Project Ankur: Assessing Mental Health Needs, Barriers and Best Practices among Sex Workers in Rural India

Marina Marcus (PhD Candidate) and Srishti Sardana (M.A. Candidate), Department of Counseling and Clinical Psychology, Teachers College, Columbia University were awarded the Advanced Consortium on Cooperation, Conflict and Complexity Research Fund, in collaboration with the Morton Deutsch International Center for Cooperation and Conflict Resolution and the Earth Institute, Columbia University for the academic year 2015-2016 to undertake the first-ever community-based mental health intervention in rural, home-based sex workers and their children. This is the first project that would assess the needs, barriers and best practices of this extremely marginalized population.

 

Project Ankur: Assessing Mental Health Needs, Barriers and Best Practices among Sex Workers in Rural India

Approximately 15 million women and girls are trafficked for sex work in India. A female sex worker is an adult woman who ‘engages in consensual sexual intercourse for money or payment in kind, as a means of livelihood’. The Suppression of Immoral Traffic in Women and Girls Act (1956) (SITA) and The Immoral Traffic (Prevention) Act (ITPA) render an ambiguous legal status to sex work in India, permitting sex workers to practice their trade privately while prohibiting public solicitation of clientele or ‘being an occupier of any space’ identified as a brothel. Further, this prevents the accurate estimation of the prevalence of sex work in the country. The quasi-legal profession of sex work prevents women engaged in it from gaining the same protections afforded to others as citizens and workers, resulting in great vulnerability. These women are exposed to the major social determinants of mental illness: prolonged exposure to violence, exploitation, social exclusion, malnutrition, stigma and physical ailments. As expected, studies have shown elevated rates for severe and common mental illness among this population. Given the marginalized status of this population, access to mental health services is particularly challenging. Despite the known high rates of common mental illness among sex workers, the consistent focus of research in this population has been on the HIV/AIDS epidemic, neglecting the systematic study of psychological impact of their occupational hazards on mental health. Such research has further stigmatized this population, often positioning them as the ‘vectors’ of sexually transmitted diseases. There is an existing dearth of literature that explores the specific barriers and best practices of creating sustainable pathways of mental health care have not been explored. Gujarat, a state along the west coast of India has a population of 50.67 million, with a density of 258 per sq.km., with 96,00,000 households and 25 districts constituted by 18,618 villages (therefore, 62.33% of the total population resides in the rural areas). MINDS Foundation is a nonprofit organization focused on providing community-based, free of cost mental healthcare support and access to rural India through an existing network of trained community mental healthcare workers (CMHWs). In collaboration with MINDS, this pilot study would develop the baseline for building future stepped-care, effective and culturally relevant pathways of integrating mental health as a vital and accessible component of the existing healthcare pathways for this vulnerable population.