An International Comparative Public Health Analysis of Sex Trafficking of Women and Girls in Eight Cities: Achieving a More Effective Health Sector Response

Abstract

Sex trafficking, trafficking for the purpose of forced sexual exploitation, is a widespread form of human trafficking that occurs in all regions of the world, affects mostly women and girls, and has far-reaching health implications. Studies suggest that up to 50 % of sex trafficking victims in the USA seek medical attention while in their trafficking situation, yet it is unclear how the healthcare system responds to the needs of victims of sex trafficking. To understand the intersection of sex trafficking and public health, we performed in-depth qualitative interviews among 277 antitrafficking stakeholders across eight metropolitan areas in five countries to examine the local context of sex trafficking. We sought to gain a new perspective on this form of gender-based violence from those who have a unique vantage point and intimate knowledge of push-and-pull factors, victim health needs, current available resources and practices in the health system, and barriers to care. Through comparative analysis across these contexts, we found that multiple sociocultural and economic factors facilitate sex trafficking, including child sexual abuse, the objectification of women and girls, and lack of income. Although there are numerous physical and psychological health problems associated with sex trafficking, health services for victims are patchy and poorly coordinated, particularly in the realm of mental health. Various factors function as barriers to a greater health response, including low awareness of sex trafficking and attitudinal biases among health workers. A more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. There are numerous opportunities for local health systems to engage in antitrafficking efforts while partnering across sectors with relevant stakeholders.

Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims

“…3 Violence and psychological manipulation are common, and victims are at increased risk of injury, sexual assault, infectious diseases, substance misuse, untreated chronic medical conditions, malnutrition, post-traumatic stress disorder (PTSD), major depression and other mental health disorders, homicide, and suicide. [4][5][6][7][8][9] Given the large number of children and youth involved and the numerous adverse effects on the victim's physical and mental health, medical providers are in a unique position to help potential victims. 10 The United Nations' "Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children," defines severe trafficking in persons as the recruitment, transportation, transfer, harboring, or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.…”

Global Human Trafficking and Child Victimization

“…4, 36, 38 -40 Although researchers suggest that victims of sex trafficking in the United States are likely to seek medical attention at some point during their period of exploitation, 44,45 trafficked immigrant children detained at the United States border may receive insufficient care, 43 and those trafficked abroad may receive little or no care at all. 46,47 However, it is important for health care professionals all over the world to be alert to possible indicators of sex trafficking, and these are described in detail elsewhere. 31 With respect to labor trafficking, potential indicators may include a recent history of immigration, unfamiliarity with the city or town where the clinic or hospital is located, or apparent control and intimidation by an accompanying adult.…”

Ethical perspectives on combating sex trafficking in Nepal

“…5 Children born from these trafficked women are also more likely to be victims of child abuse/violence and forced to join commercial sex business; thus, an intergenerational vicious cycle of violence, poverty, and exploitation is created.…”

“…4 It is present in different forms and is evident throughout the world. 4,5 Human trafficking has grown up as a lucrative and illicit form of organized transnational crime and business creating enormous economies estimated at $32 billion annually for the trafficking agents. [6][7][8] Annually, around 800,000 people are trafficked across international borders; 80% are female and half of them are minors.…”