“Causes of maternal and child mortality among Cambodian sex workers and their children: a cross sectional study”; Willis B, Onda S, Stoklosa H; BMC Public Health (2016 16:1176. DOI 10.1186/s12889-016-3838-7.


To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify and describe maternal deaths of female sex workers in Cambodia and causes of death among their children.

A convenience sample of female sex workers were recruited by local NGOs that provide support to sex workers. We modified the maternal mortality section of the 2010 Cambodia Demographic and Health Survey and collected reports of all deaths of female sex workers. For each death we ask the ‘sisterhood’ methodology questions to identify maternal deaths. For child deaths we asked each mother who reported the death of a child about the cause of death. We also asked all participants about the cause of deaths of children of other female sex workers.

We interviewed 271 female sex workers in the four largest Cambodian cities between May and September 2013. Participants reported 32 deaths of other female sex workers that met criteria for maternal death. The most common reported causes of maternal deaths were abortion (n = 13;40%) and HIV (n = 5;16%). Participants report deaths of 8 of their children and 50 deaths of children of other female sex workers. HIV was the reported cause of death for 13 (36%) children under age five.

This is the first report of maternal deaths of sex workers in Cambodia or any other country. This modification of the sisterhood methodology has not been validated and did not allow us to calculate maternal mortality rates so the results are not generalizable, however these deaths may represent unrecognized maternal deaths in Cambodia. The results also indicate that children of sex workers in Cambodia are at risk of HIV and may not be accessing treatment. These issues require additional studies but in the meantime we must assure that sex workers in Cambodia and their children have access to quality health services.

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“The health of children whose mothers are trafficked or in sex work in the U.S.: an exploratory study”Vulnerable Children and Youth Studies: An International Interdisciplinary Journal for Research, Policy and Care, Volume 11, Issue 2, 2016.


The goal of this exploratory study was to identify health problems experienced by children whose mothers are trafficked or in sex work in the U.S. and the proportion of the children who experience these health problems. Participants were adult survivors of sex trafficking and adult women in sex work. They were asked about the health of children whose mothers were trafficked or in sex work but not about their own children. This approach allows participants to discuss sensitive issues but without having to share potentially negative information about their own children. Participants were asked to identify the common and serious health problems among the children based on their observations, to rank the problems in order of seriousness, to estimate the percentages of the children who experience certain health problems, and to identify the causes of death among the children. There were numerous reports of birth defects, fetal alcohol syndrome, blindness, neonatal abstinence syndrome, and physical and sexual abuse. Nearly a third of respondents (31%) knew of the death of a child whose mother was trafficked or in sex work, and 11% reported they knew of the death of a child due to physical abuse. The majority of respondents (89%) reported that some daughters are trafficked into prostitution. The median estimate of the percentage of daughters who are trafficked was 50%. Children born to trafficked adolescents and adult female sex workers in the U.S. are potentially at high risk for many serious and fatal health problems. The magnitude of these health problems is poorly understood but warrant urgent attention.

Read and download Brian’s study here.



“Health of female sex workers and their children: a call for action”, The Lancet Global Health.

We are pleased to announce our comment and call to action for mothers who have been trafficked or in sex work and their children has been published by The Lancet Global Health, May 12, 2016.


Two very critical health and human rights issues related to sex work have been neglected globally: maternal morbidity and mortality among female sex workers and the health and wellbeing of their children. It is time to recognise the need for, and right to, maternal and child health services for female sex workers and their children.

Read and download the Lancet Global Health comment here.

You can read the article in The Lancet Global Health here>>

Spanish Translation
Read and download the Spanish Translation of the Lancet Global Health comment here.


The health and social well-being of female sex workers’ children in Bangladesh: A qualitative study from Dhaka, Chittagong, and Sylhet. Brian Willis, Ian Hodgson, and Ronnie Lovich. Vulnerable Children And Youth Studies Vol. 9 , Iss. 2,2014

We conducted this study in three cities in Bangladesh in 2010 in partnership with Save the Children USA. Among the most important findings from this study is that, according to the FSW who are mothers, 100% of their daughters are trafficked into prostitution, many of the daughters become pregnancy, and if they give birth they often have to give their infant to the madam who operates the brothels.

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Willis B. The global public health impact of sex work: a call for research. The Lancet Global Health 2013;e68. doi:10.1016/S2214-109X(13)70011-1.

You can access this comment here>>



Monique M. Hennink & Solveig A. Cunningham (2011): Health of Home-based Sex Workers and Their Children in Rural Andhra Pradesh, India, Asian Population Studies, 7:2, 157-173.

One of our Advisors, Dr. Ginny Feldman, and Brian, conducted this study with the local NGO, BIRDS, in 2006. The results were published by two of our colleagues at the Rollins School of Public Health.

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Gwadz MV, Gostnell K, Smolenski C, Willis B, Nish D, Nolan TC, Tharaken M, Ritchie AS. The initiation of homeless youth into the street economy. J Adolesc. 2009;32:357-77. doi: 10.1016/j.adolescence.2008.01.004. Epub 2008 Aug 28.

While this study included a board ranges of health and social problems experienced by homeless youth on the street, our component of the study focused on pregnancy and girls who were sexually exploited on the street. This situation underscores a poorly recognized aspect of sexual exploitation of homeless and street-based adolescent girls.

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The Public Health Impact of Sex Trafficking. Trafficking in Persons Report. U.S. State Department. June 2006.

You can read and download the report here>>



Willis B, Levy B. Child Prostitution: global health burden, research needs, and interventions. Lancet. 2002;359:1417-1421.

Our first study to address the situation of mothers who are trafficked or in sex work and their children dates to 2002 when my colleague, Dr. Barry Levy, and Brian published the first ever study to estimate the global public health impact of child prostitution. We specifically included the potential impact of maternal morbidity and mortality among trafficked adolescent girls and neonatal deaths among their children.

You can access the article here>>