This open letter, written by survivor activist Esther, and supported by 90 organisations and 562 individuals, is a response to the 10 June 2023 editorial in The Lancet entitled, ‘Protecting the health of sex workers in the EU’.

[31 January 2024: The Lancet has now published this open letter in full, with the list of signatures as an appendix. There were extensive discussions prior to this about the terminology used. Eventually Elsevier, the publisher, agreed to alter its stylesheet to accept the ‘prostitution’ and ‘prostituted woman’ woman terminology in certain circumstances.]

---

23 June 2023

Richard Horton, Editor in Chief, The Lancet

Dear Mr Horton

My name is Esther and I have lived experience of prostitution. I write in response to the editorial in The Lancet, ‘Protecting the health of sex workers in the EU’ published on 10 June 2023.

Legalising or decriminalising prostitution leads to its rapid expansion due to increased demand. The corresponding need to increase the supply of women draws more marginalised women and girls into prostitution and human trafficking also increases. The market for prostitution becomes concentrated in the hands of those who can successfully over-recruit, whether through coercion, misrepresentation of likely earnings and what prostitution really involves. It is not sex that is being sold but the right to control the sexual activity.

Lower cost to buyers, which means lower remuneration for women involved in prostitution, then adds to the demand and the cycle continues. Prostituted women will need, or be forced, to override boundaries they may have had at the outset to remain competitive. Health risks and risks to life and limb of women involved in prostitution do not decrease.

Studies have confirmed that liberalisation (whether through legalisation or full decriminalisation) lowers the price of purchasing sexual activity by as much as 33%.[*] However, brothel owners do not lower the rates they charge to the women – meaning that women have to endure more prostitution encounters, which will inevitably increase the risks of exposure to STIs and other physical and emotional harms.

Laws against sex trafficking are retained in states which have fully decriminalised or legalised the sex trade but in practice they are hard to enforce. Most sex trafficking goes undetected and there is less enthusiasm for investigating it.

Coercion into prostitution, and into performing dangerous acts to keep up with the competition remains high after decriminalisation, much of it coming from pimps and brothel-keepers themselves. They have power over whether the women can continue to receive buyers in brothels. This power deters women from complaining to the police about violence inflicted on them by buyers. Systematic data collection on the number of women involved in prostitution or the exploitation of children remains poor.

New Zealand is a small and uniquely isolated country with a population of less than 5 million. Germany’s geographical location, its population of almost 84 million and its legalisation of the sex trade have turned it into the brothel of Europe. The sex industry is the only German industry for which there are no reliable statistics about the numbers involved. Time Magazine called Germany the “Cut-rate prostitution capital of the world” and quoted a sex tourist from Florida describing it as “like Aldi for prostitutes”.

The problems in Germany are now widely recognised to be less to do with the legislation and more to do with the huge scale of the industry, the ease with which marginalised women are exploited within it, and how it is impossible for the police and other authorities to hold exploiters to account when they are operating under the cover of a legal system. All these factors apply as much to full decriminalisation as to legalisation.

This is why the economic interests and concerns for safety of people involved in prostitution and those of pimps, brothel-keepers and others facilitating the industry at higher levels and making the largest profits, including traffickers and companies which own commercial sex websites, are not aligned. 

The Nordic Model understands prostitution to be harmful, both to the individual and to society as whole, and that it is both a cause and a consequence of the inequality between men and women. It seeks to reduce demand by changing social norms and behaviour.

A much smaller proportion of the population is involved in prostitution under the Nordic Model in Sweden, Norway, and France than under legalisation and full decriminalisation in Germany, the Netherlands, and New Zealand. This suggests that the Nordic Model is effective in containing the sex industry – if not reducing its size, at least in preventing its growth.

The Nordic Model doesn’t make prostitution safe, any more than full decriminalisation does, because nothing can make it safe for women. However, when it is well implemented, the Nordic Model can reduce the amount of prostitution that takes place and the number of new women being drawn into it by reducing the demand. It also provides routes out for those embedded in it.

The acting Anti-trafficking Coordinator for the Organization for Security and Co-operation in Europe (OSCE), Andrea Salvoni, considers the current OSCE strategy for defeating human trafficking to be a failure and has recommended a focus instead on addressing the demand that fosters trafficking for sexual exploitation. This demand is the same as that which fosters sexual exploitation within a state.

It is about time that the demand issue was addressed.

Signed by Esther

Supported by the following organisations and individuals.

British organisations:

1. Nordic Model Now!
2. A Model for Scotland
3. Analytica Social and Economic Research
4. Aurora New Dawn
5. Build a girl UK
6. Campaign Against Porn Robots
7. CEASE – The Centre to End All Sexual Exploitation
8. FiLiA Hague Mothers
9. For Women Scotland
10. Isle of Man Freethinkers
11. Male Allies Challenging Sexism (MACS)
12. Manchester Feminist Network
13. nia
14. Not Buying It
15. Not for sale in Scotland
16. Rooms of our Own
17. Scary Little Girls
18. Scottish Women Against Pornography
19. Sheffield Feminist Network. I worked with women exiting prostitution in the criminal justice system and have campaigned locally on this issue for years through women’s networks. A local woman in my personal network was murdered recently in a “survival” sex encounter and I’m planning her funeral.
20. Sole Sisters. Sole Sisters is a group of women activists in Scotland. We stand with Elaine in her fight for the introduction for the Nordic Model and for states everywhere to address male sexual exploitation of women. End the demand for prostitution and provide routes out for women exploited within the sex trade.
21. The Judith Trust
22. The Reward Foundation
23. The Scottish Women’s Convention. We see prostitution as a form of violence against women and girls. We believe that the Nordic Model is the only way to decriminalise the women involved and to tackle the root cause of the issue which is the demand (men buying sex). If we criminalise the men, we reduce the demand and therefore the harm on the women and girls involved.
24. TRAC (Trafficking, Raising Awareness and Campaigning
25. WDI England
26. WDI Wales
27. Woman’s Place UK
28. Women’s Declaration International NI
29. Women’s Declaration International, Scotland chapter
30. Women’s Voices Matter
31. WWAFE – Women Worldwide Advancing Freedom & Equality
32. You my sister

International organisations:

1. 1000 Möjligheter (1000 Opportunities)
2. ADIEF
3. Alberta Radical Feminists
4. Anti Pornography and Prostitution Research Group
5. Associazione DORAD. My organisation supports migrant women from the Global South who were trafficked into the sex industry in the West. This happened because they had no alternatives and needed to survive and were thus vulnerable to promises of fantastic live in Europe. They believe legalising it would make it much more dangerous for women and girls and would in no way protect them. All of them without exception want to exit prostitution immediately and want it abolished. They believe that the legalisation will only make exploiters, pimps and brothel owners richer and more powerful and will put prostituted women in a deeper situation of sex slavery without any chance of rescue. They call for the adoption of the Nordic Model, also because it calls for states to make resources available to enable them exit prostitution. The Nordic Model is the only way to go now while the complete abolition of prostitution is made possible.
6. Bulgarian platform European Women’s Lobby
7. CAP International
8. CAPP
9. Centre for Women War Victims – ROSA
10. Comisión para la Investigación de Malos Tratos a Mujeres. We work for the abolition of prostitution in Spain and work directly with women in prostitution and victims of trafficking for sexual exploitation. You can find all the information about our courses online.
11. Coordination of Greek Women NGOs for the EWL
12. Dance Awareness: No Child Exploited (DA:NCE)
13. Defend Dignity
14. End Demand Switzerland
15. End The War on Women Collective. Prostitution, the longest known oppression of women in human history needs to stop by a Universal application of the Nordic Model NOW.
16. ESCLAVITUD XXI. We lead several street teams supporting women in prostitution in Spain. It is a shame as society to expose any girl, boy, man or woman to be used, bought and sold with the high risk of being raped, or harmed, daily. No one wants this for any of his family. Let’s act as brothers and sisters. Each woman I’ve met in prostitution has suffered child sex abuse or extreme poverty or vulnerability.
17. EURHED
18. European Center of the International Council of women
19. European Network of Migrant Women
20. Femmes solidaires
21. Fondation Jean et Jeanne Scellles
22. FONDATION SCELLES
23. Gemeinsam gegen Menschenhandel e.V.
24. Green Light Awareness Society
25. Hungarian Women’s Lobby
26. ICASM International Coalition for the Abolition of Surrogate Motherhood
27. Initiative Stopp Sexkauf
28. Iroko Charity Nigeria. Our country is a major country of origin for victims and survivors of sex trafficking. Legalisation would make that a much easier way to export women from our country to the West into sexual exploitation. That would amount to a new form of slavery and colonialisation. Our women and girls need opportunities, education and work. They do not need to become sex slaves to men in the West. The Nordic Model is the only reasonable way to go, not the legalisation you recommend.
29. Italian Coordination of the European Women’s Lobby
30. KAVOD, Holistic help for victims of sexual exploitation
31. LIBRES MARIANNES
32. Lobby Europeo de Mujeres en España
33. Malta Women’s Lobby
34. MARTA Centre, Latvia
35. Matters of Injustice
36. Mediterranean Institute of Gender Studies
37. Network of East-West Women, NEWW – Poland
38. Osez le féminisme!
39. Perla
40. Portuguese Platform for Women’s Rights (Plataforma Portuguesa para os Direitos das Mulheres)
41. Prostitution Research & Education
42. Radicailín
43. Radical Feminism Taiwan
44. RealStars
45. REGARDS DE FEMMES
46. RENATE (Religious in Europe Networking Against Trafficking and Exploitation)
47. Resist Exploitation Embrace Dignity (REED). REED has developed relationships with women in the sex industry since 2005.
48. Resistenza Femminista
49. Ruhama
50. Sexual Violence Centre Cork
51. SHAREIreland
52. Swedish Women’s Lobby
53. The Elizabeth NJ CATHOLIC WORKER
54. VCASE (Vancouver Collective Against Sexual Exploitation). Our collective has members with lived experience of prostitution and relevant professional experience
55. Verein Feministischer Diskurs
56. Women on the Frontline Ministries. We are a local charity providing support to women involved in prostitution and agree with having the Nordic Model.
57. Women’s Front of Norway
58. Women’s Network Croatia

And 562 individuals. Download a PDF copy of the letter to see the full list of names and their comments.

---

[*] Lee, Samuel, and Petra Persson. 2018. Human Trafficking and Regulating Prostitution. Working paper. New York University, Stern School of Business, New York.

Cunningham, Scott, and Manisha Shah. 2018. Decriminalizing Indoor Prostitution: Implications for Sexual Violence and Public Health. Review of Economic Studies 85:1683–1715.