Kristof calls prostitution as dangerous as...

...working for minimum wage? (And other problems of logic and evidence)
So according to Nicholas Kristof's op-ed today, Eliot Spitzer recently encouraged him to write a book about Spitzer's anti-sex-trafficking work. Perhaps he will. He certainly seems to buy the assumption that tightening penalties for johns will somehow help women who are victimized while working as prostitutes. Actually just the opposite is likely.
In addition to citing the already discredited work of Melissa Farley (who appeared on the Times op-ed page yesterday) Kristof refers to a study published 2004 in the American Journal of Epidemiology (PDF here) that makes many of the same mistakes. It takes sex workers who are identified because of "police or health department surveillance" the vast majority of whom were street workers (only 126 of nearly 2000 women worked inside at all) and who admit to selling sex as if they are representative of prostitutes in general, and it finds, no surprise, that those women are more likely to suffer violence or to be killed than women in general. This is not attributable only to their selling sex. This is much more likely attributable to their being poor, in trouble, and on the streets. A better comparison would be with another group of poor or troubled people who are on the streets but not selling sex.
Kristof makes misleading interpretations of the data, as well. In alarmist terms he claims that the average age of death of prostitutes in the study is 34, which is true. The average age of prostitutes in the study who had died was 34. Not all prostitutes died, of course. In fact, most did not. No doubt many are still alive today, and many will live to old age. If we could know all of their ages when they die, we could figure out what the average age of death for of prostitutes in the study.
I think we can agree that women whose only work is sex work face greater risk of violence directly as a result of their work than do other women in other jobs. Studies by the Sex Workers' Project of the Urban Justice Institute has produced studies of street prostitution (Revolving Door) and indoor prostitution (Behind Closed Doors) in New York City. They find that violence on the job is a very real problem, and that street prostitutes face it more frequently than indoor prostitutes. They also find that the stigma attached to prostitution both facilitates violence against prostitutes and inhibits their ability to get justice when they are victimized.
Kristof's response to violence against prostitutes?
"We as a society forbid certain behavior by consenting adults because we deem it too dangerous or harmful. We do not permit indentured servitude or polygamy, or employment for less than the minimum wage. So why permit people to work in the unusually dangerous business of selling sex?"
I don't know if Kristof's concern for prostitutes is really a concern for the women's safety or a moralistic concern about their sexual choices, but that statement makes me think it is the latter. Have we outlawed polygamy and indentured servitude because they are dangerous? I would have imagined we outlawed indentured servitude because it offends our sense of human rights and polygamy because it offends the dominant culture's value of monogamy. As for working for less than the minimum wage, lots of workers work legally for less than the minimum wage, or put another way, there is a very low minimum wage for lots of workers whose compensation comes primarily from tips, which is to say that they may in fact be working for less than the ordinary minimum wage.
Kristof is using the fact of violence against sex workers as a tool to push a prohibitionist agenda. If we want to reduce the dangers faced by sex workers we should turn to the strategies advocated by researchers and advocates who pay attention to the needs of sex workers. The Sex Workers Project recommends destigmatization so that sex workers are less frequently targeted and so they are more able to report crimes against them, expansion of other economic opportunties making exit from sex work a viable option, creating housing options for street-based sex workers, and changing policing strategies so that they don't interfere with outreach work. Decriminalization or legalization would also allow sex workers to work openly and independently.
Destigmatization, decriminalization, legalization and a fostering of respect for sex work will all be enormously more helpful to sex workers than is Kristof's recommendation that we keep the work outlawed because it is dangerous.





Evidence based policy
In citing a 2004 epidemiological study Kristof adds padding, describing this as ‘meticulous’ without stating the scientific criteria he used for such an assessment. The study is in fact quite misleading, taking women in trouble with the police, and who were in clinics getting treatment and admitted to having been involved in sex work (which few do) and then comparing them with the general population. Apart from problems with misclassification in studies using self reporting, there is a failure to control for all the other factors likely to affect mortality. If they had compared these women to other women of a similar socio-economic group with police records and in treatment, the results of the study would have been very different. These women represent a subgroup of women selling sex on the street, which in itself only represents about 10-20% of all women selling sex. To conclude that this data is typical of sex work in general is a very serious error.
Interestingly it never seems to occur to Kristof that selling sex on the street is dangerous, not because selling sex is in itself dangerous - it is not, but because of the criminal law (that he champions) and social stigma which we impose on these women. One wonders just how many countries Kristof did look at - did he look at Finland or New Zealand, and why did he assume that the approach of Amsterdam’s mayor is some sort of proof that a more liberal approach is a failure. What exactly does he know about Bulgaria other than its plan to liberalise the laws came under attack from some US radicals?
Kristof seems a fan of Sweden, a country radically different socially and legally from the US. In fact there is no evidence whatsoever that Sweden’s approach achieved any benefit, including a recently released report from the National Board of Health of Welfare (2). No country has succeeded in changing the extent of prostitution through legislation, indeed it is difficult to see how they could, but many have succeeded in creating a good deal of harm.
Kristof’s intemperate vocabulary - “rape a 13 year old” “pubescent flesh” does not suggest he is interested in an objective analysis of evidence, as opposed to pursuing moral ideology. Calmer minds might realise that such things as human rights and public health deserve equal consideration rather than waging war on something one decides one does not like.
Michael Goodyear, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 2Y9
References
1. Weitzer R. Flawed theory and method in studies of prostitution. Violence against Women 2005 11(7) 934-949
2. Kännedom om Prostitution. Socialstyrelsen Artikelnr 2007-131-48. Stockholm
Prohibitionist
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