A report on efforts to bring some balance into the British Medical Association (BMA) debate on decriminalising the sex trade.
In May 2017, the BMA Junior Doctors Conference passed a motion to lobby for the full decriminalisation of the sex trade, including pimps and brothel keepers – which if implemented would open the way for large commercial brothels in England and Wales. We were alarmed and wrote an open letter to the BMA calling on them to reject this policy, setting out our reasons. We were thrilled that 34 organisations and 298 individuals signed the letter and that we managed to send it to the BMA ten days later.
We knew that the motion at the Junior Doctors Conference would inevitably be followed with a similar motion at the BMA Annual Representatives Meeting (ARM). So we checked the agenda of the ARM that was due to take place in Bournemouth on 25-29 June 2017 and were relieved to find it didn’t include a motion about the sex trade.
But then on the Tuesday morning (27 June) it became clear that Motion 422, which calls for the full decriminalisation of the sex trade, was one of five motions that had been chosen to be debated from a long list of motions that were not on the main agenda because of time constraints. It was going to be debated two days later on the Thursday morning.
The text of the motion was as follows:
Motion by MANCHESTER & SALFORD DIVISION: That this meeting recognises the evidence that the policy approach of full decriminalisation of sex-work, as adopted by New Zealand, has resulted in public health benefits for both sex workers and wider society. This meeting therefore calls upon the BMA to:
i) publicly announce support for this policy approach and to lobby the government towards this end;
ii) develop educational resources to enable doctors and medical students to better understand and respond to the specific healthcare needs of sex workers, such as CPD events and BMJ Learning resources;
iii) write an open letter calling upon the TUC Women’s committee to also support the policy of full decriminalisation;
iv) create a working-group in order to achieve the above aims and consider collaboration with peer-led sex worker organisations such as SCOT-Pep, the English Collective of Prostitutes and the Sex Worker Open University, as well as other organisations working on this issue such as Amnesty International.
What we did
Our first response was despair. Would this motion be passed after a short debate? The BMA is held in very high popular regard and if this motion became BMA policy, it would encourage other organisations to pass similar policies, thus making the full decriminalisation of the sex trade in England and Wales ever more likely.
One of the implications of full decriminalisation is that prostitution is considered just another job not much different from waitressing. The consequences of this idea are profound given the high rates of PTSD and other health disorders prostituted women frequently suffer from. Moreover, women who have managed to exit prostitution have testified how this attitude made it harder for them to leave, because it made them feel there must be something wrong with them if they didn’t like it. We’ve heard from several women attempting to exit and recover from prostitution that they get little or no help from their GPs because of this idea that prostitution is just another job. One woman told us that her GP would not refer her to trauma counselling on the basis of her many years in the sex trade but would on the basis that she was raped as a teenager.
We knew we needed to inform the doctors at the conference of the facts and arguments that were not mentioned at the Junior Doctors Conference. One of the prostitution survivors in Nordic Model Now! organised a Twitter campaign to reach a crescendo in the run up to the vote on the morning.
We designed a flyer to hand out at the conference, setting out key facts that were not necessarily immediately obvious.
Another member went to the conference centre to hand out the flyer (along with our standard one that explains the Nordic Model) to doctors as they went in. Dr Sasha Rakoff from Not Buying It came along to help.
A number of doctors stopped to chat and many seemed shocked when we explained the implications of the motion. Generally the older doctors were more responsive than the younger ones. We’re not sure whether this is because the older doctors had come over a longer career to understand that many of the problems their patients grapple with are caused by deep social structural inequalities; or whether it’s a symptom of the heavy-handed tactics of the sex industry lobby on university campuses and elsewhere, telling people that they would be contributing to the death of “sex workers” if they don’t support the decriminalisation of pimping, and accusing anyone who disagrees of being “whorephobes.”
Altogether we gave out flyers to more than 300 people.
When we were on the train back to London, we heard the great news that, with the exception of part ii, which calls for education for doctors, the motion was roundly rejected as shown in the following table.
Results for Motion 422
The debate about Motion 422
The debate was filmed and at the time of writing is available online:
Thankfully it was a balanced debate, with three speaking for the motion and three powerful women speaking against it, each of them advocating the Nordic Model as a better approach. Clearly our Open letter to the BMA had had an impact and the arguments and research we had set out were drawn on.
It seems to us that the speakers against the motion had better, more considered and non-populist arguments than those speaking for the motion – none of whom questioned the inevitability of prostitution, or the “right” of men to buy others for sexual use and gratification, and the impact of this on the status of all women and girls.
Dr Mairi Thompson, who spoke for the motion began her speech by saying:
“The most serious threat to female sex workers is of violence. Street-based sex workers are 60 to 100 times more likely to be murdered than non-sex workers. Almost all women who engage in sex work have experienced some form of violence.”
We agree with her on this. She then went on to talk about the approach to policing prostitution in Merseyside and the success this has had in increasing the numbers of “sex workers” reporting attacks and the subsequent convictions of perpetrators. However, the motion did not advocate this model, but the full decriminalisation of the sex trade as implemented in New Zealand, which has resulted in neither a clear reduction in violence against prostituted women, nor a clear rise in them reporting attacks to the police. Moreover the Merseyside approach does not depend on decriminalising pimps and punters as advocated by the motion.
Later in her talk she drew a comparison between decriminalising homosexuality and decriminalising “sex work.” She said that decriminalising homosexuality “has not eliminated attacks on those who are gay.” This is a logical fallacy because no one is claiming that the main risk to gay people is violence from their intimate partners – whereas the main risk to prostituted women is violence from punters and pimps. In other words, the violence in prostitution is inherent to the prostitution relationship. Furthermore, homosexuality is a private, personal practice unlike prostitution, which is a commercial one, and what is being advocated is further commercialisation, often by people who stand to benefit, such as known pimps. So she was not comparing like with like.
Dr Rita Issa, who also spoke for the motion, held up our flyer near the start of her speech and said she’d use the opportunity to counteract some of the arguments it made. And then she failed to do just that.
For example, she said, “The first point says that this motion implicitly decriminalises pimps” before going to admit that it did. Then she said:
“Secondly that decriminalisation somehow normalises and legitimises prostitution. I think this is really a scaremongering point actually. I don’t think many women are going to suddenly rush into sex work. As you’ve heard already, it’s not a choice that’s taken lightly.”
She clearly doesn’t understand the dynamics of the sex trade – the amount of money that pimps and traffickers can make and the lengths to which they go to lure, groom and trick girls and young women into prostitution. She said, against all the evidence, “Sex work didn’t actually increase in New Zealand after decriminalisation.” So much for her later claim to be an “evidence-based practitioner.”
She claimed that under decriminalisation “sex workers” can work together in small groups, which provides “safety in numbers.” This is something that the proposer of the motion, Dr Khalil Secker, also emphasised. However, this is more complicated than they made out. For more on this, see The problem with “safety in numbers”.
The speakers for and against the motion were followed by an address from Dr Mark Porter, the chair of the BMA Council to whom we had addressed the open letter. He started by referring to the BMA’s policy, passed in 2010, on rape and sexual abuse, which recognises that trafficking, sexual violence and poverty force many women into prostitution and he noted that, if passed, the motion would represent a significant departure from that position.
He referred to the lobbying the BMA has received in the last three months from both sides and mentioned that the BMA had received:
“A letter signed by 34 organisations and 290 individuals, including some who identified themselves as survivors of prostitution, sexual violence and trafficking, putting the other side of the argument and based on and drawing on a human rights basis but also pointing out the health evidence.”
He was obviously referring to our open letter.
He pointed out that the evidence for the benefits of the New Zealand model are not conclusive and that there are “wider ethical, equalities and social aspects that need consideration too” and reiterated what we said in our leaflet that the approach the motion wanted the BMA to endorse would “mean that all those involved in sex work, including the pimps and the brothel owners, are decriminalised and it is treated like any other industry.”
He noted that all of the organisations that part iv) of the motion calls on the BMA to work with lobby for full decriminalisation and that “should tell you about the motives of where this motion comes from.” And he recommended that if the BMA did decide to do more work on the issue, it should ensure it takes in a wider spread of organisations, representing all sides of the debate.
His comments on part iii) are worth reproducing in full:
“It’s also in part iii), to be honest, not clear what would be gained from the BMA writing an open letter to the TUC Women’s Committee, calling on them to support the New Zealand approach. There are those who would say that this entire lobbying onslaught that is going on at the moment is simply based on trying to get the TUC Women’s Committee to change its mind. Which is why I mentioned that we are the latest trade union to be targeted in this.
However, the Women’s Committee and the Women’s Conference considered this issue in March this year and a majority of the affiliated unions voted against it. The issue has been debated within the TUC a number of times over the past decade and the position remains broadly unchanged.
A letter from the BMA on this issue is not likely to be either welcome or indeed to change a decision that the TUC has reached through its own democratic processes.”
He said the lobbying the BMA has received reminded him of “the lobbying that comes from tobacco and alcohol and other special interests” and he finished by asking delegates to reject the motion and to stay with the existing BMA policy, which is based on the rights of women.
Dr Khalil Secker then responded to the points made during the debate. He started with the extraordinary claim that the UN statement mentioned by one of the speakers, that defined prostitution as incompatible with the human rights enshrined in the Universal Declaration of Human Rights, had been made in 1947 and is now “out of date and has been updated.”
This is not true. The UN instrument in question is the UN Convention of 1949 (not 1947 as he claimed) for the Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others. We recommend Malka Marcovich’s guide to this convention, in which she explains that the argument that the convention is obsolete is:
“an argument of last resort when no other arguments prove convincing. It is as if the word, “obsolete,” has its own referential value and, therefore, critics do not have to explain how the Convention is obsolete. The discourse of modernity somehow trumps substantive explanation. Is the Convention obsolete simply because it was elaborated some fifty years ago? On this basis, many human rights instruments, including the Universal Declaration of Human Rights, would have to be declared obsolete.”
He made other unsubstantiated claims – such as the suggestion that full decriminalisation is safer for the women because punters reveal their true identity, which is clearly baloney. A popular topic on punter forums under all regimes is the best methods of hiding their identity. Married men, professional men, most men, go to lengths to hide their true identity during the prostitution encounter, and full decriminalisation does little to change this.
He misunderstands the nature of sex trafficking and that the Palermo Trafficking Protocol separates it from other forms of modern slavery because the harms are of a significantly different nature. For example, he said that the response to the tragic drowning of Chinese migrants in Morecombe Bay was not to shut down the entire fishing industry – missing the point that there are no inherent, material harms to food gathering and production, only in how it is organized, unlike in prostitution. And separating sex trafficking from prostitution is more or less impossible in practice, not least because the majority of prostitution does in fact meet the international definition of sex trafficking.
He mentioned the Lancet research that concluded that the New Zealand model of full decriminalisation is the best way forward for public health. However, there has been significant criticism of this research, not least from feminists in Germany, which has a legalised approach to prostitution not dissimilar to the New Zealand model. At the end of this article we reproduce, with permission, a letter from two of them providing a critique of the research.
A message from a sex trade survivor
Late that evening Nordic Model Now! received an email from a woman who is a sex trade survivor but who does not want to be publicly identified as such. She asked us to share the following image on social media. She summed up how many of us were feeling.
We also send our thanks to Dr Mark Porter and all the BMA reps who voted against the motion. We hope and trust that their wisdom, intelligence in assessing the evidence dispassionately, and humanity will prevail in the long term.
Letter to the Lancet from German Feminists
Dear Mr. Horton,
Your article: HIV and sex workers, published July 22, 2014.
As many of us are medical professionals or human scientists, we know The Lancet as a well reputed scientific magazine and appreciate the high standard of medical information. The more we are astonished about the latest series addressing HIV/AIDS.
Your authors’ conclusion that legalizing prostitution protects against HIV makes us wonder whether the authors haven’t been unduly influenced by the propaganda and misinformation spread by an “industry” that raises billions of Euros each year in Germany alone. We live in a country where prostitution was completely legalized twelve years ago. And it is now very clear that legalization has benefitted brothel owners, traffickers and punters.
At the same time it has seriously harmed the people in prostitution. The number of prostituted women “working” in Germany is estimated at 400,000. Only 44 of them are officially registered as regular employees who benefit from respective health insurance. Less than one percent has a working contract. That means that especially the foreign prostitutes do not have any health insurance.
Further, the legalization to the free capitalist market has made the prices fall and the punters’ demands rise. Nowadays, they demand sex without condoms and in some brothels this is the rule rather than the exception. Up to now there is no evidence for rising HIV-infections among prostituted women, but considering that most of them have no access to the healthcare system and that there is a high fluctuation of Eastern European women, this cannot be taken as evidence for the safety of legalized prostitution – rather and most probably vice versa.
Furthermore, a dissertation on women in prostitution in Lübeck has shown rates of syphilis and hepatitis types B and C that were significantly higher than for non-prostituted women.
And research has shown that new infections with HIV in Germany, the paradise of legal prostitution, are on the rise (10%), with women (a rise of 31%) significantly more affected than men (6%). While some of this is credited on new research the Robert Koch Institut concedes that there is a rise in new infections.
We also talk about human trafficking that is booming as the ILO (International Labour Organisation) published recently. There is indeed evidence that legalizing prostitution increases human trafficking and deteriorates the “working” conditions for those in prostitution, cf. the studies by Seo-Young Cho (University of Marburg, Germany) or Richard Poulin (University of Ottawa, Canada) or reports by Swedish officials and scientists like Max Waltman (University of Stockholm, Sweden).
And last but not least, we are talking about human dignity: Prostitution mostly happens because of poverty. Can one crime against humanity (i.e. poverty) justify another crime against humanity (i.e. sexual exploitation)? Can modern society claim gender equality when women can be bought for sex by men?
Please think about who profits from legalized prostitution, and therefore has the biggest motivation to keep it running.
Yvonne Smidt and Solveig Senft