Background: The existing literature linking sex work to poor well-being and mental health mainly focuses on high-income countries contexts and highlights the strong correlation between sex work and depression. However, existing studies are cross-sectional and fail to account for the fact that women could have low well-being before entering sex work. For instance, it is documented that women abused during childhood are more likely to start sex work and to have low level of well-being. In addition to the unclear causal relationship between sex work and well-being, there is currently no evidence regarding the channels through which sex work may deteriorate well-being. Identifying those factors could allow developing effective interventions to improve well-being of sex workers. We investigate such question in Senegal, where sex work is regulated by a public health but where the majority of sex workers prefer to stay illegal since sex work is morally condemned by society members.

Objective: The main objective of the paper is to estimate the effect of leaving sex work on well-being and to identify transmission channels.

Method: We use a unique longitudinal data set from 441 sex workers surveyed in 2015 and 2017. Between those two waves, 14% of sex workers (n=62) left sex work. We use a matched difference-in-differences controlling for sex workers' fixed effects to estimate the effect of quitting sex work on well-being. We control for shocks that occurred in the last two years and that are likely to influence both the probability of quitting sex work and well-being. We then perform a causal mediation analysis to investigate the direct and indirect effects of quitting sex work on subjective well-being by using linear structural equation modeling. Given that the identification strategy is based on the sequential ignorability assumption, we further test the robustness of our results by implementing a sensitivity analysis.

Results: We find that quitting sex work significantly increases subjective well-being. Sub-groups analysis shows that women who benefit the most from leaving sex work are those who have a longer experience in sex work, suffered from client violence, had a lot of clients, had occasional clients, were not registered and fear discrimination from relatives because of their sex work activity. Causal mediation analysis shows that the increase in well-being is mainly explained by an increase in self-esteem and not by a reduction in violence exposure.

Conclusion: Our study confirms the negative effect of sex work on well-being and highlights the importance to reduce time spent in sex work by developing interventions to quit sex work. It also highlights the need for psychological services for sex workers.