{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:54:59Z","timestamp":1792875299467,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Children of female sex workers (CFSW) are exposed to unique bioecological vulnerabilities that negatively affect their developmental outcomes. We interviewed 1,280 female sex worker mothers (FSWM) in eight low- and middle-income countries (Angola, Brazil, South Africa, the Democratic Republic of Congo, India, Indonesia, Kenya, and Nigeria) between January 16 and October 1, 2019. This exploratory study focused on multilayered exposures from early childhood to adolescence, resulting in maldevelopment and other negative outcomes for CFSW, as reported by their mothers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used Bronfenbrenner\u2019s revised <jats:italic>Bioecological System<\/jats:italic> Theory of <jats:italic>Human Development<\/jats:italic> as the analytical framework. The interview data included both numerical responses and brief textual answers. Quantitative information was summarized using prevalence estimates, while textual responses were inductively coded and grouped into major categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>FSWM reported that outcomes varied across countries but reflected complex interactions within and between the micro-, meso-, exo-, and macro-systems described by the theoretical framework. Findings revealed that CFSW were exposed to suboptimal child-rearing environments and faced a high prevalence of adverse outcomes. A majority (61%; country range, 45\u201367%) of daughters entered sex work at an early age (mean age: 14 years; range, 13.5\u201318 years). Both sons and daughters experienced physical harm (72%; range, 21\u201385%) and sexual abuse (sons, 57%; daughters, 74%). Daughters were often introduced to sex work as a survival strategy. Reported outcomes also highlighted bioecological vulnerabilities that impeded sons\u2019 development, as well as protective environments that supported their healthy growth. These were categorized as follows: (1) vulnerabilities associated with high-risk living environments such as brothels, hotspots, and streets where they were exposed to sex work; (2) negative psychological, physical, and behavioral outcomes, including becoming criminals, victims, and perpetrators of abuse; and (3) protective environments of living away from the mother\u2019s work and finding informal work that may mitigate the harmful effects of bioecological vulnerable exposures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The CFSW experienced significant threats to healthy development, contributing to adverse physical and psychological developmental outcomes. These findings underscore the urgent need for evidence-based policy directives, interventions, and support.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1642053","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:40:39Z","timestamp":1758692439000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Vulnerable exposures and outcomes for children of female sex workers in low- and middle-income countries: application of the bioecological vulnerability framework"],"prefix":"10.3389","volume":"13","author":[{"given":"Swarna D. S.","family":"Weerasinghe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Fitzgerald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Perttu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Wills","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy L.","family":"Macias-Konstantopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1186\/1758-2652-13-S2-S6","article-title":"Children of female sex workers and drug users: a review of vulnerability, resilience and family-centred models of care","volume":"13","author":"Beard","year":"2010","journal-title":"J Int AIDS Soc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1080\/03630242.2010.550992","article-title":"\u201cWe are mothers first\u201d: localocentric articulation of sex worker identity as a key in HIV\/AIDS communication","volume":"51","author":"Basu","year":"2011","journal-title":"Women Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1023\/B:ASEB.0000028887.96873.f3","article-title":"A qualitative exploration of female sex work in Tijuana, Mexico","volume":"33","author":"Bucardo","year":"2004","journal-title":"Arch Sex Behav"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1080\/13691058.2022.2153926","article-title":"Managing motherhood - the experiences of female sex workers in Nairobi, Kenya","volume":"25","author":"Nyariki","year":"2023","journal-title":"Cult Health Sex"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12905-020-01137-9","article-title":"\u201cI did not plan to have a baby. 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