Sex workers, stigma and self-image: evidence from Kolkata brothels

Published: 31 January 2022

We evaluate a psychological intervention aimed at mitigating these adverse effects of internalized stigma on individual choices, by reshaping the self-image of those who face such stigma.

By Sayantan Ghosal, Adam Smith Chair in Political Economy

Being poor or marginalized often brings stigma, which may distort a person’s self-image (Goffman, 1963). It can lead to a “self-fulfilling pessimism about the returns to effort for certain activities" (Loury, 1999) and result in a poverty trap. The psychology literature on Self-Affirmation (Steele, 1988; Sherman and Cohen, 2006) posits that every individual wants to maintain a self-image of being a good, moral person, and threats to the adequacy of such a self-image can result in defensive reactions yielding counter-productive outcomes.

We evaluate a psychological intervention aimed at mitigating these adverse effects of internalized stigma on individual choices, by reshaping the self-image of those who face such stigma. Our study focuses on female sex workers in Kolkata, India, who face significant social stigma rooted in repugnance towards sex work and its perceived immorality.

Our intervention comprises a self-image focused training program consisting of 8 weekly sessions in the form of group discussions among 15-20 sex workers. The program was carried out by our local partner Durbar, which is a Kolkata-based NGO that has been engaged in promoting the welfare of sex workers for over 25 years. The program began with a discussion of the participants’ individual identity as sex workers, encouraging them to reflect on some questions to help them to re-imagine their self-image: Could they perceive what they do as providing entertainment, and hence themselves as entertainment workers? Do they regard themselves as people doing an honest day’s work to earn a living? The intervention also tried to recast their group self-image and collective strength citing their successful sex workers’ cooperative bank initiative (USHA). Using this basic building block of a positively recast image, the program also suggested directed and perseverant efforts towards better life outcomes.

At the end of each week, all program participants (both treatment and control) were offered a payment of Rs. (approximately $1.38), with two options on how they could receive this payment:

  1. 1. directly into their current account
  2. 2. to a fixed deposit

While the current account offers greater liquidity than fixed deposits, the latter offer a higher interest rate and hence a higher longer-term return. In this sense, investing in a fixed deposit reflects greater future-oriented effort on part of the participant. Both types of accounts were held with the sex workers’ cooperative bank, USHA.

The control group participants came together every week (in groups of approximately 20-25) to give us their savings choices. All participants’ choices across these savings products were recorded at the end of each week, and constitutes one of our key economic outcome variables.

With regard to short-term effects, we find that the training program significantly improved reported self-image of our sample sex workers, including a lower sense of shame about their occupation, greater ability to face challenges and greater ease in public interaction.

In terms of savings choices, we find that the treatment group was 25-50 percentage points more likely than the control group to choose a fixed deposit option over the current account (Figure 1). We interpret this finding as indicating greater effort by the treatment group towards securing their future, owing to their improved self-image. We rule out several alternative mechanisms, including social desirability bias, that could be driving our savings results.

We also find positive effects of the training program on health-seeking behaviour of sex workers. In particular, we find that the treatment group were on average 9 percentage points more likely to report having visited a doctor for a routine check-up over the previous month, relative to control.

Reassuringly, we find that the program’s savings and health benefits also persist in the medium term. Using administrative (non-self-reported) data obtained from the official records of the cooperative bank and local health clinics, we find that the treatment group was 53 percentage points more likely to keep their accounts open 15 months after the program ended, along with higher account balances. We also find that the treatment group was 15 percentage points more likely to continue with preventive health check-ups 21 months after the program (Figure 2).

Note: The long-dashed vertical line indicates baseline survey. The solid vertical line indicates intervention. The dash-dot vertical line indicates endline survey. The horizontal axis depicts duration in months, from months prior to months after program.

In summary, we observe a clear positive impact of the training program both on self-image of the sex workers, and through the purposive actions taken by them towards better future financial and health choices, that persists over a 1.5 - 2 year horizon. Thus, integrating psychological interventions with existing welfare programs to support marginalized groups may strengthen their efficacy as well as generate valuable insights about effective program scale up.


We gratefully acknowledge funding from ESRC through the Centre for Competitive Advantage in the Global Economy (CAGE).

Further Information

The project  described is based on two papers:

  1.  “Poverty and Aspirations Failure”, (with P. Dalton and A. Mani), Economic Journal, Vol. 126, Issue 590, February 2016, pp.165-188. DOI: 10.1111/ecoj.12210.
  2. “Sex workers, stigma and self-image: evidence from Kolkata brothels” (with S. Jana, A. Mani, S. Mitra, S. Roy), Review of Economics and Statistics, https://doi.org/10.1162/rest_a_01013

The first paper sets out atheoretical frework for behavioral poverty traps. It is a ISI Highly Cited Paper; provides underlying model for Eliana Le Ferarra’s European Economic Association Presidential address (now published in JEEA see https://academic-oup-com.ezproxy.lib.gla.ac.uk/jeea/advance-article/doi/10.1093/jeea/jvz057/5608602 ) and her Walras-Bowley Lecture to the Econometric Society as well as the Chapter on "Behavioral welfare Economic" in graduate textbook Foundations of Behavioral Economics by Prof. S. Dhami (Oxford University Press); it is featured and discussed in the chapter on “Behavioral Development Economics” (by Michael Kremer (Harvard, NBER), Gautam Rao (Harvard, NBER) and Frank Schilbach (MIT, NBER)  in  the Handbook of Behavioral Economics (Vol 2).

The second paper reports the results of the fieldwork. Early versions of the paper of results cited in the World Development Report 2015 and summarized in the Gender Action Portal (GAP) and featured in  Harvard Kennedy School Women and Public Policy Program: http://gap.hks.harvard.edu/sex-workers-stigma-and-self-belief-evidence-psychological-training-program-india.

The project is featured as a case study in “Addressing Inequalities” Research Beacon: https://www.gla.ac.uk/research/beacons/inequalities/socialstigmakolkata/

It is cited in the New York Times article:
https://www.nytimes.com/2018/07/13/business/think-positive-climb-out-of-poverty-it-just-might-work.html).

According to Altmetric data, the first paper is the top 5% and the second top 2% of all papers in the Altmetric database and is cited and discussed in over 10 policy documents authored by staff in the World Bank. 

First published: 31 January 2022