Critique of the Médecins du Monde study into the Nordic Model law in France

In April 2018, Médecins du Monde published a study they had conducted into the operation of the Nordic Model-style law that was passed by the French National Assembly two years earlier. The 80-page report was entitled ‘What do sex workers think about the French Prostitution Act’ and it has been widely quoted as showing that the Nordic Model doesn’t work and makes things more dangerous for “sex workers.”

Initially, only an eight-page summary of the report was available in English. This was unfortunate because the headline claims in the summary are misleading and are not being backed up by the data in the full report. As a result, the headline claims are often unwittingly taken at face value in the English-speaking world. For example, Lyn Brown, the Labour MP for West Ham, quoted from the summary in her speech in the debate on Dame Diana Johnson’s Sexual Exploitation Bill on 9 December 2020.

Amicale du Nid logoIn France there has been serious critique of the Médecins du Monde study but until now this has not been available in English. We are therefore honoured that Amicale du Nid, a French NGO, has given us permission to publish an English translation of their Note on the study.

Update 27 March 2022. We have been made aware that an English translation of the full report is now available.

Note on the Médecins du Monde study

By Amicale du Nid


The study had qualitative and quantitative elements. The qualitative element consisted of:

  • Interviews with 70 people involved in prostitution and consultations with a further 38 through workshops or focus groups.
  • 24 interviews and focus groups with organisations working with people involved in prostitution across France.

10 organisations oversaw the study. It is notable that nine of the organisations on the steering committee had all taken a stand against the law prior to its introduction.

The quantitative study consisted of a questionnaire that was distributed to people involved in prostitution through nine organisations. There were 583 responses to this questionnaire (nearly 16% of which came via STRASS).[*]

The authors of the report note that there may be biases:

  • The interviews and questionnaires were arranged and distributed by organisations that work with people involved in prostitution. Those who responded were generally people with whom the organisation that introduced them had already established a relationship of trust. This “may result in respondents answering in line with the stated objectives of the organisation.”
  • Regarding the quantitative survey, the report states that “the results […] cannot be considered fully representative of all people [involved in prostitution] in France” and that there may be a “potential memory bias as people were asked to remember their practices before and after the passage of this law.”

Time frame of the study

The interviews were conducted between July 2016 and February 2018. The questionnaire was distributed between 11 January and 2 February 2018.

The report says that it’s too early to assess the implementation of the exit services for people involved in prostitution. However, it takes a very different stance on the penalization of buyers, making the assumption that, although the law is applied in only a small number of regions, just the possibility of penalising clients has already had a negative impact on people involved in prostitution.

I. The prohibition of the purchase of sexual acts

On the number of prostitution clients

The hypothesis of the study (the main hypothesis from which all the others derive): The prohibition of the purchase of sex has led to a decrease in the number of clients.

What the data really says: This drop is “mentioned in almost all interviews” by people involved in on-street prostitution. The answers were “more varied” from people involved in prostitution via the Internet.

There is no quantitative data to support this hypothesis.

What can be added: An in-depth quantitative study would be necessary to go beyond respondents’ subjective feelings. The study does not provide any clear evidence that verifies its main hypothesis (that a decrease in clients is a direct consequence of the law of 13 April 2016).

If a decrease in clients is confirmed, the link with the law cannot be verified. The study concedes that: “two people surveyed cast doubt on the link between the drop in clients and the law. They consider that the explanation may instead be increased competition and the economic crisis […]. One may wonder if the drop in the number of customers is the consequence of the law or if the new legislation may not have been the catalyst for a trend already underway and the move to making contact on the Internet.”

However, if the decrease is confirmed, it’s good news. A decrease in demand is one of the desired effects of the law, which aims to fight against the system of prostitution.

On precariousness

The hypothesis of the study: The drop in the number of clients leads to a reduction in the income of people involved prostitution, and therefore leads to precariousness.

What the data really says: The data does indicate precariousness: 78.2% of the people involved in prostitution who were questioned reported a drop in their income since April 2016; 62.9% reported a deterioration in their “quality of life.” With only four exceptions, all of those interviewed reported a drop in income.

What can be added: We didn’t have to wait for a new law for the vast majority of people involved prostitution to be in an extremely precarious situation. The study recognizes that, “a lot of [people involved in prostitution] lived in poverty before April 2016.”

At this stage, the link between a drop in income and the law is not verifiable, and there are questions about the timing. The authors mention a decline in income which, in some cases, has been observed since 2013 (while arguing that 2013 corresponds to the start of parliamentary debates). The same arguments about the link between the law and the decrease in buyers of prostitution also apply here.

However, it must be considered that the prohibition of the purchase of sexual acts may lead to an increase in precariousness for people in prostitution. The issue is then of alternatives to prostitution: what do we offer people in parallel with the criminalization of buyers?

The French law is based on four pillars: Strengthening the fight against human trafficking, prevention, support for people involved in prostitution, and the prohibition of the purchase of sexual acts. However, there are problems with the law’s implementation. In particular there is a gap between the application of the repressive and social aspects and the lack of resources allocated to social support. (These findings are shared by the authors of this note, as explained below).

On the exposure to violence

The hypothesis of the study: The fall in the number of prostitution clients and the resulting increase in precariousness means people involved in prostitution take more risks and isolate themselves more, which leads to an increase in the violence they suffer.

What the data really says: The quantitative survey does not support the conclusion that there is an increase in violence: 45.5% of people questioned via the questionnaire observed no change, 9.3% saw an improvement, 42.3% a deterioration.

The qualitative survey speaks about an increase in violence but notes that:

“Many social workers remain cautious about the link between the new law and increased violence because, during the same time period, many had developed spaces for victims to speak about the violence and obtain support. Organisations that have not implemented such measures, suggested that confidence has improved recently and this may have been behind the responses about violence.”

This would suggest that rather than an increase in violence, victims now feel more able to speak freely about the violence and so it has become more visible.

What can be added: The analysis here takes into account only related violence. People involved in prostitution are overexposed to such violence regardless of the legislative context. They were already overexposed to violence in France before 2016.

On the power relationship between prostitutes and clients

The hypothesis of the study: The power balance in the negotiation between prostitution clients and people involved in prostitution has deteriorated, or even reversed, to the detriment of people involved in prostitution, because the buyers see themselves as the ones taking the risk of being sanctioned under the law.

What the data really says: The study focuses on condom use as an indicator of the negotiation. The quantitative survey does not allow us to conclude that there has been such a change: 50% of the respondents did not observe any change, 38.3% found that it’s not as easy as it used to be, 6% say that it is easier than before. The qualitative survey specifically states that “The majority of people remember that this has always existed.”

What can be added: The authors suggest that the power balance may have been in favour of people involved in prostitution before the law. This is wrong. Patriarchy and economic inequalities underlie the prostitution system: it is always the client who has the power.

On the prostitution location

The hypothesis of the study: The fall in the number of prostituting clients and the precariousness of those involved leads them to seek to make contact with clients in more isolated places or through the Internet.

What the data actually says: The qualitative survey states that “some people […] move towards less visible spaces” or “have moved to the Internet” but “according to interviews with organisations, these changes seem to vary a lot from city to city.” The study also says that “those who have been surveyed mentioned an increase in customer demand to practice in an apartment.”

There is no quantitative data to support this hypothesis.

What can be added: In fact, discreet prostitution is now largely the norm. The reduction of visible prostitution and the increase in discreet prostitution, especially via the Internet, did not start with the law of 2016. (See for example, the Bousquet / Geoffroy parliamentary report of 2011 and the Prostcost study of 2015).

On the amount of time spent in prostitution

The hypothesis of the study: The fall in the number of clients and the precariousness of people involved in prostitution leads to an increase in the time spent in prostitution activity.

What the data really says: The quantitative study does not support this conclusion: 37.6% of people declared an increase in the hours spent in prostitution, 33.7% a decrease, 25.8% no change.

On the consequences on physical and mental health

The hypothesis of the study: The decrease in the number of clients and the increase in precariousness raises the stress level of people involved in prostitution with harmful consequences to their health.

What the data really says: People in prostitution talk about being in a condition of anxiety and physical pain. “Some people say they have increased their consumption of alcohol and drugs in a concerning way. It favours depressive states.” “The Paloma association in Nantes reports an increase in suicidal ideation.”

There is no quantitative data to support this hypothesis.

What can be added: The consequences on health mentioned in the report are indeed those observed on the field, since long before the law, and for good reason: these are the consequences of prostitution!

On pimping

The hypothesis put forward by the study: The drop in the number of prostitute clients and the increase in precariousness leads to people in prostitution having more “recourse to intermediaries” (to find buyers via the Internet, in massage parlours, in brothels abroad, etc.). The possibilities for “autonomy” are therefore more limited than before.

What the data really says: The qualitative study does not support this hypothesis. “Since the passage of the law, the people surveyed did not notice an increase in recourse to an intermediary.” “Contrary to one of the hypotheses of those opposed to the criminalization of customers, it did not clearly fuel pimping.”

There is no quantitative data to support this hypothesis.

What can be added: The “choice of autonomy” mentioned by the authors does not exist in reality: the vast majority of people in prostitution are under the control of pimps and even when they aren’t, we cannot speak honestly of “choice” or “autonomy” (because of the hold of the prostitution system, factors of vulnerability and causes of entry into the prostitution system, etc.) Using the expression “recourse to intermediaries” only reinforces this illusion of choice…

Rather, we see that criminal networks thrive in areas where legislation is more permissive (Germany, for example). The French law of 13 April 2016 reinforced the existing legal arsenal for the fight against pimping – so it would be unexpected if the new law lead to an increase in pimping: that would be totally contrary to its objectives!

On relations with the police

The hypothesis of the study: The repeal of the offense of soliciting and the penalization of clients hasn’t changed the police’s outlook. Police pressure is still high, even increased.

What the data really says: The data collected on relations with the police is as follows: 49.5% of respondents to the questionnaire did not observe any changes, 20.6% declared a deterioration, 8.9% an improvement. The qualitative survey speaks of anti-prostitution orders which continue to exist in several cities and an increase in identity checks. Fear and mistrust regarding the police are mentioned in the interviews.

What can be added: This is generally what we also observe. In many regions the police priority is public order rather than the protection of people involved in prostitution and developing good relationships with them.

There is a need to sensitize and train the police and gendarmerie forces so that the new legislative perspective is implemented in practice. This can only be done in the long term.

II. Pathway out of prostitution (PSP)

On the exit programmes, the findings of the study are similar to ours:

1. There is a lack of perspective to make a real assessment.

2. The PSP responds to people involved in prostitution expressing a need for assistance in exiting. (The provisions of the law “could respond to requests often expressed by the people surveyed,” “a majority of people surveyed expressed their wish to do something else,” “the solutions proposed correspond to an expressed demand,” among the organisations questioned, “everyone recognizes that this path can be useful.”)

3. The problems lie in how the programmes are implemented:

  • There’s a lack of information and difficulty in accessing rights.
  • The financial allowance is too low.
  • Organisations are required to do more work without additional funding.
  • Lack of general resources for the concrete implementation of PSPs (especially access to accommodation.)
  • Slowness in the implementation of departmental anti-prostitution commissions, and of anti-pimping and anti-human trafficking measures.
  • Unequal treatment from one department to another.
  • Conflicts with immigration policy.
  • To access the PSP programmes, people must commit to stopping all prostitution activity. However, people have difficulty making such a commitment. (It cannot be done overnight: the process of getting out of prostitution is long, with the likelihood of back-and-forth. The entry into a PSP must be prepared.)
  • Fear of social control and what can or cannot be said to PSP committees, in the best interests of people. (This is also the view of Amicale du Nid.)


1. On the penalization of prostitution clients, the data is clearly insufficient to assert that the law has had a negative impact on persons involved in prostitution. The only tangible data is the figures on precariousness, but the interpretation poses difficulties, and the data does not establish a link with the law.

The main problems regarding this study come from:

  • A biased analysis given by the pro-prostitution discourse, which is out of touch with reality: a naïve belief in the possibility of prostitution in good conditions with good clients, autonomy and the free choice of people involved in prostitution…
  • The form of the report which presents this analysis in a very alarmist manner, without any evidence and in contradiction with the quantitative and qualitative data obtained.

2. On the establishment of exit routes from prostitution, the findings are similar to those found by Amicale du Nid.

Further reading

[*] STRASS is “opposed to all criminalisation and other legal oppression of sex work and support its recognition as work.” This means that it is ideologically opposed to the Nordic Model approach.

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