Supporting sex workers to make informed choices

sex worker and safe abortion project helpers,Uganda,IPPF
The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau.

Pretty Lyn, a sex worker in Uganda has become pregnant twice during her time involved in sex-work. As a student without enough money to support herself as well as a child, she decided both times that she had to terminate the pregnancy. However abortion in Uganda is highly restricted and not safely accessible for most women without funds. Unaware that abortion medication is available she used what she called 'local methods'.

Close up of woman's face
Pretty Lynn, a sex worker and beneficiary of the Lady Mermaid's Bureau project in the LMB office, Kampala.

“One time I used local herbs and I was successful. Then the other time I used Omo (local washing detergent) and tea leaves but it was really hard for me. I nearly died” she said.

Pretty Lyn is not alone. Many sex workers in Uganda end up having unwanted pregnancies and then having unsafe abortions. Myths and misconceptions about contraception as well as lack of access mean that most sex-workers rely on condoms for contraception. However “Men don’t want to use condoms and the female condoms are really rare and they are expensive,” she explains.

This issue was one of the reasons why Lady Mermaid's Bureau (LMB) a sex workers rights organisation from Kampala, decided to apply for a grant from the Safe Abortion Action Fund (SAAF) in 2013. Founded in 2002 by a group of former sex workers, the organization, the first of its kind in the region, broke the silence that surrounded sex work at the time.

Under the current SAAF-funded project LMB works to prevent and reduce unsafe abortions amongst sex workers in Uganda and campaigns to decriminalize abortion and sex work.

Masitula is a sex worker who lives in Nansana slum located in the outskirts of Kampala and has been supported by LMB during the project. Masitula already had one son when she began sex work. One day a client who's name she did not know raped her and she became pregnant. Despite trying to end the pregnancy by using local herbs she gave birth to her second child who is barely three months old.

woman holding her young baby.
Masiturah, a sex-worker and beneficiary of the Lady Mermaid's Bureau project with her baby at home in Kampala.

“I don’t know his father. He just forced me. He said that he will not put on a condom that is why I tried to abort but it refused.” said Masitula.

In Uganda, about 314,500 women had abortions in 2013 despite the fact that abortion is highly legally restricted in the country. The penal code permits abortion to save the life of the woman and to preserve physical and mental health, however the laws are unclear and interpreted inconsistently by law enforcement and the judicial system, which makes it difficult for women and the medical community to understand when abortion is permitted. Because of this ambiguity, medical providers are often reluctant to perform an abortion for any reason, out of fear of legal consequences.

This is where the Lady Mermaid's Bureau comes in. Despite abortion provision being legally restricted, there is no law against providing accurate information about legal drugs. Using a harm-reduction approach they legally provide information on how medical abortion drugs are used.

By sharing this material with the women that they work with and providing counselling and referrals for post-abortion care, contraception and other services, many of the women are no longer at risk of dying from unsafe abortion.

  • Pretty Lynn graduated from university in 2013. Due to limited job opportunities she turned to sex work in order to earn a living. "Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. An organisation like Lady Mermaid’s Bureau can help young girls and women. They teach us how to protect ourselves, how to defend ourselves, about safe abortion."
    Pretty Lynn graduated from university in 2013. Due to limited job opportunities she turned to sex work in order to earn a living. "Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. An organisation like Lady Mermaid’s Bureau can help young girls and women. They teach us how to protect ourselves, how to defend ourselves, about safe abortion."
  • Joanne is a mother of two. She has been a sex worker for two years. "The problems are very many. Men don’t want to pay. They are rough, they don’t want to use condoms. So they end up infecting you sometimes. There are many women who get pregnant because of this unprotected sex. Some women who need abortions also use local herbs. Sometimes Omo (washing detergent), other times tea leaves. They are so dangerous."
    Joanne is a mother of two. She has been a sex worker for two years. "The problems are very many. Men don’t want to pay. They are rough, they don’t want to use condoms. So they end up infecting you sometimes. There are many women who get pregnant because of this unprotected sex. Some women who need abortions also use local herbs. Sometimes Omo (washing detergent), other times tea leaves. They are so dangerous."
  • Ali has worked as a programme officer and safe abortion counsellor at Lady Mermaid’s Bureau (LMB) for eight years. "Abortion among sex workers is still a very major issue. Many women are very vulnerable to becoming sex workers. They are poor, from slums and a lot of them are students. They face a lot of violence: rape, the police themselves use them and then there are clients who rape the women. So there are a lot of incidences of violence that turn into unwanted pregnancies."
    Ali has worked as a programme officer and safe abortion counsellor at Lady Mermaid’s Bureau (LMB) for eight years. "Abortion among sex workers is still a very major issue. Many women are very vulnerable to becoming sex workers. They are poor, from slums and a lot of them are students. They face a lot of violence: rape, the police themselves use them and then there are clients who rape the women. So there are a lot of incidences of violence that turn into unwanted pregnancies."
  • 35 year old Joan was a sex worker for five years. "Now with the help of Ali at Lady Mermaid's I have a fridge and I sell fruits and juice. Sex workers go through a lot of difficulties. People don’t like you. The police are not good. They chase us and others force us to have sex with them. Ali gave me counselling and helped me to get off of the streets."
    35 year old Joan was a sex worker for five years. "Now with the help of Ali at Lady Mermaid's I have a fridge and I sell fruits and juice. Sex workers go through a lot of difficulties. People don’t like you. The police are not good. They chase us and others force us to have sex with them. Ali gave me counselling and helped me to get off of the streets."
  • Musa, a police officer involved with the Lady Mermaid's Bureau project.
    Musa, a police officer involved with the Lady Mermaid's Bureau project.
  • Noor is a project officer for Lady Mermaid’s Bureau. "Our work with SAAF is about advocating for safe abortion. And we are dealing with vulnerable groups. That is sex workers."
    Noor is a project officer for Lady Mermaid’s Bureau. "Our work with SAAF is about advocating for safe abortion. And we are dealing with vulnerable groups. That is sex workers."
  • Deborah, a sex worker and beneficiary of the Lady Mermaid’s Bureau project, receives a booklet on safe abortion from LMB project officer Noor in central Kampala.
    Deborah, a sex worker and beneficiary of the Lady Mermaid’s Bureau project, receives a booklet on safe abortion from LMB project officer Noor in central Kampala.
  • One of the booklets on safe abortion produced by Lady Mermaid’s Bureau.
    One of the booklets on safe abortion produced by Lady Mermaid’s Bureau.
  • Masitula is a single mother with two sons. "I got pregnant after a client refused to wear a condom. I attempted to abort using some unsafe abortion practices but I was unsuccessful. I now have a two-month old baby whose father I do not know."
    Masitula is a single mother with two sons. "I got pregnant after a client refused to wear a condom. I attempted to abort using some unsafe abortion practices but I was unsuccessful. I now have a two-month old baby whose father I do not know."
  • Masitula and project officers Noor and Ali at her home in Kampala. "Lady Mermaid's has helped me and other sex workers. When I get some problems, I just go and tell them.  It has changed my life because I now have a friend."
    Masitula and project officers Noor and Ali at her home in Kampala. "Lady Mermaid's has helped me and other sex workers. When I get some problems, I just go and tell them. It has changed my life because I now have a friend."

By taking their safety into their own hands the sex-workers have become empowered to look out for their own health. Pretty Lyn says that there was no way she would go back to having an unsafe abortion. “You can go to the pharmacy to buy misoprostol. But when you are buying, you don’t tell them that you going to abort. You tell them they are for ulcers” she said.

Like Pretty Lyn, the last time Deborah, another sex-worker involved in the LMB project, became pregnant she used local herbs and nearly died. “They didn’t work actually. I was totally disturbed and was bleeding a lot. So they rushed me to hospital and it was really challenging. Doctors asked me many questions why I was doing such a thing but lucky enough they helped me” said Deborah.

Hands exchanging literature.
Deborah, a sex worker and beneficiary of the Lady Mermaids Bureau project, receives a booklet on safe abortions from LMB project officer Noor Nakigozi in central Kampala.

However following intervention from Lady Mermaid's Bureau Deborah understood that abortion does not have to be dangerous. The next time she became pregnant, she used the medical abortion drug misoprostol instead and it helped her to safely abort. “I wish like they can sensitise everywhere in our society even if you are not a sex worker. You can get pregnant when it is not the right time. But safe abortion is so safe just like the name sounds” said Deborah.

Through its three years of implementing the SAAF-funded project LMB has been able to work with sex-workers in towns across Uganda, providing information on their rights, what not to do in cases of unwanted pregnancy, and ensuring that they are aware of safer methods and other ways to protect their own health.

LMB has now been successful in receiving further funding from SAAF to continue the project by creating new materials aimed at providing sex-workers with comprehensive referral services to safe knowledgeable providers who are able to provide confidential post-abortion care and other reproductive health services. While doing this they continue to champion the rights of sex-workers and call for an end to the hypocritical law that pushes these women into the shadows and makes them even more vulnerable to violence despite the fact that the police themselves are often the abusers.

As Pretty Lyn herself complained "To me it is not a crime because I have not stolen, I have not beaten anyone. But then police come and take us. Sometimes they even use us and don’t pay. They say it is illegal to sell yourself. But they still use you yet they are saying it is illegal".

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