AS winter cloaks Delhi’s streets, the lives of sex workers in Majnu ka Tila and GB Road offer a glimpse into the challenges faced by some of India’s most marginalised women.Despite the legal framework allowing for safe abortions, systemic barriers, stigma and socio-economic vulnerabilities continue to impede access to reproductive healthcare. The International Day to End Violence Against Sex Workers on December 17 offers a poignant moment to reflect on these struggles, particularly in light of the Supreme Court's ruling in X versus Principal Secretary (2022) that extended abortion rights to unmarried women.For sex workers, however, this legal triumph remains largely theoretical in its impact.The legal landscapeThe Supreme Court’s September 2022 decision to recognise the right to abortion for unmarried women was celebrated as a historic step toward gender equality. The judgment, which emphasised the reproductive autonomy and dignity of women, aligned reproductive rights with the constitutional principle of equality..The Supreme Court’s September 2022 decision to recognise the right to abortion for unmarried women was celebrated as a historic step toward gender equality..Advocate Dr Amit Mishra, who represented the petitioner, described the ruling as groundbreaking. However, he highlighted the significant gap between the law’s promise and its practical implementation.“The judgment is a landmark decision, but its practical impact is limited. While educated individuals might be aware of it, most women— including medical practitioners— remain unaware of the legal provisions.“Sex workers, being marginalised and often without access to information, are largely ignorant of their rights under the Medical Termination of Pregnancy (MTP) Act,” Mishra noted..Why India urgently needs a Union law to protect healthcare workers.The Medical Termination of Pregnancy (MTP) Act, 1971 allows any woman to seek an abortion up to 20 weeks of pregnancy. Vulnerable groups such as minors, widows and unmarried women are granted an extended limit of 24 weeks under Rule 3-B of the MTP Rules.However, procedural requirements, such as approval from two medical practitioners for abortions beyond 20 weeks, create significant hurdles. These barriers are particularly daunting for sex workers, who often lack the necessary documentation, information or support networks to navigate the system.Moreover, the burden of proving eligibility under the MTP Rules further complicates the process. For sex workers, whose occupation is still shrouded in stigma, this requirement becomes an almost insurmountable obstacle.Barriers to accessThe global reproductive health crisis is alarming. According to the United Nations Population Fund, 2022, 257 million women of reproductive age want to prevent pregnancy, yet 172 million lack access to modern contraception, leading to unintended pregnancies.In India, the situation is equally concerning, with six million abortions annually— two million spontaneous and four million induced. Shockingly, only 1–2 percent (5–6 lakh) of these abortions are legal..The Medical Termination of Pregnancy Act, 1971 allows any woman to seek an abortion up to 20 weeks of pregnancy..One of the most pervasive barriers to accessing safe abortions for sex workers is the requirement of an Aadhaar card, which is often mandatory for medical procedures. Many sex workers lack this essential identification document due to unstable housing, social exclusion and bureaucratic hurdles. Despite the Supreme Court’s earlier directive to waive the need for residence proof for sex workers applying for Aadhaar cards, implementation remains patchy.Divya, a 25-year-old sex worker, shared her struggle: “I have been to many hospitals, but they all ask for the same thing— an Aadhaar card. It is like I don’t exist without it. Without this card, I can’t even get a simple checkup, let alone an abortion.”Without identification, many sex workers are forced to turn to unregulated, unsafe alternatives, increasing their vulnerability to life-threatening complications..India’s confusing legal landscape does not serve persons with intellectual disabilities.Mishra explained that hospitals often require identity proof to comply with Section 19 of the Protection of Children from Sexual Offences (POCSO) Act, 2012, which requires reporting cases involving minors to police. However, this process deters adult women, especially sex workers, who fear stigma and legal repercussions.For many sex workers, the lack of an Aadhaar card is not just a logistical issue but a reflection of their systemic invisibility. Without this document, they are excluded from welfare schemes, healthcare services, and even basic legal protections. The result is a vicious cycle of marginalisation, where their lack of documentation perpetuates their exclusion from essential rights and services.Stigma and unsafe practicesEven when sex workers manage to access healthcare facilities, they often face discrimination and hostility from medical professionals. Samiksha, a sex worker from Majnu ka Tila, recounted her harrowing experiences: “We are often given just a pill, which leaves us ill for months. The side effects are unbearable, and it affects our work.”.The power dynamics inherent in sex work exacerbate these issues. Male clients often refuse to use condoms, citing myths about reduced pleasure..For sex workers, the economic realities of their profession frequently clash with medical advice. A gynaecologist explained, “Following an abortion, the cervix remains partially open, increasing the risk of infection. It is crucial to avoid penetrative sex for two-three weeks to allow proper healing.”However, for women who depend on daily earnings to survive, adhering to such recovery guidelines is nearly impossible.The stigma surrounding their profession further compounds these challenges. Hospitals often treat sex workers with disdain, refusing them the dignity and care afforded to other patients. This mistreatment not only discourages them from seeking professional medical help but also drives them toward unsafe and unregulated practices.The power dynamics inherent in sex work exacerbate these issues. Male clients often refuse to use condoms, citing myths about reduced pleasure..Lack of Braille-embossed packaging on medicines hampers accessibility among India’s visually impaired population.Rakhi, a sex worker from GB Road, explained, “Many customers refuse condoms, but we try to educate them about HIV and AIDS. When things go wrong, abortion becomes a necessity— but even that is out of reach due to stigma and inadequate post-care facilities.”The role of community supportIn the absence of institutional support, community interventions have proven to be a lifeline for sex workers. Samiksha, who was lured into sex work under pretence, faced immense difficulties accessing abortion services. Eventually, a local community leader intervened, helping her navigate the healthcare system and secure the care she needed.Such stories highlight the critical role of grassroots organisations in bridging the gaps in healthcare access for sex workers. By providing legal assistance, health counseling and support networks, these groups play an indispensable role in ensuring that sex workers can exercise their reproductive rights.Integrating healthcare for sex workersResearch indicates that abortion rates among women sex workers are significantly higher than those among other women of reproductive age. This disparity is driven by several factors, including a lack of access to contraception, the criminalisation of sex work, and the stigma surrounding their profession..India cannot claim true development while its most marginalised communities remain excluded from basic rights and services..To address these challenges, it is essential to integrate sexual and reproductive health services into broader healthcare programmes. This includes combining HIV testing, family planning and safe abortion services under a unified framework.Innovative approaches, such as video counseling and trauma support for sex workers who solicit clients online, can also help address emerging challenges. Healthcare providers must adopt a judgment-free approach, ensuring that sex workers receive care without discrimination.Training medical professionals to understand the unique needs and vulnerabilities of this group is crucial. Additionally, targetted awareness campaigns can help educate sex workers about their rights and the availability of sexual and reproductive health services.The need for data-driven policiesAs Caroline Criado-Perez argues in Invisible Women: Data Bias in a World Designed for Men, data-driven policies are essential to addressing the systemic neglect of marginalised groups. Collecting and analysing data on the healthcare experiences of sex workers can inform evidence-based interventions, ensuring that their needs are integrated into national health missions..Some personal reflections on prison medical care.Policymakers must also recognise the evolving nature of sex work. As solicitation increasingly shifts to online platforms, healthcare services must adapt to these changing patterns. This includes offering remote consultations, digital resources and trauma-informed care tailored to the specific challenges faced by online-based sex workers.Bridging the gapIndia cannot claim true development while its most marginalised communities remain excluded from basic rights and services. Addressing the healthcare needs of sex workers requires a multifaceted approach, combining legal reforms with societal change.Legal scholar Prabha Kotiswaran, in her work, highlights the intersection of law, labour and human rights in the context of sex work, emphasising the need for structural reforms to ensure justice for these communities.Ensuring unbiased, accessible reproductive healthcare for sex workers is not just a matter of public health—it is a matter of justice. Only when every woman, regardless of her profession, receives the care and respect she deserves can we truly bridge the gap between law and justice.
