“We Have Come to Work as Maids, not Sex Slaves”: young women domestic workers and sexual violence in Uganda

Abstract

Introduction

Young women with limited education who migrate from rural to urban areas in Uganda for household domestic work face multiple, intersecting vulnerabilities that increase their risk of sexual violence and other forms of exploitation. These vulnerabilities are often shaped by economic dependence, limited social support, and unequal power dynamics within households. This study explored their lived experiences, perceptions, barriers, and facilitators to accessing support following sexual violence.

Methods

Within a community-based cross-sectional study, we conducted a qualitative study using 18 in-depth interviews (IDIs) and 10 focus group discussions (FGDs) between November 2023 and March 2024. A total of 84 female domestic workers aged 15–24 years were purposively selected from urban communities in Uganda to capture diverse experiences. Interviews and discussions were audio-recorded with participants’ consent, transcribed verbatim, and translated into English where necessary. Data were analyzed using an inductive thematic analysis in NVivo 12 to identify key themes and subthemes related to sexual violence. The study findings are reported narratively, supported by illustrative quotes from participants.

Results

Multiple levels of intersecting individual, interpersonal, and structural vulnerabilities were identified. (1) Male household members perpetrated sexual violence, exploiting workers’ social isolation and economic dependence. (2) Sexual violence resulted in negative reproductive and mental health outcomes. (3) Survivors remained silent due to victim-blaming, stigma, shame, and police corruption. (4) Exploitative workplace practices, like wage theft, denial of formal contracts, and long working hours, increased young women’s vulnerability to sexual violence and limited their ability to seek help. (5) Domestic workers advocated comprehensive interventions, including legal reforms, workplace protections, community services, and labor rights advocacy.

Conclusions

Overlapping vulnerabilities, including exploitative workplace practices, power imbalances within households, social isolation, economic dependence, and limited access to reporting and support systems, drive sexual violence against domestic workers. Addressing these issues requires comprehensive, rights-based approaches, including stronger legal protections, enforcement of labor rights, improved access to survivor-centered services, and community efforts to reduce stigma and foster protective norms, thereby safeguarding the safety, dignity, and justice of these marginalized young women.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04677-8.

Introduction

Domestic work is a largely hidden and undervalued form of labor, employing over 75 million workers globally [1]. Worldwide, most domestic workers (83%) are female, including adolescent girls and young women (AGYW) [1]. In high-income countries such as the United States, domestic work is mostly performed by people who already live in urban areas [2]. In contrast, in many low-income regions, such as Sub-Saharan Africa (SSA), AGYW often migrate from rural areas to urban centers in search of work, hoping to earn higher wages, experience economic growth, and improve their quality of life [3]. However, due to limited education, a lack of formal skills training, poverty, and family financial pressures, most tend to accept low-wage jobs, such as domestic work in private households [4]. Young women who move from rural areas to urban centers often leave behind established social support systems, extended family networks, and community accountability structures, which serve as traditional protective mechanisms [3]. In contrast, working in private households, often behind closed doors, where violations may often go unnoticed and unaddressed, fosters social isolation and enables exploitative conditions that strip young women of basic labor protections and human rights [5]. Additionally, gender-based power dynamics within households frequently place these young women in subordinate positions to male employers and other household members, further increasing their vulnerability to exploitation and abuse [6].

Sexual violence against domestic workers is common and is primarily perpetrated by males in the household, including employers, sons, relatives, or visitors, who exploit the social isolation, economic dependence, and legal vulnerability of live-in domestic workers to commit sexual harassment, assault, and rape [7]. These violations have serious consequences, including psychological trauma, unplanned pregnancies, increased risk of HIV and other sexually transmitted infections (STIs), as well as difficulties in accessing healthcare and support services [8, 9]. Despite their increased vulnerabilities, there is a notable lack of disaggregated data and targeted research on domestic workers within the broader population of AGYW in East and Southern Africa. Most epidemiological studies aggregate AGYW without distinguishing occupational subgroups, thereby obscuring the distinct vulnerabilities and risks of sexual violence faced by AGYW domestic workers [10]. Furthermore, evidence on their experiences of sexual violence, including contexts in which it occurs, patterns of perpetration, and barriers to reporting or seeking support, remains limited. There is also a limited understanding of how workplace conditions, employer-employee power dynamics, mobility, and social isolation influence the risk of sexual violence and their ability to access protection and support services [11]. These gaps create a significant blind spot in efforts to prevent and respond to sexual violence among AGYW domestic workers.

To address these evidence gaps, qualitative research is needed to explore the lived experiences of AGYW domestic workers, focusing on sexual violence and the barriers and facilitators to accessing protection, reporting, and support services. Research should also examine the socio-cultural and structural dynamics that shape their vulnerability to sexual violence and their ability to seek help. Facilitating access to prevention and response services for survivors requires a nuanced understanding of individual agency, employer-employee relationships, and power dynamics, community support systems, and broader structural barriers [12]. Engaging employers and communities to reduce stigma, strengthen accountability, and promote protective norms is essential for improving prevention and response to sexual violence. Recognizing the widespread reliance on domestic work by households where parents work outside the home [13] and the vulnerability of many young women in these roles, understanding their lived experiences, barriers, and facilitators to seeking support is critical for designing effective interventions that address the intersecting risks faced by AGYW domestic workers. To address the lack of evidence on these risks and experiences, this study aimed to explore the lived experiences, perceptions, barriers, and facilitators of sexual violence and access to justice and support, including the uptake of sexual and reproductive health (SRH) services among AGYW domestic workers in Uganda.

Methods

Population and procedures

Participants in this study were drawn from a larger parent study, the ‘Bakozi’ Study, which translates to “domestic workers” in Luganda [local language]. This was a community-based cross-sectional study to assess the prevalence of STIs among 262 AGYW aged 14 to 24 years who were employed as household domestic workers (locally known as ‘maids’ or ‘house girls’) in the Kampala Metropolitan area [14]. In this setting, domestic work involves cooking, cleaning, laundry, gardening, and caring for children and elderly relatives, often with unclear employment terms, no written contracts, long hours, inadequate food and rest, physical confinement in the home, and delayed or unpaid wages [15]. The study took place from November 2023 to April 2024 at community health care workers’ offices, known locally as Village Health Teams (VHTs), or in designated safe spaces under the Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) project [16], a multi-component intervention designed to address the root causes of vulnerability to HIV among AGYW across SSA. VHT members were identified and trained in basic ethical research practices before the study’s commencement. They identified potential study participants in their communities using a door-to-door approach and a preregistered list of domestic workers in each community, compiled by the Platform for Labor Action and the Domestic Workers Association of Uganda, both civil society organizations. Participants were then screened and recruited by trained research assistants from five clusters within local communities of Kasangati Town Council, Nansana division, Nabweru, Wakiso Town Council, and the administrative divisions of Rubaga and Kawempe.

Study procedures are described elsewhere [14]. All participants with positive STI test results received standard antimicrobial treatment for curable STIs. Those diagnosed with HIV were linked to antiretroviral therapy following Ugandan guidelines [17]. Participants needing counseling or legal services for sexual and gender-based violence were referred to appropriate organizations.

Sampling and recruitment

A purposive sample of 84 participants was drawn from the Bakozi quantitative study to explore their diverse lived experiences of domestic work. Of these, 66 participated in focus group discussions (FGDs) and 18 in in-depth interviews (IDIs). Participant selection was based on key characteristics, including age, duration of employment in domestic work, living arrangements (live-in versus live-out), and experiences of sexual violence, its adverse effects, and access to support or justice mechanisms. The sample also intentionally included AGYW who reported workplace exploitation, including sexual violence, as well as those who tested positive for STIs or reported risk-taking sexual behaviors such as multiple sexual partners, transactional sex, and inconsistent condom use, given their heightened vulnerability. We included AGYW aged 18–24 years, and those aged 14–17 who were considered emancipated or mature minors, according to the 2014 Uganda National Guidelines for Research Involving Humans as Research Participants [18], who were willing and able to participate and provided a signed and dated informed consent form. Consenting individuals were invited to participate in either FGDs or IDIs, with the choice of method guided by sensitivity to participants’ experiences and their willingness to participate in a group or individual setting. This was to ensure that the final sample selected reflected a range of experiences, including those shaped by structural and interpersonal vulnerabilities to sexual violence.

Data collection

Authors AAO and PAA conducted 10 FGDs with participants, stratified by age: 14–17 years and 18–24 years, to create safe spaces for participants to openly discuss sensitive experiences related to sexual violence and workplace exploitation. At three study sites, FGDs consisting of 3–5 emancipated minors (i.e., aged 14–17 years) were conducted due to the limited number of females in this age group. Younger domestic workers were harder to reach, as many were live-in employees with restricted mobility and heightened concerns about employer reactions to participation in a study addressing workplace abuse. However, we conducted these smaller FGDs to ensure younger participants could still share their perspectives in a safe and supportive environment. Additionally, 18 IDIs were conducted. For the IDIs, participant selection aimed to ensure variation in age, duration of employment in domestic work, living arrangements, and experiences with sexual violence and its adverse effects, as well as access to support and justice services. Participants for the FGD were purposively selected to reflect diversity in age groups and work settings. FGDs were conducted with groups of AGYW domestic workers to explore shared experiences and norms related to workplace conditions, vulnerability to sexual violence, and barriers to seeking support, while IDIs provided a more private setting for participants to share personal and sensitive experiences of abuse and reporting pathways that they might not feel comfortable discussing in a group. All participants were approached by trained female research assistants in private settings to ensure confidentiality and safety when discussing experiences of sexual violence. Recruitment continued until no new themes related to the experience of sexual violence, reporting, and access to support services were emerging from the discussions and interviews.

The FGD and IDI guides explored: (i) knowledge, attitudes, and practices about SRH services, (ii) experiences with SRH services and involvement of partners and employers, (iii) barriers and facilitators to SRH services, (iv) HIV/STI status disclosure, (v) behaviors associated with adverse SRH outcomes, and (vi) local guidelines and policies related to domestic work and health. The FGD and IDI guides used in this study were originally developed and approved to explore SRH experiences and service uptake among AGYW domestic workers. However, during inductive data analysis, experiences of sexual violence emerged as the most prominent and recurring theme across participants’ narratives. Given the depth, frequency, and public health significance of these experiences, this manuscript focuses specifically on sexual violence. The interview guides are attached in the supplementary appendix. FGDs and IDIs were conducted in English and Luganda by AAO and PAA through both face-to-face and telephone interviews. In-person interviews were held at community safe spaces to ensure privacy and confidentiality, and telephone interviews were conducted in a private room over speakerphone at participants’ request, with approval from the local ethics committee. This addressed potential barriers to participation, including time constraints, limited autonomy to move outside their employment area, and concerns about stigma or fear of scrutiny from employers or community members. Phone-based interviews, therefore, provided a more discreet and convenient alternative, enabling participation while maintaining privacy, comfort, and control over the interview setting. All FGDs and IDIs lasted between 45 and 90 min, were audio-recorded with the permission of all participants and were transcribed into English by the interviewer. Quality checks were performed for each transcript, with corrections and revisions made for errors identified. All participants received refreshments during data collection and were reimbursed UGX 20,000 (approximately USD 6) in accordance with local ethics committee guidelines.

Data analysis

We used triangulation of data collection methods and sources, cross-verifying data from IDIs and FGDs, to confirm findings, reduce bias, and enhance the validity and trustworthiness of our conclusions. Data were analyzed using an inductive thematic approach grounded in the Social-Ecological Model (SEM) [19], which posits that interactions between an individual and their environment are reciprocal, meaning the individual influences and is influenced by their environment. All transcripts were read in full to ensure comprehensive familiarization with participants’ views, experiences, and perceptions of sexual violence. Following this, two transcripts were selected to support the development of an initial coding framework. Inductive open coding (conducted by AAO and AT) was then applied to these transcripts, with relevant segments of text identified and assigned preliminary codes. To improve the reliability and consistency of the coding process, the preliminary framework was reviewed collaboratively with a second coder and an external qualitative analyst. During this process, we systematically compared the initial codes to the original transcript data, reaching consensus on code definitions and their application. The coding framework was then iteratively refined and applied to the full dataset using NVivo Version 12 to support data management and organization. All transcripts were subsequently coded, and the codebook was further developed and refined, led by author AT. All analysis was guided by an inductive thematic approach, with themes generated from the data and later interpreted using the SEM to understand multilevel factors shaping experiences of sexual violence, including influences on the individual, interpersonal, organizational, community, and policy levels. The study’s findings are summarized in the results, accompanied by representative quotes supporting the analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study findings [20].

Ethical considerations

The study received ethical approval from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2024-148) and the Uganda National Council of Science and Technology (HS3152ES). It was conducted in accordance with the 2014 Uganda National Guidelines for Research Involving Humans as Research Participants [18], the WHO guidelines for the safe and ethical conduct of research on violence against women [21], and the Declaration of Helsinki [22]. Emancipated minors (i.e., individuals < 18 years who were pregnant, married, had a child, or supported themselves for their livelihood) or mature minors (those with drug or alcohol dependency or a sexually transmitted infection) were permitted to provide independent informed consent without parental or guardian consent, in line with Uganda guidelines at the time of the study. All participants underwent a comprehensive informed consent process, and participation was entirely voluntary, with the right to withdraw at any time without consequence. Informed consent was obtained in writing for face-to-face interviews and verbally for telephone interviews, in English or Luganda. Illiterate participants provided a thumbprint in the presence of an impartial witness. All personal identifiers were anonymized during analysis, and data were stored securely on password-protected computers and in locked cabinets.

Results

Participant characteristics

Of the 84 participants enrolled in this study, the median age was 20 years; 60 (71%) had completed only primary education, 58 (69%) lived with their employer, and 51 (61%) were single (Table 1). Most (n = 71, 84.5%) had migrated from rural to urban areas in search of work.

Table 1.

Participant socio-demographic characteristics

Variable	N (%)
Age
14–17	29 (34.5)
18–24	55 (65.5)
Education level
None	17 (20)
Primary	60 (72)
Secondary or tertiary	7 (8)
Marital status
Married	14 (1)
Single	51 (61)
Divorced, separated, or widowed	19 (38)
Rural-Urban Migration for work
Yes	71 (84.5)
No	13 (15.5)
Living arrangements
Live-in	58 (69)
Live-out	26 (31)

The majority (n = 62, 74%) were paid in cash, and 82% earned less than USD 50 per month. Forty-seven (56%) had been employed in domestic work for one to two years, but only eight (10%) had written contracts. Half reported working 50–100 h per week, and 41 (49%) worked in households with 5–10 family members (Table 2).

Table 2.

Participant employment characteristics

Variable	N (%)
Remuneration method
Cash	62 (74)
Non-cash	22 (26)
Monthly pay (USD)
< 50	69 (82)
50–100	12 (14)
> 100	3 (4)
Duration of domestic work
< 6 months	11 (13)
6–12 months	18 (21)
1–2 years	47 (56)
> 2 years	8 (10)
Employment terms
Formal (contract-based)	8 (10)
Informal (no contract)	76 (90)
Number of persons in household
< 5	28 (33)
5–10	41 (49)
> 10	15 (18)

Emerging themes

The analysis identified five main themes that revealed the individual, interpersonal, and structural factors trapping young women domestic workers in cycles of sexual violence, workplace exploitation, health vulnerabilities, and silent suffering. The first (sexual violence perpetrated by male employers in the home) explores how male household members exploited domestic workers’ social isolation, economic dependence, and power dynamics to coerce sexual compliance when the female employer was away. The second (sexual violence resulted in reproductive and mental health trauma and economic precarity) highlights the negative reproductive, mental health, and economic consequences of sexual violence and the heavy burden of physical illness, emotional trauma, financial instability, and social isolation experienced by survivors. The third (a culture of hidden violence and stigma silenced survivors) assesses the silence and shame surrounding sexual assault, including victim blaming, healthcare-related stigma, poor enforcement of labor laws, and lack of access to justice, which, together with the psychological trauma of having an STI or pregnancy after assault, further silenced survivors. The fourth (health consequences of workplace maltreatment) explains how wage theft, economic control, and physical and emotional abuse limited workers’ ability to leave abusive situations, independently access healthcare, and make autonomous decisions about their sexual and reproductive health. The fifth (young women’s recommendations for change) highlights the need for multisectoral interventions to break the cycle of violence, including legal reforms, workplace protections, community-based services, and labor rights advocacy, to address the overlapping vulnerabilities faced by young women domestic workers. Together, these lived experiences show how domestic workers encounter intersecting, mutually reinforcing inequalities rooted in age, gender, power dynamics, workplace maltreatment, and structural barriers to reproductive care utilization (Fig. 1).

Fig. 1.

The intersecting vulnerabilities of young female domestic workers illustrated through the socioecological model

Sexual violence was perpetrated by male employers in the home

Domestic workers were subjected to rape and defilement within private homes by male employers when the wife was not present. The wife’s absence was seen as an opportunity for exploitation, highlighting the opportunistic nature of sexual violence and the perpetrators’ awareness that their actions violated social and legal norms. Perpetrators exploited their power, knowing that young women were economically vulnerable and socially isolated, and likely to remain silent following abuse. The private setting of homes and the lack of witnesses allowed perpetrators to act freely, feeling protected from punishment.

“…He closed the door, and I screamed. Then he told me no one would come to my rescue because he had no relationship with the neighbors. He used a lot of force and raped me. The next morning, I did not do any work, and he warned me not to tell anyone, not even the wife.” -- IDI_17 years

“My journey has not been easy when it comes to sexual harassment. [It] has been very hard. When the wife of my boss goes to work, the man harasses me sexually. He stays home pretending to be resting, and yet he forces me to have sex with him.” -- IDI_21 years

Sexual violence was perceived to increase the risk of STIs among domestic workers. Rape or defilement often occurred without condoms, and survivors frequently lacked access to emergency contraception or STI testing and treatment. Fear of disclosing STIs to female employers to get permission for reproductive health services or treatment was rooted in fear of blame, which discouraged survivors from reporting sexual violence. Revealing sexual violence, STIs, or seeking contraception led to unwanted questions.

’Being a house girl is not easy! How can they even hear that you have an STD or want family planning?… For what?… With who? Yet my male employer is always in my bed when my female boss goes to work upcountry.’’ -- FGD_14–17 years

“Sometimes you get the infection from your male employer, and it is not possible to tell the female employer that you got the infection from the man; she will ask you when you started sleeping and having sex with [her] husband, so it is hard.’’ -- FGD_14–17 years

Sexual violence resulted in reproductive and mental health trauma and economic precarity

Ongoing sexual violence resulted in negative reproductive outcomes and psychological harm. Young women experienced adverse reproductive health issues, including repeated abortions that risked their lives, and unwanted pregnancies were kept secret from their female employers. Sexual violence went beyond physical assault, causing psychological distress, as shown by one survivor’s depression and suicide after her employer denied paternity despite his assault.

“He raped me several times…I had like four abortions in the last 2 years. The last one almost killed me, so I have now decided to keep this pregnancy. He knows it is his; his wife does not know.” -- IDI_21 years

“Like that incident I just saw… the girl had the boss who raped her, and she got pregnant, the man said “I’m impotent” … the girl got depressed and ended up committing suicide… now a situation like that, if someone feels it’s too much, you end up taking your own life…” -- FGD_14–17 years

Survivors faced an almost impossible dilemma: revealing negative reproductive outcomes like STIs to employers could result in immediate job loss and loss of essential income, as female employers often refused to keep domestic workers with STIs, including HIV acquired through sexual violence, viewing them as threats to family health rather than victims needing support. Fear of financial repercussions also hindered disclosure. Survivors faced intense healthcare-related stigma, including fear of judgment from community members who saw them accessing STI treatment services. This mix of economic hardship, employer power, and healthcare stigma effectively silenced survivors, forcing them to avoid essential post-rape medical care such as STI treatment. Ultimately, survivors carried the heavy burden of physical illness, emotional trauma, financial instability, and social isolation.

“Let me first talk about our bosses, if I get an STD and I tell my boss… she says I can’t stay with someone with an STD. You can give it to my children, my family… the way she has said it will affect you as a person. That’s why some people keep quiet, she might tell the boss who will take it differently, and she ends up losing the job…” -- FGD_14–17 years

“There’s also someone I know. The boss raped her many times… they said that she now has ‘silimu’ [HIV], so she shouldn’t come close to people at home… they chased her away” -- FGD_18–24 years

“I did not tell my boss about gonorrhea because she would ask where I got it from and use my salary to buy treatment” -- FGD_14–17 years

“…how do they see me in the line looking for medicine for syphilis” -- FGD_14–17 years

A culture of hidden violence and stigma silenced survivors

Domestic workers who reported sexual violence or its negative effects often faced victim-blaming from their partners or employers. Cultural narratives that blamed women for men’s predatory sexual behavior led to suspicions that domestic workers “provoked” the assault through their clothing, actions, or simply by being present. This victim-blaming helped exonerate perpetrators and silence survivors, reinforcing patriarchal hierarchy by suggesting that if a woman was sexually assaulted and experienced a negative consequence, it implied she was promiscuous, because of entrenched gender norms that hold women solely responsible for sexual health. For these young women, silence was not a choice but a logical response to the repercussions of disclosure.

“Sometimes you fear telling the boss because she can ask how you got it [STD]. She starts to suspect that if she isn’t around, you walk around [find sexual partners] or you seduce her husband. Work can stop you from telling her and going to the hospital, and you keep quiet.’’ -- FGD_18–24 years

“The men are so harsh [that] women fear telling them that they have [an] infection because men will chase the women away, and there is a belief that women always bring the infection.” --IDI_22 years

Domestic workers with intimate partners or who were married and experienced negative consequences of sexual violence, such as an STI diagnosis or unwanted pregnancy, faced a tough choice: they had to seek treatment and disclose to their partner. However, revealing this could result in emotional distress, being blamed for infidelity by their intimate partner, or abandonment. This fear was worsened by partners who knew they had an STI but refused to seek treatment, creating a troubling pattern where young women silently treated themselves before their partners agreed to get care.

“Most times I don’t need to tell him…because you may tell him that maybe I’m suffering from such and such a thing, in most cases when you tell him, he may show you that indeed he is with you, but some of them start talking about you, saying ‘that lousy girl, got infected with this and that’ most times he may even leave you because you have diseases and stuff you’re suffering from.’’ -- FDG_18–24 years

’’It can’t be easy to tell him the reason…you can say I’m treating something, but he knows that he has it…and you first treat yourself because he knows he has it.’’ -- FGD_18–24 years

Even when domestic workers overcame personal and social barriers to reporting, including psychological trauma and negative consequences like pregnancy or contracting an STI after sexual assault, they still faced significant obstacles. These included police skepticism, employers bribing police to ignore complaints, and local authorities dismissing their concerns or refusing to investigate allegations against wealthy or influential employers.

“…if I, a house help, go to the police or local council [LC], they should listen to me, and I also get justice because I can grow the pregnancy if I get justice from the owner of the pregnancy.” -- FGD_18–24 years

‘’Now, in most cases, you can go to the LCs or the police wanting to get help, and they tell you to call your boss, and when they call the boss, he can give them money or say that girl is just accusing me.’’ --FGD_18–24 years

Weak protective laws and limited labor rights worsened the plight of domestic workers. Participants proposed that maids be hired through recruitment agencies, with brokers following up to check on their well-being. Participants also suggested that advocating for the rights of domestic workers, updating employment policies, and establishing clear labor regulations could help create supportive environments for survivors to access services.

“We as maids at home might not know our rights or the law. When my boss hasn’t paid me, I have no way of going to the police because the police might not listen to me, and I don’t know my rights as a person, which means they must help us and sensitize us about our rights.” -- FGD_14–17 years

“The laws governing domestic care workers should be made known to everyone, including our employers, because I know they do not know… after all, even I, as a maid, don’t know anything concerning my rights.” -- FGD_14–17 years

“…people [brokers] who link up maids to homes should check on them because some maids may be taken for prostitution instead of domestic work” -- FGD_14–17 years

Health consequences of workplace maltreatment

Workplace exploitation in domestic work directly impacted young women’s general health. Wage theft, including non-payment, underpayment, or unjust deductions, caused financial instability, blocking access to essential services such as post-rape care, sanitary products, and nutritious food. Workers recounted instances where wages were held back, promised payments were not received, or they faced physical assault when asking for money for medical needs. This economic abuse hindered young women from affording essential health services. This was exacerbated by physical confinement. Poor nutrition and a lack of healthcare contributed to ill health.

‘’…sometimes she [boss] comes back when she is annoyed and beats me and abuses me, and she sometimes refuses to give me food, yet I’m the one who has cooked it, and I spend some days without eating, and I get sick, and it’s me to treat myself, on my money. She sometimes doesn’t pay me, so I’m just there like that’’ -- FGD_14–17 years

“…the challenge I go through includes not being paid. Sometimes the employer says they are sending the money to your [family] instead of giving it directly to you, and sometimes the money is not sent home. You don’t get the money to go to the hospital on time in case of any health concern.” -- FGD_18–24 years

“My boss locks the gate. We have a security guard at home” -- IDI_14–17 years

Harsh treatment by employers also affected reproductive health and caused ‘period poverty’. Menstrual hygiene was overlooked due to emotional and physical abuse, limited time, financial barriers, and employer restrictions on accessing healthcare. Limited financial resources prevented domestic workers from purchasing essential items, such as feminine hygiene products, and from paying for transportation to healthcare facilities.

“Some of the bosses are too tough and hard. For instance, my bosses [employers], both the woman and the man, are very tough, even when you request a sanitary towel during your menstrual period, she says that it’s not a big issue” -- FGD_14–17 years

“Our employers are very hard, rude, and tough. Some can even beat you when you ask for your money. They even refuse, and instead of giving you the money owed to go for treatment, they give you very little money, like 5,000 instead of 20,000 [shillings]’’ -- FGD_18–24 years

Young women’s recommendations for change

Domestic workers emphasized the importance of employer support in preventing sexual violence. They emphasized the role of community and local leaders in engaging employers, mediating conflicts, and promoting fair labor practices such as granting time off for health services. Domestic workers also highlighted bias in the justice system, which often favored employers, calling for fair investigations and protection of workers’ rights, regardless of their socioeconomic status. Additionally, they emphasized the need for improved access to counseling, health education, and employer sensitization to support disclosure and care. Community-based advocacy was recognized as crucial for promoting dignity, protecting rights, and enhancing the well-being of domestic workers.

“I want to advise our leaders to be available… You go to the police, they ask for money… even the community leaders… should care to see that domestic workers are also talked about in the community, that they also have their own rights.” -- IDI_17 years

“I request the policy makers, the youth councillors, to play their part in protecting domestic workers…we are the ones who elect them, but they don’t play their part … You vote for them, and tomorrow, they stop caring; they don’t even come to the area to hold youth gatherings. You really see that these people don’t mind.” --FDG_18–24 years

’Our employers should introduce us to their family [members] …and tell them we have come to work as maids, not sex slaves’ -- FGD_14–17 years

Overall, young women domestic workers showed a deep understanding of the multi-level strategies needed to improve their working conditions, safety, and health. Their suggestions reveal a strong awareness that individual support must be combined with systemic reforms to bring about real change.

Discussion

This qualitative research with young female domestic workers in central Uganda highlighted a cycle of exploitation, sexual violence, health risks, and poor health outcomes faced by these young women. Using the socio-ecological model, the study found that their vulnerabilities were shaped by a vicious cycle of intersecting individual, interpersonal, and structural factors related to age, gender, class, limited education, economic precarity, internal migration, and informal employment. The cycle began with rural poverty and limited economic opportunities, prompting migration to urban areas. Brokers and informal networks often facilitated this process, placing women in exploitative situations with no formal contracts, vague terms, and little oversight. Once employed, they endured long hours, low pay, and physical confinement, which fostered economic dependence and social isolation, increasing their risk of financial, emotional, and physical abuse and sexual violence by employers. These intersecting vulnerabilities, workplace exploitation, and experiences of sexual violence often left survivors trapped in silence, compromising their health and well-being.

Sexual violence perpetrated by male employers within private homes was a defining feature of young female domestic workers’ experiences, reflecting a deliberate exploitation of structural conditions that rendered these girls and women uniquely vulnerable. The private domestic setting, combined with the frequent absence of female employers, created enabling environments in which sexual coercion and rape occurred with little risk of detection or accountability. Perpetrators were aware that their victims were economically dependent and socially isolated, and they leveraged this knowledge to ensure silence. This pattern is consistent with previous qualitative research among female domestic workers from Uganda, Mali, and South Africa, which consistently found high levels of sexual violence against domestic workers, especially those residing in their employers’ homes [23–25]. Consistent with other data from Africa, young urban Ugandan domestic workers reported that sexual coercion was often accompanied by threats of physical harm, job loss, or being reported to authorities, which increased their vulnerability and limited their options for resisting or escaping [24]. Survivors described experiencing constant fear, hypervigilance, and emotional distress, unsure of when violence might recur, similar to previous findings [26]. The consistency of this pattern across multiple contexts indicates that sexual violence against domestic workers is not an isolated phenomenon but a systemic one, rooted in gendered power imbalances, economic coercion, and the structural invisibility of domestic labor. The private household, excluded from formal labor oversight, functions as a space where exploitation is both enabled and concealed, suggesting that the existing protective frameworks are fundamentally inadequate. Meaningful reform must therefore extend enforceable labor protections to domestic workers, establish safe and confidential mechanisms for reporting abuse, and address the underlying economic precarity that places girls and young women in conditions of dependence.

Reproductive and mental health trauma, compounded by economic vulnerability, emerged as a direct and devastating consequence of ongoing sexual violence against young domestic workers. They endured repeated unwanted pregnancies, multiple unsafe abortions, and untreated STIs, with one participant reporting four abortions over two years as a direct result of ongoing rape by her employer. The psychological burden was equally devastating, manifesting as depression and, in at least one documented case, suicide following a perpetrator’s denial of paternity. Domestic workers have higher HIV prevalence than other groups of young women, largely due to sexual violence [14, 27]. Previous reports indicate that the intersection between sexual violence and negative health consequences among young female domestic workers is often intensified by their limited sexual and reproductive health literacy [28]. Similar to our findings, young women in previous research often migrated from rural areas with little sex education, a poor understanding of HIV transmission, prevention, or treatment [29], and limited knowledge of how to access healthcare following sexual violence, partly due to limited sexuality education in primary schools (i.e., grades 1–7 or less than seven years of schooling) [29, 30]. This study found that economic precarity deepened this harm, with survivors who disclosed STIs risking immediate dismissal, as female employers frequently viewed them as threats to family health rather than as victims requiring support, findings consistent with previous reports among female domestic workers [31]. The convergence of physical illness, psychological trauma, financial insecurity, and the constant threat of job loss left survivors feeling trapped, as reporting abuse might stop the violence but would almost certainly cost them their employment, income, housing, and the ability to support themselves and their families, similar to a previous qualitative study among female domestic workers in the Middle Eastern countries and Rwanda [32, 33]. These severe reproductive and mental health consequences often result from structural failures that leave young domestic workers without protection, recourse, or care. The fact that disclosure of illness often triggered dismissal rather than support reveals profound failures in responsibility, exposing how informal labor arrangements enable employers to act with impunity, leaving survivors to bear the full burden of harm. Addressing these outcomes requires coordinated action across multiple sectors. Healthcare systems must develop accessible, confidential, and trauma-informed services for domestic workers, including post-exposure prophylaxis, safe abortion care, and mental health support. Education systems must extend comprehensive sexuality education to rural primary schools to equip young women with the knowledge and agency they need before entering the workforce. Finally, labor policy must extend formal protections to domestic workers, including mechanisms that allow survivors to report abuse without forfeiting their livelihoods.

A pervasive culture of hidden violence and stigma was a structural mechanism that systematically silenced survivors and shielded perpetrators from accountability in this study. Cultural narratives attributing sexual assault to women’s behavior, clothing, or perceived promiscuity exonerated male employers and reinforced patriarchal norms in which women were held solely responsible for sexual health outcomes, similar to previous findings [34]. This dynamic operated across multiple relationships simultaneously. Female employers suspected domestic workers of seducing their husbands, intimate partners threatened abandonment upon learning of an STI diagnosis, and community members stigmatized workers seen accessing treatment for STIs. Cultural taboos surrounding adolescent sexuality further marginalized domestic workers, reinforcing silence and self-blame. When survivors attempted to report, they encountered police skepticism, employer bribery of local authorities, and institutional dismissal of complaints against wealthy or influential employers, findings consistent with previous research among female domestic workers in Uganda [23, 35]. In this study, most female domestic workers did not report sexual violence or seek formal justice due to fear of losing their jobs; findings similar to previous qualitative research in Cyprus and South Africa [25, 36]. For young women who migrated from rural areas specifically to earn an income and support family members back home, losing their jobs often results in financial hardship for themselves and their dependents [25, 37], as employers frequently dismiss workers who report sexual violence, particularly when the offender is a family member [31]. Similar to our findings, previous research among female workers has shown that even when employers are understanding, the social and family complications that follow an admission that a husband, son, or relative has committed sexual assault often lead to retaliatory missal rather than legal action against the perpetrator [23, 38]. Silence was, therefore, not a personal failing but a rational response to the near-certain social and economic consequences of disclosure. These findings expose a self-reinforcing system of impunity in which cultural, institutional, and economic forces converge to protect perpetrators and punish survivors, with implications that span legal reform, institutional accountability, and community-level change. The near-universal failure of formal reporting mechanisms, driven by police skepticism, corruption, and institutional deference to wealth and status, reveals that justice systems as currently constituted do not serve this population and may actively deter help-seeking. Reforming these systems requires not only anti-corruption measures and the enforcement of mandatory reporting protocols, but a fundamental reorientation of how law enforcement and judicial institutions respond to sexual violence committed by employers in domestic settings. Equally important is the need to challenge the cultural narratives that distribute blame onto survivors, through sustained, community-based interventions that reframe sexual violence as an exercise of power and a violation of rights rather than a consequence of women’s behavior. Employers, including female employers, must also be engaged as potential agents of accountability rather than passive bystanders, given their role in either enabling or foreclosing justice for survivors in their households.

Young women reported that workplace maltreatment, including wage theft, physical abuse, restricted movement, and denial of necessities, was a direct and systematic cause of poor health outcomes. Non-payment or underpayment of wages prevented survivors from accessing post-rape care, buying sanitary products, affording transportation to health facilities, or purchasing prescribed medicines, consistent with previous research [39]. Our participants reported physical confinement, enforced through locked gates and deliberate restriction, which cut off access to both healthcare and social support, similar to previous studies among female domestic workers [40, 41]. Our findings are consistent with previous studies confirming that domestic workers’ reliance on employers affected their access to essentials, including food, housing, and healthcare [42], and labor exploitation and sexual violence are interconnected forms of abuse that reinforce each other [43]. Menstrual hygiene was especially neglected, with some employers refusing to provide sanitary products and dismissing workers’ menstrual needs altogether, leading to period poverty. The physical toll of domestic labor, combined with limited rest, poor nutrition, and lack of healthcare, contributed to chronic health problems that remained unaddressed due to the financial and physical circumstances imposed on domestic workers. These findings imply that labor exploitation is not a secondary concern but a proximate cause of serious and preventable health problems, with implications that demand an integrated response across labor, health, and human rights frameworks. The deliberate withholding of wages, freedom of movement, and necessities functioned as instruments of control that directly obstructed survivors’ ability to seek care, compounding the health consequences of sexual violence with the additional harms of poverty and physical confinement. This interconnection between labor abuse and health outcomes makes clear that health interventions alone are insufficient. Improving the health of domestic workers requires first addressing the exploitative labor conditions that generate and sustain that harm. Enforceable minimum wage protections, prohibitions on physical confinement, and mandatory employer provision of necessities, including menstrual hygiene products, must be treated as health imperatives, not merely labor standards. Inspection and accountability mechanisms that can operate within private households are essential, as is the recognition of domestic workers as formal employees entitled to the full protections of labor law.

Young women domestic workers proposed sophisticated, multi-level structural reforms to protect their safety, health, and rights, underscoring that systemic change is indispensable to any meaningful improvement. Domestic workers called for employers to formally introduce them to household members and clarify their role boundaries, and for community and local leaders to mediate disputes, enforce fair labor practices, and grant workers time off to access health services. They identified deep-seated bias within the justice system, including police corruption and the dismissal of complaints against wealthy employers, as a fundamental barrier to accountability, and called for fair investigations regardless of socioeconomic status. Similar to other settings, community oversight plays a crucial role in protecting domestic workers [44] by improving reporting, facilitating early intervention, and promoting employer accountability. Its success depends on officials’ commitment, training, resources, and safeguards against corruption or bias by local elites [45]. Addressing police corruption, bias, and poor responses to workers’ complaints requires systemic reforms [46]. Justice system reforms are effective with sustained effort, sufficient resources, and ongoing oversight [47], but often face resistance from those who benefit from the current system, requiring persistent advocacy and political commitment [48]. Our participants emphasized their lack of awareness of legal rights and labor protections as a critical vulnerability exploited by employers, consistent with previous research [49], and called for systematic rights education alongside policy reform. These recommendations align with evidence supporting comprehensive, multi-sectoral strategies that simultaneously promote labor rights, access to justice following sexual violence, and community empowerment [50]. Previous studies consistently show that single-focus initiatives are inadequate for tackling the root causes of exploitation and sexual violence [51] and that effective support services must include legal advice, practical assistance in finding alternative employment, dispute resolution, emergency shelter, and emotional support [36]. Consistent with our findings, domestic workers were more likely to use sexual health services offered by trusted community-based organizations, which were viewed as more approachable and better attuned to their circumstances than government institutions [52], underscoring the importance of expanding such services to reach socially isolated workers. Evidence further supports integrated service models that address the interconnected health, legal, and labor needs of domestic workers through co-located services, seamless referrals, and coordinated data systems [51], thereby representing the comprehensive structural response that participants themselves identified as essential.

Our study’s strengths include the participation of domestic workers from urban and peri-urban areas in Central Uganda, a group of young women who are often overlooked and unseen in HIV/STI research and programs in East and South Africa. Our convergent design collected FGD and IDI data simultaneously, which were triangulated, analysed for direct comparison and contrast, and integrated into the themes. Our study adds to the knowledge about HIV/STI risk and violence experienced by female domestic workers in this setting. However, the study has limitations. Non-random sampling may have led to the inclusion of domestic workers with higher HIV/STI vulnerability. Those who declined to participate out of fear of losing their jobs may have had poorer adverse outcomes than we observed. The limited number of emancipated minors participating in FGDs might have created bias and a lack of representativeness due to their smaller sample size. While our qualitative findings are not generalizable, they may inform the programmatic delivery of multisectoral interventions for this group of women in Uganda and potentially in other African contexts. Nonetheless, our study contributes to the existing literature on the intersecting vulnerabilities of young women domestic workers in East and Southern Africa.

Conclusions

Young women employed in domestic work in the Kampala Metropolitan Area of Central Uganda experience heightened vulnerability, including sexual violence by male employers. This is enabled by unregulated household environments and structural power imbalances, with severe mental and reproductive health consequences. This abuse is sustained by victim-blaming cultural norms, economic dependency, stigma, and institutional failures such as police skepticism and employer bribery. In response, young women recommended confidential healthcare, community education, economic alternatives, and non-judgmental support systems. Multi-sectoral solutions should include extension of legal labor protections to domestic workers, strengthening trauma-informed health services, and empowering communities to challenge harmful norms and address the economic precarity that drives vulnerability. Sexual violence is systemic and demands a coordinated, rights-based response from governments, healthcare systems, and communities, ultimately promoting gender justice, safer work environments, and health equity.

Abbreviations

FGD

Focus Group Discussions

IDI

In-depth Interviews

CT

Chlamydia Trachomatis

SRH

Sexual Reproductive Health

AGYW

Adolescent Girls and Young Women

VHTs

Village Health Teams

DREAMS

Determined, Resilient, Empowered, AIDS-Free, Mentored, Safe

PrEP

Preexposure Prophylaxis

UNCST

Uganda National Council of Science and Technology

REC

Research Ethics Committee

NG

Neisseria Gonorrhoea

STI

Sexually Transmitted Infections

SEM

Socioecological Model

HIV

Human immunodeficiency Virus

WHO

World Health Organization

Authors’ contributions

All authors contributed to the study. AAO: Funding acquisition, Project administration, data collection, data analysis, draft manuscript writing. AAO is the guarantor; AT: Data analysis, project supervision, manuscript reviews; AP: Data collection, Data analysis, Manuscript reviews; RPR: Project supervision, manuscript reviews; MMH: Project supervision, manuscript reviews; JHM: Project supervision, manuscript reviews; BC: Project supervision, Manuscript reviews; S.O; Project supervision, Manuscript reviews; YCM: Project supervision, Draft manuscript writing and reviews; AM: Project supervision, Draft manuscript writing and reviews. All authors read and approved the final manuscript.

Funding

This work was partially supported by an early-career grant from the Royal Society of Tropical Medicine and Hygiene, awarded to Dr. Annet Aketoko Onzia at the Infectious Diseases Institute, Kampala, Uganda.

Data availability

The Focus Group Discussions and In-depth Interview IDI guides are attached in the additional files. The source data is recorded voice, which could compromise participants’ anonymity. The FGDs and IDIs were anonymized and transcribed. The data analyzed for this manuscript will not be made available online because of its sensitive nature, but the corresponding author can be contacted on a case-by-case basis to provide data following a reasonable request.

Declarations

Ethics approval and consent to participate

The study received ethical approval from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2024-148) and the Uganda National Council of Science and Technology (HS3152ES). It was conducted in accordance with the 2014 Uganda National Guidelines for Research Involving Humans as Research Participants, the WHO guidelines for the safe and ethical conduct of research on violence against women, and the Declaration of Helsinki. Emancipated minors (i.e., individuals < 18 years who were pregnant, married, had a child, or supported themselves for their livelihood) or mature minors (those with drug or alcohol dependency or a sexually transmitted infection) were permitted to provide independent informed consent without parental or guardian consent, in line with Uganda guidelines at the time of the study. All participants underwent a comprehensive informed consent process, and participation was entirely voluntary, with the right to withdraw at any time without consequence. Informed consent was obtained in writing for face-to-face interviews and verbally for telephone interviews, in English or Luganda. Illiterate participants provided a thumbprint in the presence of an impartial witness. All personal identifiers were anonymized during analysis, and data were stored securely on password-protected computers and in locked cabinets.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.