The Meanings and Experiences of Motherhood in Women Diagnosed With Severe Mental Illness: A Tidal Model-Informed Qualitative Study.

Female sex workers (FSW) in low-and-middle-income countries (LMIC), many of whom are mothers, are a highly marginalized group of women []. Due to their social situation and economic precarity, many FSW experience elevated risks for a range of poor health and social outcomes, including HIV and other sexually transmitted infections, gender-based violence, mental health problems ranging from depression to suicidality, and substance use []. In addition to these vulnerabilities, FSW often experience heightened barriers to healthcare and support services, such as unaffordable costs, concerns about confidentiality, stigma related to sex work, and disrespectful treatment from providers [,]. These structural barriers and cumulative risks likely increase the risk of premature mortality for FSW. However, there is limited information on the causes of death among FSW, particularly in LMIC. A 2019 study identified maternal causes, particularly abortion-related complications, murder, HIV/AIDS, and suicide, as leading causes of death among FSW in LMIC []. Identifying the leading causes of death among FSW is critical to designing preventive policies and programs, monitoring their effectiveness, and detecting shifts in causes of death trends that would necessitate modifications or additional interventions. During the COVID-19 pandemic, globally there was excess mortality and shifts in the leading causes of death [,]. The World Health Organization (WHO) estimated that COVID-19 resulted in approximately 14.9 million excess deaths from the COVID-19 pandemic [–]. While many deaths were directly caused by the COVID-19 virus, a large number of other deaths resulted from the social and economic impact of the pandemic []. These impacts were particularly severe in LMIC where the pandemic further strained already austere social and economic conditions [].