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In most countries, children of sex workers are a group that is largely out of view. When they get sick, they may never make it to a hospital, and when they die, there is often no official record of their death. As NPR's Gabrielle Emanuel reports, researchers are now trying to shed light on the difficulties these children face.
GABRIELLE EMANUEL, BYLINE: Patrick Ezie has been a doctor in Nigeria for 15 years, and he says he's seen a lot. But when his hospital recently started a unique program specifically for pregnant sex workers and their children, he was taken aback by the level of need.
PATRICK EZIE: It is shocking, and we don't get shocked easily. The issues are quite overwhelming.
EMANUEL: Ezie is the medical director at Silver Cross, a small hospital in Abuja, Nigeria. He says both the mothers and their children have such dire health problems he thinks it amounts to a state of emergency. Many of the moms haven't had prenatal care, so from the moment of delivery, there are complications. Many of the babies come out small.
EZIE: Unresponsive, weaker than they should be, needing resuscitation, oxygen more than the general population.
EMANUEL: He says that these babies are born struggling, and that struggle often continues into childhood. Many of the 5-year-olds he cares for look like 3-year-olds because they're malnourished. Wendy Macias-Konstantopoulos is with Harvard Medical School and the nonprofit Global Health Promise. She says in most countries, the children of sex workers are almost invisible.
WENDY MACIAS-KONSTANTOPOULOS: They could be born in a brothel, and their birth is not registered. So for many of these children, on paper, they may not exist.
EMANUEL: Which is one reason there's such little information about their lives and their deaths.
MACIAS-KONSTANTOPOULOS: Although there are studies on HIV among female sex workers, this population of children are not making the radar.
EMANUEL: Macias-Konstantopoulos is trying to change that. She's lead author of a new study published in the Journal of Global Health. To gather information, she and her team used an approach called community knowledge. They interviewed sex workers in eight countries in Asia, Africa, South America and asked about kids who had died within their community.
MACIAS-KONSTANTOPOULOS: What we found was that there are a large number of deaths among the children of female sex workers across these countries.
EMANUEL: Outside experts say this research leaves a lot of questions unanswered, like how does this large number of deaths compare to the general population? But they say it's a good starting point for understanding this difficult-to-reach community. And the study provides some insights on why these kids are dying. For example, malnutrition was a common cause of death, as were accidents like house fires.
MACIAS-KONSTANTOPOULOS: Having to do with the fact that sometimes children are left alone, and, you know, they don't have an easy way out of the home if something catches fire.
EMANUEL: Something else that came up a lot - kids overdosing on medications. This doesn't surprise a sex worker from Port Harcourt City, Nigeria.
HAVILAH ULOMA: My name is Havilah.
EMANUEL: Havilah Uloma says one of her fellow sex workers lost her 2-year-old to an overdose. The mom had to go to work at night and didn't have anyone to watch her daughter. So she gave her child tramadol. It's a strong painkiller known to make people drowsy. She hoped it would help her toddler sleep through the night.
ULOMA: Unfortunately to her, before she came back, the child died.
EMANUEL: Uloma knows how hard loss can be. At around 8 months old, her son, named Kamsi, started seeming sick and feverish. This went on for months. She didn't have money to go to a hospital, so eventually, she bought medicine from a roadside vendor.
ULOMA: I was buying roadside drugs to give him. That was when he gave up. He left. He died.
EMANUEL: He died six months ago.
ULOMA: It's a moment that I don't want to remember.
EMANUEL: Uloma says it's so painful she's deleted all the pictures she had of her baby. She still doesn't know what caused his death. Perhaps the meds were counterfeit. Maybe it was an infection. What Uloma does know is that she wants things to change.
ULOMA: Most times people don't really know that sex workers - they even have children. The community, the society need more awareness.
EMANUEL: She says she tells anyone who comes to her community that sex workers have children and that those children have their own lives to live.
Gabrielle Emanuel, NPR News. Transcript provided by NPR, Copyright NPR.
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