Challenging demand for prostitution: international evidence review

7. Learning from New Zealand and the Netherlands

The focus of this chapter is to provide an overview of the evidence assessed on the cases of New Zealand and the Netherlands. Both jurisdictions have adopted very different legislative approaches to prostitution than challenging demand models, favouring instead the decriminalisation of the selling of sex and the legalisation of regulated forms of purchase. Evidence on both cases was assessed with the aim of maximising opportunities for learning through the identification of examples of best practice with regards to welfare and safety provisions which may support women and men involved in prostitution. An examination of the merits of the legislative approaches adopted in both jurisdictions lies beyond the scope of the present review.

Similar issues with regards to the availability and quality of the evidence identified in research on challenging demand approaches were encountered in the literature on New Zealand and the Netherlands. The identification of examples of best practice was limited by sparse research directly addressing "what works" with regards to support and welfare provisions in both countries. Relevant research primarily draws from small scale qualitative and quantitative studies with limited representativeness and generalisability. In the case of the Netherlands, the evidence points to the existence of an extensive unlicensed sector that has been difficult to monitor (Verhoeven & van Gestel 2017). The reliance on literature published in English, however, may mean some key evidence is not included. In New Zealand, the literature points to gaps in knowledge with regards to indoor prostitution, the issuing of brothel certification, human trafficking and coerced cases of prostitution (Abel 2014a; Abel & Ludeke 2021; Thorburn 2017).

The assessment of examples of best practice was also limited by the incompatibility of some of the provisions introduced in both countries which run contrary to challenging demand's core principles outlined in Chapter 4. Research on the effects of the legalisation of brothels and purchase was, therefore, not considered. The evidence examined does nevertheless provide some potentially useful insights with regards to approaches to improved representation of women and men involved in prostitution in policy making as well as stakeholder engagement and collaboration. In the case of New Zealand, the evidence suggests that specialist organisations and collectives can act as key facilitators of policy, providing valuable operational insight, information and leadership needed to secure support among those involved. In the Netherlands, parallels can be drawn with some of the barriers encountered by challenging demand models in relation to gaps in support provisions for migrant women and men involved. The evidence highlights the importance of targeted outreach to improve access to health check-ups particularly among those harder to reach as well as coordinated responses to enforcement and information sharing. These can be summarised as follows:

The New Zealand Prostitutes' Collective

New Zealand introduced a decriminalised model in 2003 which sought to recognise prostitution as a legitimate occupation subject to the same rights and conditions as other forms of employment (Abel 2014a). The central purpose of the Prostitution Reform Act 2003 (PRA) as cited in New Zealand's Ministry of Justice's Report of the Prostitution Law Review Committee on the Operation of the Prostitution Reform Act 2003, was to create a framework that:

• "safeguards the human rights of sex workers and protects them from exploitation";
• "promotes the welfare, occupational health, and safety of sex workers", "is conducive to public health";
• and "prohibits the use of prostitution of persons under 18" (2008: 22).

Under current provisions both the selling and purchasing of sex are legal, however, they are subject to regulations such as mandatory certification of brothels, the prohibition of coerced forms of prostitution, and the use of adequate protection to minimise risk of STI infection (Abel 2014a; Armstrong 2017a). Purchase must be consensual between adults over the age of 18 and cannot be done with holders of temporary visas, an issue which has led to criticisms that current provisions exclude migrant women and men involved (Armstrong 2017a).

Much of the evidence examined with regards to safety and support provision for women and men involved in prostitution centres on the role of the New Zealand Prostitute's Collective (NZPC). The NZPC is frequently referenced as an example of good practice by "sex worker" advocates but also in peer-reviewed academic literature on account of its ability to broker between agencies, government and women and men involved and its role in information sharing with regards to issues such as safe practice, legislative and support provisions and risky clients (Abel & Healy 2021; Healy et al. 2017; Laverack & Whipple 2010; Pérez-y-Pérez 2016; Radačić 2017).

The evidence is in the main, however, limited to small qualitative research much of which has been conducted either by the NZPC or in collaboration with the NZPC, raising questions about the objectivity and generalisability of the findings. Larger scale quantitative data is primarily drawn from survey research, which although useful, is unable to draw causal inferences about the effectiveness of the approaches adopted by the NZPC. The evidence does, nevertheless, suggest the organisation has played a leading role in the development of guidance on best practice and has succeeded in positioning itself as a central point of reference for stakeholders engaging with women and men involved such as law enforcement and health workers. It also points to possible operational advantages of the establishment of national and regional bodies that:

• coordinate responses through guidance and liaison between stakeholders and women and men involved in prostitution;
• and which prioritise the experiences and views of women and men involved in service design.

Originally established in 1987 in response to the AIDS crisis with funding from the Ministry of Health (MOH), the NZPC became a key health provider for women and men involved in prostitution (Abel 2014a; Pérez-y-Pérez 2016: 31) and has played a central role in the promotion, design and introduction of a decriminalised model in New Zealand (Healy et al. 2017). It is largely run by individuals with experience of working in different "sectors of sex work" (Healy et al. 2017: 50) and has branches in Wellington, Auckland, Tuaranga, Christchurch, and Dunedin^[96]. It adopts a "harm minimisation" approach hosting clinics, service referral and outreach targeting on-street workers and brothels as well as providing information on drug and sexual health treatment and supplies such as condoms, "safe sex paraphernalia" and needle exchange (Pérez-y-Pérez 2016: 32).

Some of the literature suggests that the NZPC has played an important role in providing guidance aimed at supporting enforcement and encouraging women and men involved to report sexual violence through initiatives such as the joint publication of the "Guide for Sex Workers who have experienced Sexual Assault" entitled What to Do available on their website^[97], and workshops on sexual assault conducted for officers and detectives from specialised units to encourage empathy and understanding as well as collaboration between agencies (Healy & Abel 2021: 178-179).

According to the NZPC national coordinator and founding member, Catherine Healy, the NZPC has acted as a central conduit between brothel operators and the Ministry of Health, helping to review and supply non-stigmatising guidance and information (Healy & Abel 2021: 181-182). The booklet, Stepping Forward, aimed at new "sex workers", provides tips on staying safe and sexual health (Healy & Abel 2021: 183). Accounts of the work conducted by the NZPC members suggest that the collective has been heavily involved in assisting "sex workers" in Dispute Tribunals in addition to training Medical Officers of Health responsible for inspecting brothels, providing them with insights into how to work with women and men involved in prostitution as well as brothel operators (Healy et al. 2017: 54-58).

Little evaluation of the effectiveness of these initiatives was identified in the literature, however, the evidence does indicate reports of increased self-esteem, empowerment and sense of community among members of the collective (Radačić 2017: 7). Interviewed "sex workers" found NZPC resources useful in making them feel they "had rights", in deciding to pursue "sexual services", and in finding a "tangible community" (Healy & Abel 2021: 183). Radačić's qualitative study which involved 16 interviews with NZPC members, an interview with a former MP and now former detective superintendent, and three interviews with academics, suggested that part of the "success" of the NZPC has been its focus on human rights-framed policy work, diversity and solidarity among its members, wide networks, motivated and determined leadership, financial stability and a supportive socio-political leadership (Radačić 2017: 11).

Pérez-y-Pérez's qualitative study undertaken with representatives from 13 Christchurch human service agencies, Christchurch City Council and government public health department in 2010 and 2011, suggests that the collective has acted as a key facilitator of "information sharing", "collaboration" through education and training of "mainstream/government staff", and in "instigating initiatives with sex workers" (Pérez-y-Pérez 2016: 38). Interview responses suggested that the NZPC's "unique positioning as a peer-based group and (state sanctioned) health service provider" meant it was frequently consulted by agencies who felt insufficiently resourced and trained (Pérez-y-Pérez 2016: 37). The collective was found to have played a particularly prominent role in police strategies aimed at changing enforcement approaches from being focused on "prosecution" to "protection" (Pérez-y-Pérez 2016: 34). Intelligence-sharing initiatives such as "Phone Text" and "Ugly Mugs Book" saw the NZPC mediate between police, telecommunications company and "sex workers" by alerting service users of potentially violent clients verified by police through mobile texts and resources provided to both indoor and outdoor workers (Pérez-y-Pérez 2016: 37). These were identified as being effective means for improved reporting and cooperation between police and "sex workers" (Pérez-y-Pérez 2016: 37).

Another study examining the relationship between police and on-street "sex workers" following decriminalisation found some indications that the initiatives adopted in Christchurch have resulted in an improved relationship between enforcement and women involved in prostitution (Armstrong 2017b). While interviewed "sex workers" continued to express a lack of trust in some police officers, Christchurch-based interviewees highlighted a change in attitudes towards police (Armstrong 2017b: 578). Police were reported as being more concerned with women's well-being and interviews suggested that the changing relationship between police and "sex workers" were not the direct result of decriminalisation but the specific efforts made in Christchurch to have more positive engagements with "sex workers" (Armstrong 2017b: 577-578). Information sharing was highlighted as occurring between women and police officers, with the latter often warning them of incidents and risky clients and coming across as more approachable (Armstrong 2017b: 578). The research did, however, note instances of inadequate police intervention particularly with regards to managing disputes between women and "clients" which continued to highlight power imbalances between "sex workers" and police officers (Armstrong 2017b: 581). It also suggested that building greater trust in police takes time.

Survey results build on some of these findings, suggesting that the NZPC has become an important source of information and advice for women and men involved. Abel and Healy note that in 1997, a survey of 303 "sex workers" in Christchurch found that only 6% reported getting information and advice from NZPC when they started engaging in prostitution (Healy & Abel 2021: 182). Survey results for research commissioned by the Prostitution Law Review Committee conducted nine years later with women and men involved (n=772) found that 44.1% of respondents stated they had received information from the NZPC when they first entered into prostitution (Abel et al. 2007: 85), and 86.8% stated that they would get information about employment rights from the NZPC (Abel et al. 2007: 143). The NZPC also emerged as the second most common confidant for bad experiences with clients (72.9%) after fellow workers (84.5%) (Abel et al. 2007: 122). 65.7% of participants accessed the NZPC in Auckland, 67.2% in Christchurch and 82.3% in Wellington (Abel et al. 2007: 58). These findings are, however, now quite out of date and more recent research is needed to determine whether the NZPC's role as a central mediator has been sustained.

Indeed, some of the literature highlights significant shortcomings in New Zealand's approach such as a failure to provide adequate exiting resources for those wanting to leave (Pitt & Johnson 2021; New Zealand Government 2008) and migrant women and men involved (Armstrong 2017a) as well as regional inconsistencies (Abel 2014a; Armstrong 2017b) and issues with continued stigma experienced by women and men involved in prostitution (Armstrong 2016 & 2018; Schmidt 2017; Wahab & Abel 2016). Little evidence addressed indoor prostitution and while some argue there has consistently been no signs of human trafficking in New Zealand (Healy et al. 2017) others have raised questions about the lack of monitoring by the NZPC and New Zealand government as well as a low number of brothel inspections (Pitt & Johnson 2021)^[98]. The dominant role played by the NZPC has been criticised on the basis of a lack of accountability and public scrutiny and a lack of interest in the provision of exiting support for women and men involved in prostitution (Raymond 2018).

The Netherlands: Accessible health and cross agency collaboration

In the Netherlands, the ban on brothels was lifted in 2000. Like New Zealand, selling and purchasing are legal provided they occur between consenting adults who have the necessary legal residence permit required for employment (Verhoeven 2017). Operators of a sex business need to obtain licenses and demonstrate they meet the requisite health and safety measures, and indoor and on-street prostitution outside of designated areas is prohibited (Altink et al. 2018).

Identifying examples of best practice in the Netherlands is hindered by a mixed picture of the impacts and effectiveness of the regulationist model currently in place. The existence of a substantial unlicensed sector that has not been sufficiently monitored by enforcement agencies and local authorities has meant that the full extent of the scale of prostitution has been difficult to determine (Daalder 2007; Outshoorn 2012; Huisman & Kleemans 2014). Moreover, overlaps with human trafficking, organised crime networks and pimping (Huisman & Kleemans 2014; Staring 2012) in addition to the exclusion of non-EU migrant women and men involved in prostitution from licensing provisions (Tokar et al. 2020), limits the extent to which the effects of support and safety measures can be ascertained.

Recent public discourse has seen increased criticism of existing regulations among policy makers and "sex worker" advocates alike^[99] around the suitability of legislative provisions. The evidence suggests that contrary to initial aims, the licensing scheme has struggled to adequately improve working conditions for women and men involved in prostitution (Daalder 2007; Outshoorn 2012), in some cases contributing to increasingly repressive approaches to tackling the unlicensed sector (Daalder 2007; Post et al. 2019; Wagenaar 2017). Research published in 2013 and conducted in Rotterdam, The Hague and Utrecht showed that brothel owners still largely occupied positions of authority, enforcing "dress codes" and taking high percentages of earnings contrary to regulations set out by schemes such as "Opting-in"^[100] (Wagenaar et al. 2013).

Similarly, an analysis of police files of Dutch criminal investigations into human trafficking in Amsterdam's Red Light District between 2006 and 2010, as well as interviews with police investigators and public prosecutors points to the existence of extensive informal networks of pimps, drivers, errand boys, accountants and bodyguards (Verhoeven & van Gestel 2017). The study showed "sex workers" often relied on these networks to gain access to housing and income but were often monitored and subject to controlling behaviour. The authors however, flagged limits in the generalisability of the findings due to a reliance on police data.

Licensing's regulation and enforcement at municipal level has also raised concerns about the uneven issuing of licenses across the Netherlands which in some cases has resulted in a decrease in the overall numbers of licensed premises despite national regulations prohibiting the rejection of brothels on the basis of ethical or moral grounds (Leek & van Montfort 2004; Seals 2015)^[101]. Moreover, there are reports of a lack of complementarity between local authority and police enforcement approaches with municipalities adopting varied measures and police forces lacking sufficient capacity to target sex trafficking and the unlicensed sector (Daalder 2007; Huismans & Kleemans 2014). Such diverging implementation practices make it difficult to develop a cohesive understanding of the effectiveness of the Dutch model.

The evidence does nevertheless provide some insights into health provision which has been a focal point in attempts to improve safety and support conditions for women and men involved. "Sex workers" are encouraged to regularly access free and anonymous health check-ups (Swanson 2016). Some STI clinics such as the Prostitution and Health Center, P&G292, in Amsterdam provide specialist healthcare near the Red-Light District (Drückler et al. 2020) and conduct outreach by targeting brothels, sex clubs and windows with the aim of providing counselling, testing, and Hepatitis B vaccinations (Verscheijden et al. 2015). All licensed workplaces are required to provide access to staff of STI clinics and public health services at least four times a year during which health workers provide voluntary testing (Verscheijden et al. 2015). Licensed facilities are encouraged to promote safe-sex practices through guidance and STI testing (Verscheijden et al. 2015) and "sex workers" are invited to attend municipal health services once a year (Wagenaar et al. 2013: 71).

The effectiveness of these interventions is, however, difficult to determine given the varied experiences of support provision among those involved such as migrant women involved. Research examining STI positivity rates since implementation shows that the number of positive STI diagnoses stabilised among female "sex workers" between 2006-2013 (Verscheijden et al. 2015). Risk factors for increased positivity identified in the study was being younger and from a country outside Western Europe (Verscheijden et al. 2015). Possible contributing factors identified by the authors included reduced surveillance and targeted health services available to migrant workers (Verscheijden et al. 2015: 6). The latter may be a reflection of a lack of access to regular testing among migrant "sex workers" more generally.

Qualitative research studying access to HIV testing among female Eastern European non-EU migrant "sex workers" in Amsterdam found that non-EU residents who were unable to acquire the necessary residence and work permits to engage in "sex work" often used tourist visas and actively sought to avoid detection by health agencies and enforcement agencies (Tokar et al. 2020: 9). The study's analysis of online adverts showed the majority engaged in high risk behaviours such as oral sex without condoms and were reported as being the hardest to reach by interviewed stakeholders with experience of working in services with "sex workers" and/or migrants. The study identified a number of key barriers to HIV testing such as fear of being caught, stigma and self-stigmatisation, lack of trust in healthcare providers, low language fluency, previous negative experience when accessing healthcare in home countries, time and transport costs, and low perceptions of HIV risk and understanding. The authors concluded that there was a need for approaches that addressed the diversity of women's experiences and the scaling up of outreach interventions which were reported as being one of the few means through which migrant women accessed testing. Stakeholders also emphasised the importance of building trust and access to multi-lingual services as a key potential facilitator of increased testing.

The evidence suggests that the licensing sector has seen improvements with regards to health and hygiene conditions in brothels more widely (Wagenaar et al.'s 2013; Vanwesenbeeck 2011). Interviewed health workers in Rotterdam reported that proprietors were in the main cooperative and that it had been months since they had encountered a positive STI diagnosis (Wagenaar et al. 2013: 71-72). However, similar to the studies described above, the research also found gaps in support provisions for migrant women and men which may be making them more vulnerable to exploitation^[102]. Some quantitative research has also drawn attention to the heterogeneity of experiences among male and trans "sex workers", many of whom have been found to engage in higher-risk sexual behaviour such as substance use while working more frequently compared to their female counterparts (Drückler et al. 2020).

With regards to mental health and exposure to violence, the evidence is similarly mixed. The 2007 evaluation indicated that emotional well-being among those who sell sex had declined since the introduction of regulation (Daalder 2007). More recently, a small quantitative study examining the relationship between prostitution and quality-of-life factors and post-traumatic stress experienced by women involved in prostitution showed that 23.9% reported having experienced violence while engaging in prostitution (n=88), a rate which was lower than those reported in previous studies and substantially lower than those reported in Germany which also adopts a regulationist model (61%) (Krumrei-Mancuso 2017: 1851-1852). The study also found that fun or excitement were reported as being the primary reason for engaging in prostitution and that being motivated to engage for financial reasons, having less confidence in finding alternative work, and desiring to exit were associated with elevated negative mental health symptoms (Krumrei-Mancuso 2017). The author concluded there was a need for increased services available to those wanting to exit, and argued that the findings suggested that a focus on achievement, having a sense of fair treatment from others and life, and self-acceptance were associated with better mental health (Krumrei-Mancuso 2017).

A study conducted by the "sex worker's" union PROUD, however, found indications of a much higher rate of experiences of physical violence among women and men involved (PROUD & Aidsfonds-Soa AIDS 2018). The study funded by the Ministry of Justice and Security and which involved 308 participants showed that 60% had experienced physical violence in the 12 months prior, while 78% had experienced sexual violence, 58% financial emotional violence and 93% socio-emotional violence (PROUD & Aidsfonds-Soa AIDS 2018: 18). The results are not, however, based on a representative sample of women and men involved in prostitution.

In terms of enforcement, the evidence indicates that sustained collaborative networks focused on information sharing may have improved enforcement. Wagenaar et al.'s research suggests that where the Dutch model has worked best has been in the development of close collaboration between relevant actors such as city officials from the Department of Public Safety, police, Immigration and naturalisation services, district attorneys, the Chamber of Commerce, Labour Inspection, Public Health, social work and outreach, youth services and the tax office (Wagenaar et al. 2013: 73). These networks have been "formalised" in most cities into Regional Information Centres and so-called "chain management" where complementary services have been linked in a sequential chain and led by a chain manager to effectively coordinate resourcing and delivery (Wagenaar et al. 2013: 74-75).

According to the authors, these have resulted in genuine collective learning, information sharing and the development of trust among across agencies (Wagenaar et al. 2013: 74-75). The main facilitators of information and networking identified in the study were "careful design" focused on "concrete cases", "sufficient power to make decisions", the presence of a "chain manager", and higher administrative and political leadership (Wagenaar et al. 2013: 90). Exactly how this translated into improvements in day-to-day implementation is unclear and further research is needed to evidence this empirically and ascertain whether this has been sustained.

Finally, some evidence examining the effects of tippelzones ("designated legal street prostitution [zones] where soliciting and purchasing sex is tolerated between strict opening and closing hours" (Bisschop et al. 2017: 28)) on crime rates suggest there may be a relationship between the opening of tippelzones and decreased sexual assault. Bisschop et al.'s difference-in-differences analysis of crime statistics in 25 Dutch cities between 1994-2011, found indications of a 30-40% decrease of registered sexual abuse and rape in cities within the first two years of when the tippelzones had been opened (Bisschop et al. 2017). The study examined total annual number of reports for different crime categories across the 25 cities, 9 of which had introduced a tippelzone^[103]. However, it is worth noting that the majority of tippelzones have since been closed due to conflicts between those involved in prostitution, and the study was unable to account for contributing factors behind the trends observed.