In India, the ordeal of female sex workers (FSWs), doesn’t simply end with stigmatisation and discrimination within society. They face a significant health challenge as well, which is unintended pregnancies.
Refusal to use condoms by clients lead to unintended pregnancies
One of the biggest factors contributing to unintended pregnancy is the refusal to use condoms by their clients.
A 2025 cross-sectional study of 210 female sex workers conducted in rural areas of eastern state West Bengal, aged 19-49 years stated that only 25 (18.8%) used condoms regularly with cohabiting partners. Condom breakage was reported by 177 participants (84.3%), with most responding by washing genitalia only, and only 6 (3.5%) using emergency contraception.
Condom promotion among female sex workers is a key intervention in India’s National AIDS Control Program but a 2013 study of mobile female sex workers in India found that fewer than one in five participants were able to successfully persuade an unwilling client to use a condom or negotiate condom use at a new work site.
A 2022 study stated that pregnancy prevention is a greater motivation for condom use than HIV prevention among female sex workers.
Abortions, miscarriages common among sex workers
Doctors say that both abortions and miscarriages are common among sex workers. But often sex workers are forced to carry on with their pregnancy because government hospitals neglect them or stigmatise them when they visit their doctors seeking abortion. Dates for abortions often get postponed by doctors thus risking the lives of sex workers.
Most studies and government data on health challenges faced by female sex workers focus primarily on the prevalence of HIV, there is no comprehensive data on unintended pregnancy or miscarriages or abortions of sex workers.
Antenatal care is rare for female sex workers
Under India’s Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), every pregnant woman including female sex workers must receive free, comprehensive, quality antenatal care on the 9th of every month at designated public health facilities.
But a 2026 study titled Maternal Health of Female Sex Workers in Six Low- and Middle-Income Countries, which was conducted in Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa, the estimated access to antenatal care for sex workers is around 57% in India. This, however, was still much lower than general population averages in sub-Saharan Africa where “maternal healthcare access has traditionally been challenging and where 78% of women receive at least one antenatal visit”.
This 2026 study stated that in India, female sex workers were not allowed to access antenatal care by their bosses -- brothel managers. Sex workers also indicated a variety of personal reasons for not accessing antenatal care including the perception that it was not necessary, fear of being tested for HIV, revealing pregnancy, not planning to continue the pregnancy, lack of self-esteem, lack of interest, stigma due to absent partner, fatigue, and substance use.
There is no national programme specifically designed to address the maternal healthcare needs of female sex workers. Most government efforts targeting female sex workers have primarily focused on HIV prevention and management of sexually transmitted infections. Consequently, structural barriers—including stigma, mobility, workplace control, and fragmented service delivery—continue to limit access to antenatal care despite formal availability.
According to a 2007 report from the United Nations Development Programme's Trafficking and HIV/AIDS project, almost “50 per cent of sex workers [surveyed across nine states] reported not seeking services like ante-natal care and institutional delivery from the public health facilities.”
A 2023 study stated that many female sex workers avoid antenatal care because of long-wait times at government healthcare facilities or poor treatment by clinic staff.
Brothels do little to reduce risk
Some brothels help sex workers to reduce the risk of unintended pregnancy by making it mandatory for clients to use condoms and promoting community empowerment among brothel residents. Interventions focusing on improving contraceptive access, counselling on dual protection, and addressing the dynamics of intimate partnerships are critical to enhancing reproductive health outcomes in this vulnerable group.
Yet, unintended pregnancies among female sex workers are a reality. There is very little help to assist childbirth at brothels though.
While many female sex workers give birth at government hospital or are attended by midwife during childbirth. But they return to work within three months after giving birth to child, the 2025 study stated.
Children born in brothels
A small-scale study conducted in western Indian city Pune in 2017 revealed that sex workers give birth in their brothels and ignore the health needs of their growing children for fear of meeting prejudice in the medical system. Many of their infants are malnourished and lack the most basic of immunisations. In most cases, the pregnancy is unwanted, and mothers lack adequate resources to raise the children.
Despite India has a promising right to education law, where no children could be denied formal education, children of sex workers often face discrimination in schools.
A 2018 report by the National Commission for Protection of Child Rights (NCPCR), under the Ministry of Women and Child Development, documented widespread discrimination against the children of sex workers in educational settings. The report found that these children frequently experience bullying, social exclusion, and stigma from their peers, driven by the pervasive belief that they are likely to enter sex work themselves because of their parents' occupation.
The NCPCR report further highlighted the adverse psychosocial impact on children of sex workers, noting that many experience depression, stigma, and discrimination from an early age. According to the report, these children often avoid interacting or socializing with others because they fear being judged or discriminated against.
What’s the future of these kids?
In 2022, the Indian Supreme Court issued directions to protect the rights of sex workers and their children. As children of sex workers are particularly vulnerable to prostitution and trafficking, the Juvenile Justice (Care and Protection of Children) Act, 2015 provides the legal framework for protecting such vulnerable children, when they are found to need care and protection.
Previously, in 1997, the Supreme Court considered that "accommodation in hostels and other reformatory homes should be adequately available to help segregation of these children from their mothers living in prostitute homes as soon as they are identified".
Unfortunately, three decades later, children of sex workers continue to suffer.