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Childhood Sexual Trauma among Women Who Trade Sex
Background: Previous research demonstrates that adverse childhood experiences are a common experience for many women who are involved in sex work, ranging from poverty and neglect to physical and sexual abuse. Of particular importance is the role of childhood sexual trauma (CST), as it has pervasive impacts on women’s formulation of sexuality and relationships. This study explores women’s experiences of childhood sexual trauma and their understanding of its impact on their lives.
Methods: This study was part of a community-engaged research project that partnered with an organization that provided harm-reduction services to women in sex work. Women who met inclusion criteria were approached with information about the study. Participation involved completing an ACASI questionnaire; 51 women completed this portion of the study. Questionnaires examined adverse childhood events, depressive symptoms, substance use, sexual behavior, and maternity experiences. A subset of women (n¼19) also participated in in-dept qualitative interviews structured around women’s life courses, specifically focusing on experiences of motherhood and child custody loss, sex work, substance use, and mental health. This study received approval from the Medical College of Wisconsin IRB.
Results: Of women who participated in the quantitative survey, 59% reported CST, compared to 20% of other low income Wisconsin residents. Although not specifically asked, 8 of 19 women completing the qualitative interview reported CST. Of these women, multiple reported perpetration by family members or direct knowledge of involvement of family members; two women reported being sold to men by their mothers as children to help pay for drugs. Many women were able to see direct connections between their experiences with CST and their relationships later in life, from straightforward connections, like anger toward those involved, to more complex consequences. One participant directly related her understanding of sex as a commodity to experiences being abused by her brother, who would always give her money afterward.
Conclusions: Childhood sexual trauma is an extremely common experience for women involved in sex work. They report direct and indirect links of CST to their continued experiences of trauma and engagement in sex work. This study provides further evidence for the continued need to prevent CST, raise awareness of CST, and provide appropriate interventions to those affected by CST.
2. Pregnancy Outcomes in Three Title X Clinics Prior to Options Counseling Restrictions
Background: In the United States, 75% of adolescent pregnancies are unintended, and 24% of adolescent pregnancies end in therapeutic abortion. Abortion restrictions have historically affected younger and minority populations disproportionately. Recently, Title X restrictions were implemented that prohibit providers from referring directly to abortion clinics. Thus, we sought to determine the demographic characteristics and pregnancy outcomes of patients with positive pregnancy tests in our Title X clinics prior to the implementation of the new restrictions in order to better understand their potential impact.
Methods: We reviewed the charts of all patients with positive pregnancy tests in 2017 and 2018 in three clinics receiving Title X funding, including general Adolescent Medicine, BC4U (a family planning clinic) and the Young Mother’s clinic (antenatal care for young mothers and their babies). We computed descriptive and comparative statistics (medians and chisquared tests). This project was determined to be Quality Improvement so did not require IRB approval.
Results: 326 patients had positive pregnancy tests; ages ranged from 14.9 to 24.9 with median age 20.3 years. Demographic analysis showed that 49.7% were primigravid, 21.8% were black, 27.0% were white, 51.2% were other race and 55.2% were Latinx. 21.3% reported that they were “trying” to become pregnant. After positive pregnancy tests, 72.7% stated that they wished to continue the pregnancy, 7.6% stated they would seek an abortion, and 17.1% were unsure what they would do. Of those with known outcomes, 75.3% had prenatal care, 17.2% had a miscarriage, and 7.1% obtained an abortion. Patients choosing to have an abortion were similar to all others except that they were less likely to be in a relationship at the time (42.1% v. 69.8%, p¼0.01) and less likely to report that they were “trying” to get pregnant (23.0% v. 0%, p¼0.017).
Conclusions: There are patients in our Title X clinics who seek abortion care and therefore could be negatively impacted by abortion counseling restrictions. Additionally, the many patients who are unsure of their pregnancy decision may be influenced by the inability of providers to discuss options. The majority of pregnancies in our clinics are unintended, which highlights the need to offer comprehensive counseling. The state of Colorado allows minors to have abortions without parental consent and the Title X restrictions may prevent patients from learning this information, which would affect their ability to make informed decisions. This Quality Improvement project will use this data and compare it with data collected after implementation of the restrictions in order to determine the effect on pregnancy outcomes for our patients.
3. Adolescents in Foster Care: How are their Experiences Represented in Research?
Background: Adolescents in foster care need to be included in research so that evidence-based approaches can be relevant for them. To understand the current status of inclusion of adolescents in foster care, we sought to a) determine the percentage of recent publications that included data collected directly from minor adolescents (ages 10-17 years) b) characterize the consent process; and c) describe the topics addressed.
