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“For my first customer, I was tied up and taken to him when I was 12. After that, whenever I saw a man, I used to cry. But still, I was forced to take customers until I got older and took charge.”
Bilkis Begum (pseudonym), a 32-year-old sex worker, who has been at the Daulatdia brothel in Rajbari for 20 years, said when talking about her life.
While organisations, including the World Health Organization (WHO), have been pushing to increase mental health awareness across the globe, it remains a dire scene for sex workers in Bangladesh.
Talking to several sex workers, The Business Post found out that many of them have symptoms of various mental health issues such as trauma, post-traumatic stress disorder (PTSD), anxiety, suicidal tendencies and depression.
“That fear (of doing sex work) did not go away easily. It took me time, and a police officer helped me. He protected me from having to do sex work. He is not here anymore, he was transferred to Sylhet. But he helped me, and then, I got used to it,” Bilkis, who was sold at the brothel at 12, said about how she finally overcame her trauma.
Another sex worker, Farida Parvin (pseudonym), spoke about her mental health issues, “When I was younger, I was scared of being tortured as there was nobody who could help me. I passed night after night sleeplessly and thought about those. I was afraid that if a man hits me, then who would stop him?”
She said she was frightened of going to customers. She wanted to quit but she was helpless as she had no place to go.
“If we had any way out of this place we would do that but people hate us and we are considered pariahs,” Farida said with a deep sigh.
She added, "I feel very sad about this (doing sex work). Nobody stays here because they want to. They are here just to earn their bread and butter."
Another part of Farida’s anxiety stems from hiding her identity. If her identity is disclosed, her children will have to bear the brunt of it.
“I cannot tell anybody what I do. If I reveal it, my daughter's marriage will be broken off and my son might end up harmed. That is the reason people know that I am working for an NGO,” she said.
Sheuli Banu (pseudonym), yet another sex worker, shared her suicidal thoughts as she began her life at the brothel.
“At the beginning, a feeling of disgust came over me but I had no other way. It made me cry. I felt heartbroken but there was nothing I could do. The thought of suicide came across my mind very often,” she told The Business Post.
According to Dr Sultana Algin, a Professor of Psychiatry at the Bangabandhu Sheikh Mujib Medical University, sex workers need help for both physical and mental health.
"They suffer from depression, PTSD and other forms of mental health issues. They also face substance abuse such as cigarettes, marijuana, and others. They are abused in various ways by clients. This is why they need help," she told The Business Post.
An official from the Sex Workers Network of Bangladesh, citing anonymity, said the mental health of sex workers is extremely important as they go through severe trauma.
"Their work is not pleasant and they have to hide their job identities. Many of them commit suicide and many are murdered. They need a lot of counselling to get out of that mental illness," they observed.
According to a 2015 research by Michael P. Hengartner, Md Nazrul Islam, Helene Haker and Wulf Rössler published under the headline ‘Mental Health and Functioning of Female Sex Workers in Chittagong, Bangladesh’ female sex workers in Chattogram were ‘very vulnerable and highly impaired as expressed by high rates of abuse and mental disorders’.
A study in September 2022 by the Sex Workers Network of Bangladesh, after interviewing 40 female sex workers in Dhaka, found that all of them were victims of violence at least once in life.
But there are no co-relations between the study and the current situation and there hasn’t been any research on the mental health of sex workers recently.
Work on only physical health, not mental health
According to data from the Department of Social Services, there were 11 registered brothels in Bangladesh in May 2021 with 3,168 registered sex workers.
While there have been concerns and research on both the physical and mental healthcare of sex workers, the government projects are only focusing on physical aspects.
According to the 4th Health, Population and Nutrition Sector Programme (HPNSP) by the Directorate General of Health Services, which ran from January 2017 to June 2022, the only programme related to sex workers was ‘Tuberculosis-Leprosy and AIDS STD Programme’, which was all about physical health issues.
A high-level official at the DGHS, seeking anonymity, said they provided means towards the physical safety of sex workers such as contraceptives, condoms, medicines, etc.
But no projects were found on mental health and the Director of the National Institute of Mental Health, Dr Bidhan Ranjan Roy Podder, confirmed that they had no ongoing projects on the mental health of sex workers.
“Our institution does not have any projects on this matter (mental health of sex workers),” Dr Podder told The Business Post.
Little help from the NGOs
There are no projects from the government and the operations of non-government organisations that work with sex workers are also inadequate.
Dr Algin explained the situation, “NGOs work on physical health. Mental health comes to the fore but is never highlighted. As far as I have seen, they keep it aside and don’t work much on it.”
For example, Gonoshasthaya Kendra, a registered Public Charitable Trust established in 1972, works in brothels in Faridpur and Rajbari and has designated counsellors in its workstations.
But it too employs one counsellor for each district against 1300 sex workers in Rajbari (Daulatdia brothel) and 406 in Faridpur (Rathkhola and C&B Ghat brothel).
“Everyone has different problems. I listen to them and try to provide them with insights. I try to chat with them dearly and try to find out what is wrong,” said Renu Akter, the counsellor at the Daulatdia office of Gonoshasthaya Kendra.
"The biggest problem here is substance abuse. Some have suicidal tendencies following depression. But I have not seen anyone ready to commit suicide,” Renu Akter said.
Shapla Mohila Sangstha, Payacot Bangladesh and Shuktara Kalyan Sangstha are NGOs working in various brothels across the country but they don’t have any programmes either for mental healthcare.
“We do not have any specific health programmes right now. We have awareness programmes. We do not work about mental health specifically,” Chanchala Mandol, Executive Director of Shapla Mohila Sangstha, said.
Ashahay Nari Oikko Shangothan (Organisation for distressed women) is an NGO run by sex workers at the Daulatdia brothel. Secretary of the organisation, Moni Begum, said they talked to mentally distressed sex workers to help them.
“When someone is feeling mentally down or thinking about committing suicide we talk to them. We tell them how to deal with it. We try to counsel them as much as we can,” Moni told The Business Post.
What can be done?
Mental healthcare is a distant dream for sex workers in Bangladesh at this moment but voices are being raised regarding this issue.
“We should also think about the mental health of sex workers. Steps have been taken by many private and government organisations but more research is required on the matter,” Dr Lima Rahman of Action Aid Bangladesh said in September.
Dr Algin said NGOs can form multi-faceted teams in their centres at the brothels to help sex workers.
"NGOs can appoint a multi-disciplinary team including psychologists and psychiatrists there to provide sex workers with mental health support. Creating mental health awareness does not require everyday activities. There can be monthly programmes.
"Then, those who are traumatised and are suffering from other issues can be provided with a schedule on a weekly or daily basis to provide them with treatment,” she told The Business Post.
But it still remains a distant dream for the sex workers to receive mental healthcare as Farida said they had nobody to seek help from.
“There are no doctors for mental health. No counselling. I cannot seek help from anyone. There is nobody,” Farida said.
For Bilkis, leaving the brothel is a dream, even after 20 years.
“I don’t want to stay here. I want to run away. There’s nothing here. This is a place for those who are unloved,” she said with anguish.
[This story was written and produced as part of a media skills development programme delivered by Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.]
