Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel.
The Ministry of Health, Jerusalem, Israel.
Isr J Health Policy Res. 2024 Sep 2;13(1):43. doi: 10.1186/s13584-024-00627-7.
Women in the sex trade encounter significant challenges in obtaining reproductive healthcare. Reports of reproductive healthcare for women in the sex trade center on the prevention and termination of pregnancies, yet most women in the sex trade globally experience full term pregnancies and bear children. This study aimed to explore barriers and enabling factors to providing reproductive healthcare for women in the sex trade in Israel.
We conducted a qualitative study utilizing a grounded theory method. Data were collected through semi-structured interviews, conducted between June 2021 and July 2022. Interviews were conducted with practitioners in healthcare settings (n = 20), practitioners in social services settings (n = 15), and women in the sex trade who received reproductive health care-related medical services (n = 13) in Israel. The interviews were audiotaped, transcribed, and thematically analyzed.
The findings indicated a multilayered structure of healthcare system-related factors and women-related factors. Stigma was noted as a multidimensional barrier, reflected in service providers' attitude towards women in the sex trade, impairing the patient-provider relationship and impeding women's help-seeking. However, the creation of a relationship of trust between the women and healthcare providers enabled better health outcomes.
Based on the findings, we propose recommendations for designing and implementing reproductive healthcare services for women in the sex trade. The recommendations offer to (a) include women with lived experiences in planning and providing reproductive healthcare services, (b) adopt a trauma-informed approach, (c) emphasize nonjudgmental care, (d) train healthcare providers to reduce stigma and bias, and (e) enhance the affordability of health services for women experiencing marginalization.
性交易中的女性在获得生殖保健方面面临重大挑战。关于性交易女性生殖保健的报告主要集中在妊娠的预防和终止上，但全球大多数性交易女性都经历了足月妊娠并生育子女。本研究旨在探讨为以色列性交易女性提供生殖保健的障碍和促进因素。
我们采用扎根理论方法进行了定性研究。数据通过半结构化访谈收集，访谈于 2021 年 6 月至 2022 年 7 月进行。访谈对象包括医疗保健机构的从业者（n=20）、社会服务机构的从业者（n=15）以及在以色列接受过生殖健康相关医疗服务的性交易女性（n=13）。访谈进行了录音、转录和主题分析。
研究结果表明存在医疗体系相关因素和女性相关因素的多层次结构。污名被认为是一个多维障碍，反映在服务提供者对性交易女性的态度上，损害了医患关系，阻碍了女性寻求帮助。然而，女性与医疗保健提供者之间建立信任关系可以带来更好的健康结果。
根据研究结果，我们为性交易女性的生殖保健服务的设计和实施提出了建议。这些建议包括（a）让有过性交易经历的女性参与生殖保健服务的规划和提供，（b）采用创伤知情方法，（c）强调非评判性护理，（d）培训医疗保健提供者以减少污名化和偏见，以及（e）提高边缘化女性负担得起医疗服务的能力。
