Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
The child protection system can be a highly consequential social institution for mothers who do sex work, yet the health impacts of its policies on this already disadvantaged population remain under-examined. This dissertation aims to understand how child custody loss through this system shapes the health and wellbeing of women sex workers in Vancouver (Canada), a high proportion of whom are Indigenous women.
Two studies were conducted with the Evaluation of Sex Workers’ Health Access (AESHA) prospective cohort study. In the first study, analyses drew on longitudinal data from 2010-2015 in a subsample of women sex workers (n=466) who ever had a live birth and examined the association between involuntary child removal by the child protection system and self-rated health, as well as joint effects on health when child removal spanned two generations (themselves as children and their own children). Results showed child removal was associated with poorer self-rated health among sex workers that was further worsened when family separation spanned two generations; an intergenerational consequence that disproportionately affected Indigenous women.
In the second study, drawing on data from in-depth, semi-structured qualitative interviews with a subsample of AESHA participants (n=31), analyses identified three interconnected trajectories linking child custody loss to deteriorating health. First, events of child
custody loss were described as leading to a proliferation of stress, most evident in mental distress, including suicidality and grief, and increased use of drugs/alcohol. Second, women experienced increased poverty following losses that was more severe among Indigenous women, and also contributed to worsening health during this period. Third, women faced increased social displacement in aftermath, undermining access to social relationships and support as resources for health.
Overall findings suggest that child custody loss has consequences for health beyond the single mechanism of mental distress and related poor health, to further alter sex workers’ social conditions, leading to an accumulation of socioeconomic disadvantage that also had implications for health. Sex worker and Indigenous-led family support and preservation services are needed to help keep families intact, along with post-separation supports to address the health and social needs of mothers not living with their children.