# Strengthening interventions to support the sexual and reproductive health and wellbeing of young women involved in sex work amid conflict and distress migration in Ethiopia

## TL;DR

This study examines how conflict and migration in Ethiopia push young women into sex work and how peer-based education can improve their sexual health and wellbeing.

## Contribution

The study is the first to explore how recent conflict in northern Ethiopia affects sex work and sexual health, and how interventions can be improved.

## Key findings

- Stigma, poverty, and conflict in northern Ethiopia push young women into sex work through exploitative recruitment.
- Peer-based comprehensive sexuality education is needed for under-18 sex workers due to their heightened vulnerability.
- Interventions should involve police, legal systems, and social services to address violence and improve health outcomes.

## Abstract

Amid growing global recognition of the importance of young people’s sexual and reproductive health and wellbeing, an intervention to support peer-based comprehensive sexuality education (CSE) for young women involved in sex work in Ethiopia was implemented in 2020. Since 2018, conflict has driven an upsurge in distress migration by young women to some intervention sites.

This article explores the experiences of young women involved in sex work alongside peer facilitators to understand the strengths and limitations of the CSE intervention and the broader impacts of conflict and distress migration, in order to identify implications for future interventions in Ethiopia.

The article draws on qualitative findings from implementation research undertaken with young women involved in sex work (n = 60) and peer facilitators (n = 15) in Addis Ababa, Bahir Dar and Hawassa cities.

Participants’ entry into sex work is characterised by an absence of supportive networks, yet their social isolation is exacerbated by the stigma of sex work. In areas affected by distress migration, adolescent girls and young women entering sex work are younger, and thus particularly vulnerable to abuse and exploitation by brokers, which further undermines their sexual and reproductive health and rights.

CSE interventions should include adolescent girls involved in sex work who are under 18, given their heightened vulnerabilities. Interventions should engage with a broader range of stakeholders, including police, social services and legal systems, to enhance the sexual and reproductive health and rights of girls and young women, and address violence and exploitation.

Main findings: Stigma, poverty, conflict and a lack of supportive family networks in northern Ethiopia intersect to shape experiences of sex work, driving increasingly young and vulnerable women to enter sex work in urban areas, often through exploitative processes of brokerage and recruitment.Added knowledge: Existing work has not explored how sex work in Ethiopia is affected by conflict, particularly the recent and evolving situation in the north of the country; our work highlights how this exacerbates sexual and reproduction health and rights challenges, and the implications for interventions.Global health impact for policy and action: Future interventions must target those girls and young women who may be less visible, and/or who are under-age, and must go beyond information and access to sexual and reproductive healthcare services to offer a broader range of support, including mitigation and response to gender-based violence, legal support and social protection.

Main findings: Stigma, poverty, conflict and a lack of supportive family networks in northern Ethiopia intersect to shape experiences of sex work, driving increasingly young and vulnerable women to enter sex work in urban areas, often through exploitative processes of brokerage and recruitment.

Added knowledge: Existing work has not explored how sex work in Ethiopia is affected by conflict, particularly the recent and evolving situation in the north of the country; our work highlights how this exacerbates sexual and reproduction health and rights challenges, and the implications for interventions.

Global health impact for policy and action: Future interventions must target those girls and young women who may be less visible, and/or who are under-age, and must go beyond information and access to sexual and reproductive healthcare services to offer a broader range of support, including mitigation and response to gender-based violence, legal support and social protection.