We had written for In Plainspeak in October 2021, shortly after the second wave of the pandemic, and shared the exacerbated vulnerabilities of female and trans sex workers at the time. We have now revisited some of our understandings and perspectives of that time, and in this article reflect on any shifts and changes since then to the rights and entitlements of sex workers.
Since the time we wrote the last article, the Supreme Court of India on 7 May 2022, in Budhadev Karmaskar vs State of Bengal, affirmed that sex workers are entitled to the same constitutional rights as other citizens and laid down certain key social security provisions for the community[1]. While the court’s ruling in Budhadev is a much needed and critical step in a promising direction, there continues to be a dire need for statutory protections, social security and rights. Let us explore this from a policy lens and understand what is wanting in our policies that continue to restrict sex workers’ rights.
While equality and inclusivity are the main tenets of all our health policies, they do not reflect the intersectionality of identities and their diverse needs. For vulnerable and disadvantaged groups such as sex workers, people living with HIV (PLHIV), and members of the trans community, it is imperative that policies take into account their multiple marginalisations and layered identities. In the absence of an intersectional lens, the success of mandates such as Universal Health Coverage will continue to be limited.
As an example, India’s flagship health insurance policy, the Pradhan Mantri Jan Arogya Yojna (PMJAY) is for everyone who is unable to afford quality healthcare. It provides a health cover of Rupees Five Lakh per family per year for secondary and tertiary care hospitalisation to over 12 crore families that form the bottom 40% of the population, and in that sense covers everyone who falls in this bracket based on their economic status. It goes a step further, and within its inclusion criteria, also details criteria of occupational categories, for rural and urban areas, covering a vast range of informal workers such as domestic workers, rag pickers, sweepers etc but misses out sex workers[2]. That sex workers are workers and sex work is work is still a contentious subject, an elephant in the room that is not being addressed. The assumption that the onus lies on sex workers to access the scheme without specifying them in the eligibility criteria, as well the absence of provisions to address stigma and discrimination that they may potentially face while engaging with the health system hinders their access to quality healthcare.
Secondly, without an intersectional understanding woven into policies, the experience of stigma will never cease to exist for those on the margins. None of the central or state resource handbooks, manuals or textbooks elaborate on existing sex workers or their rights. Further, a close reading of India’s various health and education policy documents shows that sex workers are only mentioned within the context of HIV and sexually transmitted infection and diseases, hence limiting their existence only to this space.
It is also necessary that policy actors and bureaucrats inform themselves about the intersectional identities of sex workers and other socially disadvantaged groups to address their needs. Solutions need to be embedded in an intersectional approach where a single identifier or marker does not define what they can or cannot access. It is important to see individuals as whole beings who have a sum total of identities, and for the success of a welfare scheme, it is imperative that multiplicity of existence is understood as a real-life fact and not a text-book concept.
In addition to understanding, recognising the need for intersectionality and incorporating this particular lens into both policy development as well as implementation, in the case of sex workers who operate primarily in city centres, there is a need to resist homogenising formal health care delivery systems[3]. For instance, in the case of sexual and gender-based violence, seeking assistance at one-stop-centres often requires liaising with the police who are more often than not on contrarian terms with the sex worker community. Therefore, in addition to being gender sensitive, and trauma informed, health care delivery mustn’t take a top-heavy approach but instead seek to resolve issues by inviting consultation and inputs from the community. In this case, instead of involving the police, a civil society led restorative justice initiative might be a lot more helpful and less damaging in its approach.
Reportage[4] [5] [6] from the last two years, primarily after the pandemic, is rife with the struggle of sex workers to access basics like ration, housing (Pradhan Mantri Awas Yojana), access to general healthcare beyond sexual and reproductive health, customised birth certificates for children of sex workers (without the father’s name), and pension for sex workers above the age of 50 years. As elections are ongoing in India, drives to create voter IDs for sex workers have gathered steam, and it would be a huge step if other forms of identity proof for entitlements are also provided to them.
Lastly, a much-awaited step would be the unequivocal decriminalisation of sex work. Ensuring the protection of sex workers’ physical and emotional wellbeing, as well as safeguarding their rights to life, profession, labour freedom, health, and reproductive and sexual rights is fundamental within a constitutional democratic society.
[1] https://www.openglobalrights.org/india-supreme-court-rules-to-protect-sex-workers-amid-covid-pandemic/
[2] https://www.thehindubusinessline.com/news/variety/pmjay-know-about-ayushman-bharat-pradhan-mantri-jan-arogya-yojana/article66702022.ece
[3] Priya R, Singh R and Das S (2019) Health Implications of Diverse Visions of Urban Spaces: Bridging the Formal-Informal Divide. Front. Public Health 7:239. doi: 10.3389/fpubh.2019.00239
[4] https://indianexpress.com/article/cities/pune/with-a-manifesto-listing-their-demands-sex-workers-look-forward-to-voting-9299897/
[5] https://indianexpress.com/article/india/sex-workers-aadhaar-crad-sc-7925945/
[6] https://www.deccanherald.com/elections/india/sex-workers-demand-promise-of-pension-school-admissions-without-fathers-name-in-election-manifestos-2977050
