Since 2010, Venezuela has been facing an escalated socioeconomic and political crisis that has affected the daily life of its inhabitants and institutions, including its health system. Precarious conditions, including shortage of medicines, supplies, and vaccines, force people to choose between buying these items in the black market or not being able to access them at all (Rada 2022). The material scarcity sums to a massive emigration of human resources, including physicians, nurses, and other medical workforce, affecting the system's ability to provide essential services (MSPSC 2019). In Venezuela, hospitals barely cover the needs for reproductive and sexual health. The country has no updated numbers on the unmet need for contraceptives (Rivillas-García et al. 2021), and between 2015 and 2016, child deaths increased by 30.1% and maternal mortality by 64.4% (Rada 2022). Along with the precarious economic and social situation, international organizations and NGOs have reported that the need for reproductive and children’s healthcare is one of the principal motivations for leaving the country.

Colombia is the leading receptor country in the region for Venezuelan migration. Like other refugee crises, the constant flow of Venezuelan families to Colombia represented a challenge for the receptor country’s institutions, including its health system. Public hospitals had to explore ways to adapt to the population increase and to respond with emergency services to migrants without health insurance or legal documentation. In Medellin, one of the key receptor cities, Venezuelan migrant mothers describe their lives as a "daily struggle." A person walking downtown may find them asking for money in the streets, working in the service industry, or looking for clients in the red-light districts. Their lives are in tension with institutional control, economic insecurity, systemic violence, xenophobia, and sexism. In this article, I focus on the struggles experienced by Venezuelan women who left their homeland in search of better economic opportunities and ended up working in the sex industry in Medellín. I use the reproductive justice framework to argue that their difficulties accessing reproductive care result from the incapacity of local institutions and providers to attend to their necessities as migrants, sex workers, and mothers. My analysis derives from my ethnographic fieldwork in Medellin in 2022, which included 26 in-depth interviews with sex workers and healthcare professionals and participant observation in reproductive health events[1].

Reproductive justice is a theoretical and political framework that women of color, feminist scholars, and health professionals developed to understand people’s reproductive needs using human rights and intersectional/decolonial feminism. Its foreground principles are "(1) the right not to have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments" (Ross and Solinger 2017, 9). Recently, the right to maintain personal bodily autonomy and sexual pleasure was added to the list (SisterSong 2023). Reproductive justice draws attention to the context in which individuals live and make decisions. It "insists on the social, economic, and political transformations that would allow all families and communities to thrive" (Murillo and Fixmer-Oraiz 2021, 762) and contributes to expanding the traditional notions of family, gender, and sexual pleasure (Stacey 2018). In what follows, I use reproductive justice to expose the landscapes of precarity in Medellin derived from the entanglements of sex work, migration, and reproductive health.

1. The right not to have a child.

Venezuelan migrants in Colombia have experienced problems getting health insurance, primary care, and out-of-pocket expenses (Rivillas-García et al. 2021). Mobility restrictions, unstable employment, and bureaucratic barriers increase their difficulties accessing contraceptives and abortion in Medellin. Religious beliefs also conflict with providing or receiving an abortion in Medellin. Artemisa, an obstetrician, explains: "Here, the issue of abortion is a mess. In 2013, a nurse explained to me that only one doctor performed abortions in the public network. The rest claimed objection of consciousness because of their Catholic beliefs." These situations result in vulnerable populations like victims of human trafficking or rape, and those engaging in sex work lacking essential methods to protect their sexual health (Rivillas-García et al. 2021).

In some cases, sex workers perform “unsafe sex” (sex without a condom) because of the client's coercion. This situation affects their consistency in maintaining contraception. Flor, a mother of two, told me: "In Venezuela, I got the subdermal implant, but I have to replace it. Here, I don't have the money for that. It's going to rot in there!" More desperately, Alexandra will attempt to extract the implant herself: "They told me that I had to pay 100,000 COP. I will cut my arm to remove it anyway, but I don't know what it looks like." Having an expired implant or attempting to remove it without medical training increases the risk of infection, breakage, or implant migration. In addition, it can lead to unwanted pregnancies, often experienced as economic burdens and stress factors (McClelland and Newell 2008).

2. The right to have a child.

In Western culture, many believe that motherhood and prostitution are incompatible (Cristoffanini 2017). Women in the sex industry are often described as corrupt, addicted, degraded, prone to disease, and bad mothers (Dickson 2019). The stigma of their work creates increased challenges and may target them for eugenic-based programs. Casandra, who recently arrived at Medellin, visited an institution offering sterilizations to migrant women: "There are many Venezuelans being sterilized. They [the doctors] are like: 'knife goes in, guts come out.' It's something like that, very fast." Casandra narrates that she did not receive information about the potential risks of the procedure, and nurses scolded her for being "too anxious." Although there have not been reports of forced sterilizations in the city, my observations confirmed that NGOs and health centers concentrated their efforts on sex-working sites. In these contexts, the borders between facilitating access to family planning or targeting the rights of specific populations to reproduce are difficult to trace.

Some health professionals were also uncomfortable with sex workers getting pregnant. Merida, a nurse, told me that a different "management protocol" would be necessary due to "increased risks." Similarly, the obstetrician Violeta said that a pregnant sex worker would be considered high risk: "Above all, the risk is social, although she also has risks due to possible STIs, right?" Merida and Violeta assumed sex workers were prone to infections and additional risks during their pregnancies, probably because of how sexual behavior is understood in nursing and medical schools in Colombia as a risk factor. However, generalizations from school or daily clinical practice can easily become prejudices. Most women in my study told me they never engaged in sexual practices without protection, even when clients offered them more money. Prejudices around sex work and motherhood increase medical discrimination and restrict women's decisions to have children.

3. The right to parent in safe environments.

Venezuelan women in Medellín are far from having safe and sustainable environments to parent, a common trend for sex workers around the globe (Beckham et al. 2015). I heard multiple stories of discrimination, harassment, and violence occurring in the city, at work, inside their families, and during institutional encounters. Mona reported that her clients often "had knives, scissors… they pull one's hair and hit us." Similarly, Oriana mentioned that the brothels had no safety conditions: "No one knows what is happening there; the man comes in and drugs you. When you wake up, you are robbed, naked, and hurt." Some of these reports have reached local media, including histories of torture, murder, dismemberment, and impalement. Susan Fernández, a 22-year-old Venezuelan trans woman who worked in the sex industry in Medellin, represents a recent case. Susan was murdered with a knife by a client in the clandestine brothel where she worked.  The client managed to escape and is still on the run (Carvajal Bolívar 2023).

Sex workers also avoid accessing healthcare and welfare services for fear of having their children apprehended by Child Protection Services (Duff et al. 2015). Oriana, with tears in her eyes, described how the police took away her son one time she had to carry him while selling candies: "I was dragging, I didn't want anyone to talk to me, I just wanted the earth to swallow me. The suffering lasted 15 days until I recovered my son." Other women narrated similar stories and believed the local police surveilled their families with more severity for the mere fact of being Venezuelan migrants.

4. The right to maintain personal bodily autonomy and sexual pleasure.

According to Morison et al. (2022), "sexual and reproductive injustice is not restricted to sexual and reproductive healthcare spaces but part of the wider context in which sex workers live and work" (23). Unfortunately, reproductive justice has rarely been used to analyze and address the sexual and reproductive health needs of sex workers, including their parenting experiences. The only exception I found was the study of Stevens, Dlamini, and Louskieter in South Africa, published in Morison et al. (2022). So far, reproductive justice scholars have failed to research the labor conditions of women in the sex industry, defend their bodily autonomy and sexual choices, and work toward the eradication of human trafficking and child prostitution.

With the appropriate conditions and protections, sex work can be another strategy that adult women use to provide for themselves and their families; as Diana said: "I enjoy the job, one gets many friends and regular clients. This work is what I do to support my children, and I am not ashamed of it." Following the fourth pillar, reproductive justice should support women’s rights to decide over their bodies and fight against the prejudice surrounding sex work. It is time for prostitution to be included in conversations about justice, healthcare, and human rights.

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The four pillars of reproductive justice help us broaden our vision and reflect on how Venezuelan migrants in the sex industry experience barriers to accessing sexual and reproductive healthcare in Medellin. Their migratory situation, economic precarity, and unsafe labor conditions impact the care they deserve and their opportunities to navigate the health system. Their testimonies demonstrate that reproductive justice should fight structural xenophobia, sexism, and classism if it wants to be effective. The ethnographic information presented in this article suggests the need for a stronger coalition between grassroots movements, local authorities, and NGOs to close the health access gap for migrants and sex workers in Medellin. Additional research should be done to understand the healthcare needs of migrant sex workers in other contexts and facilitate the creation of policies directed toward the specific needs of this population.

Works Cited

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Carvajal Bolívar, Sebastián. August 8, 2023. “Asesinaron a una mujer trans en barrio residencial de Medellín.” El Tiempo. https://www.eltiempo.com/colombia/medellin/medellin-asesinaron-a-una-mujer-trans-en-barrio-residencial-794209

Cristoffanini, Macarena Trujillo. 2017. "Maternidad Y Prostitución ¿contradictorias Y Excluyentes?" Estudos Feministas 25(1): 167-85. https://doi.org/10.1590/1806-9584.2017v25n1p167

Dickson, Holly. 2019 "Sex Work, Motherhood, and Stigma." Sexual and Relationship Therapy 34(3): 332-34. https://doi.org/10.1080/14681994.2019.1573980

Duff, Putu, Jean Shoveller, Jill Chettiar, Cindy Feng, Rachel Nicoletti, and Kate Shannon. 2015. "Sex Work and Motherhood: Social and Structural Barriers to Health and Social Services for Pregnant and Parenting Street and Off-Street Sex Workers." Health Care for Women International 36(9): 1039-055. https://doi.org/10.1080/07399332.2014.989437

McClelland, Gabrielle Tracy, and Robert Newell. 2008. "A Qualitative Study of the Experiences of Mothers Involved in Street-based Prostitution and Problematic Substance Use." Journal of Research in Nursing 13 (5): 437-47. https://doi.org/10.1177/1744987108095409.

Ministerio de Salud y Protección Social Colombia (MSPSC). 2019. Plan de Respuesta del Sector Salud para el Fenómeno Migratorio. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE%20/COM/plan-respuesta-salud-migrantes.pdf

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Murillo, Lina-María and Fixmer-Oraiz, Natalie. 2021. “Chapter 48: Reproductive Justice in the Heartland. Mothering, Maternal Care, and Race in Twenty-First-Century Iowa”. In Maternal Theory. Essential Readings, The 2nd Edition. Edited by Andrea O’Reilly. Demeter Press: 761-777

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Ross, Loretta, and Rickie Solinger. 2017. Reproductive Justice: An Introduction / Loretta J. Ross and Rickie Solinger. Reproductive Justice; 1. Oakland, California: University of California Press.

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Stacey, Judith. 2018. "Queer Reproductive Justice?" Reproductive Biomedicine & Society Online 7: 4-7. https://doi.org/10.1016/j.rbms.2018.06.004