cehat.org Ravi Duggal 14th October 2003 Coordinator, CEHAT ABSTRACT This is a paper on the practice of abor- tant determinants regarding choice of the tion and prevention of pregnancy among the service. Sex-workers bonded within power re- sex-workers. In recent times sex-workers are lation were forced to avail unregistered, clan- emerging as a category of professionals claim- destine health clinics for termination of preg- ing workers’ rights. Identified as a high-risk nancy that did not guarantee safety and care. group for AIDS, the use of contraceptives has Areas, which were not strongholds of the sex- become a very important issue within the worker’s forum, could not attempt to break profession. This paper explores the impact of through the power nexus of the trade yet. Le- the workers’ rights movement on termina- galization of MTP had enhanced autonomy tion of pregnancy and contraception in the and mobility for sex-workers but only for the last few years in Kolkata. Secondary data be- ones with greater relative autonomy. The ing scarce, the study is based on in-depth differential nature of the trade persisting at personal interviews of brothel-based sex- different locations shaped the economic workers. Information regarding abortion serv- standing of each woman and hence influ- ices, contraceptive devices and childbirth are enced her choice. collected from traditional red light areas of Sex-workers depended on traditional Sonagachhi, Kalighat and Khidirpur in mode of prevention although use of modern Kolkata. Aspects such as access to abortion devices was initiated. Rather, termination services, prevailing patterns of contraceptive and prevention of pregnancy existed simul- use and family structure of the sex workers taneously. The shift from abortion to a spe- have been examined. Apart from data, prac- cific preventive mode of condom use was yet tices, experiences and linkages within the to be established although it was projected trade were also enquired upon through the as the most effective preventive against in- interviews. fection from STD/ HIV. The sexual trade It is observed that the incidence of abor- market was demand driven and the only tion is high among the sex-workers. With le- route to universal use of the condom in sex- galization of abortion, dependence on unreg- work would be possible through the educa- istered private clinics has been largely re- tion of the male client to be responsible in placed by state hospitals. The nature of power the relationship at one level and strength- structure within the trade and the income ening the regulations at the supply end for differential among women were two impor- compulsory condom use. vii ACKNOWLEDGEMENTS I acknowledge the cooperation of Sanlaap, Calcutta Samaritans and Durbar Mahila Sammanaya Committee received during the course of fieldwork. viii “PROFESSIONAL” ABORTION SEEKERS: THE SEX-WORKERS OF KOLKATA* I. INTRODUCTION and concerns that emerge from the find- ings. This paper deals with the practice of ter- mination and prevention of pregnancy for a The sex-worker is a ‘public’ woman, as- specific group of women- the sex-workers. sociated with sexual pleasure and stands The sex-workers are in a way the largest in opposition to the family oriented client group for abortion service. In recent woman. She, by her very existence is ex- times sex-workers are emerging as a cate- cluded from the domain of procreative sex gory of professionals claiming workers’ and this makes her a specific subject of rights. Identified as a high-risk group for study. With the socially assigned role of AIDS, the use of contraceptives has become fulfilling male desire, the sex-worker’s a very important issue within the profession. body becomes a significant site for explo- This paper explores the impact the workers’ ration with respect to the reproductive rights movement has had on termination of health of a woman. We examine the vari- pregnancy and contraception in the last few ous aspects of conception, contraception years in Kolkata. The paper is divided into and abortion related to the brothel based four sections: sex-worker woman. l The first section is the introduction that Reproductive health acquires new mean- defines and frames the problem. ing with respect to a sex-worker. In spite of the fact that reproduction is socially prohi- l The second section deals with metho- bited for a sex-worker woman, the sexual per- dology and describes the construct of the formance that is required of her cannot iso- study. The sex-workers are a somewhat late pleasure and procreation as two sepa- less visible and accessible group. Since rate spheres of activity. The sex-worker as secondary data is not available, the study the active female partner of the non-famil- as organised on primary survey has been ial, heterosexual