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Leading Causes Of Death Among Children Of Female Sex Workers Revealed In Eye-Opening New Study

IMAGE CREDIT: Global Health Promise/Instagram

The study, the largest ever conducted on the deaths of children of female sex workers (FSW), documents the preventable causes of death among these children in eight low- and middle-income countries.

PORTLAND, OR – The first-ever study on deaths among children of female sex workers (FSW), spearheaded by Global Health Promise, an Oregon-based nonprofit dedicated to supporting the maternal health of mothers in sex work and the health of their children, sheds light on the dire plight facing many children of female sex workers (CFSW) in eight low-to-middle income countries. The study also highlights steps needed to prevent additional deaths among these extremely vulnerable children.


Published by the Journal of Global Health, the study analyzed the deaths of 589 CFSW reported by FSW during the study. Country-specific causes of CFSW deaths varied; however, nutritional deficiencies comprised the leading cause of mortality, accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides.


“No matter the age of the child or the cause of death, the truth is that these children are living in brothels or homes where they are chronically exposed to the economic hardship, psychosocial stress, and violence often associated with sex work. These children are exposed daily to adverse childhood experiences that shape them and leave them vulnerable to future polyvictimization if they survive to adulthood,” explained Dr. Wendy L. Macias-Konstantopoulos, Global Health Promise’s global policy advisor and an emergency physician and faculty at Harvard Medical School. She is also the lead author of the study.


“The suffering and death of these children is unacceptable,” added Brian Willis, Director of Global Health Promise, and a co-author of the paper. “Too much funding and emphasis from governments, especially the US government, and major donors, is on HIV/AIDS among FSW while completely ignoring the situation of millions of children of FSW.”


The study collected data between Jan. 16, 2019 and Oct. 1 2019, across 24 cities in Angola, Brazil, India, Indonesia, Kenya, South Africa, the Democratic Republic of Congo (DRC), and Nigeria. Global Health Promise collaborated with partners at Massachusetts General Hospital (Boston), Harvard Medical School (Boston), Dalhousie University (Canada), Mothers for the Future (South Africa), and sex worker organizations and other NGOs in these eight countries, on the study and analysis.


“Our local partners acknowledge that other than Global Health Promise, no other organization is focused on the maternal health of FSW or the health of their children. To be clear, the maternal health of FSW is directly tied to the health of their children: when the mothers do not have quality antenatal care and nutrition during pregnancy, the health of their newborns is compromised; and when the mothers die during or soon after giving birth, the majority of their newborns also die. It is clear: to save the children we must support pregnant FSW and FSW with infants and young children,” Willis said.


According to Dr. Macias-Konstantopoulos, “This study is paramount to understanding mortality outcomes among the children of mothers who support their children through sex work in low- and middle-income countries. Previous health studies have largely focused on causes of morbidity among FSW, but few have examined the causes of mortality among this highly vulnerable group of women and children.”


A total of 1,280 FSW mothers participated in 165 information-gathering sessions across the eight study countries and reported child deaths during these sessions. According to the study, the largest number of CFSW deaths were reported in the DRC (46.2%) followed by Kenya (26.5%) and Nigeria (14.1%).


The ages of the deceased children ranged from those less than a day old to 23 years. The highest death count was reported among children aged one to four years (38.9%) followed by infants under the age of one year (32.3%) and five to nine-year-olds (17%).


By publishing this study, Global Health Promise advocates for governments, non-governmental organizations, UN organizations, and international child and health organizations to begin counting these deaths in country health statistics as well as create policies and targeted interventions that focus resources on improving the physical, mental, and socioeconomic health of FSW mothers and their children.


“Sadly, far too often FSW mothers and their children are discriminated against and stigmatized by many in society, including governments and donors, which fail to take action to address their maternal and child health needs. Although it is much easier to do nothing, we have the moral responsibility to do more to protect the lives of all women and their children without judgment,” said Dr. Macias-Konstantopoulos.




Brian Willis

Director for Global Health Promise


ABOUT GLOBAL HEALTH PROMISE: Headquartered in Portland, Oregon, and founded in 2007, the nonprofit has made it its mission to conduct research, provide direct services, create strategic partnerships, and advocate for mothers in sex work and their children.  For more information, visit their website at, or email GHP at, and follow them on Facebook, Instagram, Twitter, and LinkedIn.

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