Haycock-Stuart, Elaine

Stenhouse, Rosie

Amsri, Paichit

EMPOWER Foundation Thailand

2026-05-18T13:11:03Z

2026-05-18

This thesis examines migrant women sex workers' (MWSWs) experiences of healthcare access and provision in Thailand. Grounded in a constructivist paradigm and guided by an intersectionality lens, the study applies thematic analysis to explore how MWSWs experience and navigate formal healthcare systems. Despite Thailand’s widely praised achievement in developing a system of universal healthcare, qualitative semi-structured interviews with MWSWs and the Thai NGO EMPOWER Foundation (n=39) suggest that MWSWs' lives are not lived under the umbrella of universal provision. Rather, their healthcare navigates precarious and contested negotiations. Intersectionality theory is used to identify how overlapping systems of disadvantage, including migration status, gender, socio-economic position, documentation, and sex work stigma, interact to shape the MWSW’s healthcare access and exclusion. Findings identify four interrelated forms of exclusion: •Communicative and Cultural Exclusion, •Symbolic Misrecognition, •Systemic Inaccessibility, and •Intersectional Hierarchies. Collectively, these forms of exclusion illuminate how policies, institutions, and everyday practices interact to position MWSWs as marginal, illegitimate, or invisible patients. At the same time, MWSW participants fought against their discouragements and exclusions through bounded strategies using: selective disclosure, peer solidarity, and NGO intermediation. Although such practices served to mitigate immediate harm, the women were also restricted by the structures that they sought to manage their situations. To capture this paradox, the thesis develops the concept of the exclusion–resistance feedback loop, which demonstrates how exclusion and resistance are not sequential but co-occurring processes that reinforce one another over time. The study makes three key contributions. Empirically, it offers an intersectional analysis of MWSWs' healthcare experiences in Thailand in a systematic manner that supplements the existing literature, which is predominantly centred on HIV/STD. Theoretically, it contributes to the practical use of intersectionality in health research and introduces my development of exclusion–resistance feedback loop as a model for understanding how exclusion and agency are co-constituted. Ultimately, this thesis argues that the universalist healthcare system in Thailand is diminished by women having to backdoor stratified access to services. Healthcare rights are theoretically recognised but unattainable in practice for people on the legal, labour, and social margins. Addressing this requires systemic transformation that dismantles communicative, symbolic, systemic, and hierarchical exclusions whilst embedding the capacities of peer and NGO networks into formal healthcare systems.

https://era.ed.ac.uk/handle/1842/44713

https://doi.org/10.7488/era/7228

en

The University of Edinburgh

Migrant Women Sex Workers (MWSWs)

MWSWs

Healthcare Access

Intersectionality

Exclusion

Thailand

Migrant women sex workers: a qualitative thematic analysis of their healthcare access experiences in a Thai context

Thesis

Undergraduate

MPhil Master of Philosophy