Sex Workers, Stigma and Self-Belief: Evidence from a Psychological Training Program in India
Sex workers who undergo a comprehensive training program focused on improved agency and psychological empowerment exhibit positive changes in self-esteem, outlook, future-orientation, and health and economic behaviors.
Stigma and social exclusion can lower a person’s self-esteem and distort her self-image, leading to a feeling of not being capable -- or worthy -- of a better life situation. Well-known work in psychology suggests that a sense of self-efficacy (the ability to succeed in a particular situation, despite barriers) is important to motivate individuals to put in effort and strive in the face of challenges. This study aims to examine whether psychological empowerment training can overcome the adverse effects of stigma and exclusion. Researchers in collaboration with an NGO (Durbar) work with a population that faces such acute stigma– sex workers in India. As with other disadvantaged populations, these women are also often deprived of access to social programs, education, and healthcare and have developed a feeling of hopelessness. The study consists of an 8-week psychological training program aimed to raise sex workers’ self-esteem and sense of self-efficacy. It uses a randomized control trial design to measure the program’s impact on self-reported well-being measures and choice outcomes.
Sex workers who participated in the training program exhibited improved self-efficacy, a greater sense of agency, and willingness to invest in the future.
- Sex workers who received the training program were 68 percentage points more likely to report higher self-esteem, and were 29 percentage points more likely to report a positive self-image or self-perception.
- Compared to sex workers who did not receive the training program, sex workers who received the program were 9 percentage points more likely to have visited a doctor since the program’s commencement, even though the initial rate of health-check up visits was high (79%).
- With regards to self-reported happiness, sex workers who received the training program were 12 percentage points more likely to report being happy and were 40 percentage points less likely to feel ashamed of their occupation.
- When compared to sex workers who did not receive the program, program participants were 25 to 50 percent more likely to choose a future-oriented savings product over a present-biased one.
The training program proved to be an effective means of improving sex workers’ feelings of self-worth, empowerment and agency.
The 8-week training program was instituted in Kolkata, India with sex workers from three “red-light” districts: Kalighat, Bowbazar, and Chetla. From these districts, 467 sex workers, all less than 35 years old, were chosen to participate. Following selection, 264 sex workers were randomly assigned to the treatment arm, which consisted of receiving the 8-week program, while the remaining 203 sex workers were assigned to the control arm.
The two main goals of the sessions were to empower women to challenge the norm of stigma and societal assumptions and to instill in women the belief that they themselves can change this norm in their own lives. At the end of the training sessions, both treatment and control participants were compensated Rs. 100 (about 2 USD) with three options regarding how they would like to receive the payment: as a direct deposit into the participant’s own account; as a disbursement to a fixed deposit; or as a disbursement to a fixed deposit in which the participant could match the amount equally. The first option offered an 8% interest rate on the amount and would allow the participant to use the funds immediately, while the second and third options offered interest rates of 12% and 15%, respectively, and the returns to investment from these two options would not be accessible to participants for a year. These compensation options were put in place to gauge the level of “future-oriented” commitment from the subjects after the training program.