Kathleen S Kenny1, Flo Ranville2, Sherri L Green1, Putu Duff2, Melissa Braschel2, Ronald Abrahams3, Kate Shannon4,5. 1. Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, USA. 2. Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. 3. Fir Square Combined Care Unit, BC Women's, 2nd Floor, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. 4. Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. dr.shannon@cgshe.ubc.ca. 5. Department of Medicine, University of British Columbia, Vancouver, V6Z 2K5, Canada. dr.shannon@cgshe.ubc.ca.
Abstract
OBJECTIVES: Involuntary child removal via the child protection system disproportionately affects marginalized women, yet the impacts on maternal health are under-investigated. This study prospectively examined the association of child removal with self-rated health of mothers who are sex workers. Given high levels of intergenerational family separation in this population, particularly among Indigenous sex workers, we also estimated joint effects of child removal spanning two generations. METHODS: Analyses drew on 2010-2015 data from AESHA (An Evaluation of Sex Workers' Health Access), a prospective cohort of sex workers (n = 950) in Vancouver, Canada. Using logistic regression with generalized estimating equations, we modeled the association of past child removal and current self-rated health in a sample of 466 sex workers who ever had a live birth. Joint effects of child removal and history of removal from own parents were also investigated. RESULTS: Of 466 sex workers, 180 (38.6%) reported child removal at baseline and 147 (31.6%) had a history of removal from own parents. In main effects model, child removal was associated with increased odds of poorer self-rated health [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.04, 2.16]. Joint effects model showed higher odds of poorer self-rated health (OR 2.04, 95% CI 1.27, 3.27) among women with intergenerational family separation. CONCLUSION FOR PRACTICE: Child removal was negatively associated with sex workers' health that was worsened when family separation spanned two generations. Findings underscore need to develop sex worker and Indigenous-led family support services, along with tailored interventions to address health needs of those separated from their children.
OBJECTIVES: Involuntary child removal via the child protection system disproportionately affects marginalized women, yet the impacts on maternal health are under-investigated. This study prospectively examined the association of child removal with self-rated health of mothers who are sex workers. Given high levels of intergenerational family separation in this population, particularly among Indigenous sex workers, we also estimated joint effects of child removal spanning two generations. METHODS: Analyses drew on 2010-2015 data from AESHA (An Evaluation of Sex Workers' Health Access), a prospective cohort of sex workers (n = 950) in Vancouver, Canada. Using logistic regression with generalized estimating equations, we modeled the association of past child removal and current self-rated health in a sample of 466 sex workers who ever had a live birth. Joint effects of child removal and history of removal from own parents were also investigated. RESULTS: Of 466 sex workers, 180 (38.6%) reported child removal at baseline and 147 (31.6%) had a history of removal from own parents. In main effects model, child removal was associated with increased odds of poorer self-rated health [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.04, 2.16]. Joint effects model showed higher odds of poorer self-rated health (OR 2.04, 95% CI 1.27, 3.27) among women with intergenerational family separation. CONCLUSION FOR PRACTICE: Child removal was negatively associated with sex workers' health that was worsened when family separation spanned two generations. Findings underscore need to develop sex worker and Indigenous-led family support services, along with tailored interventions to address health needs of those separated from their children.
Entities:
Keywords:
Child protection; Child removal; Health disparities; Life course theory; Sex work
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