Selling Sex in Sub-Saharan Africa: What a New Review Shows, and Who It Leaves Out

A new review in the journal Sexuality & Culture, Commercial Sex Work Among Women in Sub-Saharan Africa, brings together 25 years of evidence on why women sell sex, what they face and which responses have helped. It was published in July 2026. Its authors are based at the University of Ghana, the University of Environment and Sustainable Development and Ghana’s Ministry of Gender, Children and Social Protection.

The review draws on 150 sources published between 2000 and 2025 - 90 journal articles, 20 book chapters and 40 policy and NGO reports. It deliberately focuses on adult women who enter commercial sex without direct coercion, and keeps them separate from people who are trafficked. That distinction matters. It also means the review is not about the girls we work with. Read alongside our work, though, it shows clearly where the pathway starts.

Constrained choice

The review’s central finding is that entry into commercial sex is rarely a single decision. It describes “constrained choice” - a decision made inside a narrow set of options. The drivers it identifies are:

• Poverty. Unemployment, low wages and the need to support dependants come first in almost every study.
• Gender inequality. Women and girls have less access to education, land, credit and formal work, and carry most of the burden of caring for children and relatives.
• Migration. Women moving from rural areas into cities arrive with few skills, contacts or resources. The review cites research in Ghana on migrant women who enter and stay in highly exploitative work.
• Lost schooling. Lower education is consistently linked to greater vulnerability. In Uganda and Malawi, adolescents without secondary education are over-represented in sex work.
• Aspiration. In some studies, young women and girls exchange sex for phones, cosmetics and branded goods linked to a modern lifestyle and peer approval.

It also records that some women are forced in through trafficking and coercion, and that some girls are pushed into transactional sex by parents or guardians as a contribution to the household.

The same conditions, earlier

Every one of those drivers is present in Northern Ghana, and every one of them reaches girls before it reaches women. A girl who leaves school early, whose family is poor and who is expected to earn, is the woman this review describes ten years later. Girls who migrate south to work as kayaye in Accra’s markets meet the migration pathway in their teens.

The aspiration finding matters too. Exchanging sex for phones and status is what we found during our pilot in Tamale, where girls were trading sex for mobile data, as set out in From Tamale to Madrid. The TikTok to OnlyFans pipeline now sells the same promise to girls through their phones. In Ghana’s universities, it has been rebranded as “hookup”.

For children, there is no constrained choice. In law, a child cannot consent to commercial sexual exploitation, and recruiting a child into it is trafficking whatever the circumstances. That is why prevention has to come first.

What has helped

The review finds that responses worked best where they combined health care, legal support and income, and where women themselves helped to design them. It points to integrated programmes in Kenya and South Africa, and to peer-led health programmes in Ghana. It finds that policing alone pushes women away from health care and justice, and exposes them to police harassment and violence.

Livelihood programmes on their own had mixed results. The review cites microfinance schemes in Ghana that were limited in scope, poorly funded or unsustainable, and women who returned to selling sex because the alternative did not earn enough. A sewing machine does not fix a labour market.

On child protection, the review cites community sensitisation campaigns by Ghana’s Department of Social Welfare and NGOs that reduced the recruitment of children into sex work in high-risk areas. Prevention in communities works.

Who the review leaves out

The review is about the women who sell sex. It says almost nothing about the men who buy it. Clients appear as a legal category and as a source of violence, but not as the reason the market exists.

The authors acknowledge the critique themselves. They note that researchers such as Sheila Jeffreys argue that framing entry as constrained choice “distracts the focus” from male domination and the economics that drive the expansion of the global sex industry. That critique deserves more than a paragraph. Poverty explains why a woman or girl is available to be bought. It does not explain why someone is buying.

Any serious response has to look at both sides - the conditions that leave girls with few options, and the demand that profits from them.

Our research in Tamale

The review shows two gaps. It has little to say about girls, and little to say about the men who pay. Our next study is designed to look at both.

Pathways from Poverty to Exploitation is a study of transactional sex and HIV among young people in Tamale. It is going through ethics review now. Fieldwork begins in February 2027, and the results are expected in July 2027. It is led by Dr Mitra Naseh of the Forced Migration Initiative at the Brown School, Washington University in St Louis, with Dr Maryam Rafieifar of the University of Texas at Arlington. We are the field partner, and our team in Tamale will carry out the interviews.

The study interviews young women aged 18 and over about their school years - the age at which our pilot in Tamale found girls already trading sex for mobile data. It asks what young women need money for, the role of the phone, how exchanges start, who the men involved are, what families know, how school fits in, and what follows, including the risk of HIV.

The review describes where adult women end up. This study asks how the pathway begins, in Northern Ghana, in young women’s own words.

Where we fit

The review calls for gender-responsive economic policy, and for responses designed around differences of age, education and migration status. Our SMART Schools Program teaches Junior High School students in Northern Ghana how recruitment works, online and offline, before the offer arrives. Our SOMA Girls’ Empowerment Program works with girls who have left school, building mentorship, sisterhood and a sense of what else is possible.

The women in this review made decisions inside the options they had. Our work is to widen those options while they are still girls.