The effect of becoming a legal sex worker in Senegal on health and wellbeing

Senegal is the only low-income country where prostitution is legal and regulated by a health policy. To solicit clients in public places, female sex workers need to register with a health facility and attend monthly routine health checks aiming at testing and treating sexually transmitted infections and distributing free condoms. While this policy was first introduced in 1969 to limit the spread of sexually transmitted infections, there is no evidence so far on its impact on sex workers' health. The paper aims to fill this gap by exploiting a unique data set of legal and illegal Senegalese sex workers. Using propensity score matching we find that becoming a registered sex worker leads to an improvement in health but has a detrimental effect on wellbeing. Precisely, registered sex workers are found to engage in riskier and more degrading sex acts and to have less social support from their co-workers. Our results are robust to the use of a super learner to improve the specification of the propensity score and the use of entropy balancing in order to achieve covariate balance. The results are also robust to the violation of the conditional independence assumption. The results suggest that psychological services should be offered to sex workers part of the registration policy in order to overcome its negative effect on wellbeing.