Children of female sex workers and drug users: a review of vulnerability, resilience and family-centred models of care
OBJECTIVE To determine the childcare practices of commercial sex workers (CSWs). DESIGN A descriptive cross-sectional survey was conducted between July and December 2000 during which a structured questionnaire was administered. SETTING Kibera slum, Nairobi, Kenya. SUBJECTS Three hundred eighty five CSWs and four focus group discussions (FGDs) held. Health cards from 126 under five years old children belonging to the respondents were reviewed for immunization status and regularity of growth monitoring. RESULTS The mean age of the 385 CSWs surveyed was 32 +/- 7 years and mean duration of sex work was 6 +/- 4 years. The mean number of living children was 3.4 +/- 2 and 81.2% of the mothers lived with their children. Three quarters of the CSWs practised prostitution at home. The most common daily childcare activities by the mothers were food preparation (96.2%) and washing children's clothes (91.3%). Overall 96.8% of their under-five years old children were fully immunized and 80% of their under one year old children had their growth monitored monthly. About three quarters of the mothers with adolescent children educated them on HIV/STDs. Health seeking behaviour for the children was hampered by health care cost (71.4%) and consumption of alcohol by the mothers. Like other mothers, the CSWs encouraged their adolescent children to take up some adult roles such as maintaining a clean house (93.3%). However only 2.0% took time to converse or counsel the children. Focus group discussions (FGDs) with the CSWs showed that children were left unattended at night while the mothers went out in search of clients. Efforts to provide better education for the children were undermined by lack of funds (52.2%) and truancy (46.6%). One third of the study population had invested for the future maintenance of their children. CONCLUSION There was more emphasis on physical, rather than psychological aspect of childcare. The practice of living with the children ensured that earnings from the sex trade were used for the immediate needs of the children such as food. However this practice had a negative influence on the children as the majority of the respondents conducted their sexual business at home with little or no privacy. Health seeking behaviour for the children was hampered by lack of funds and to some extent alcohol consumption by the mothers. Efforts to invest in the education of their children were undermined by lack of funds and truancy.