A lot of times just survival mode. Like it is…you know…I guess for them it is more like well, as long as I have food on my plate then I’m fine. (S5, LM)
Theme . | Illustrative Quotes . | Mental Health Care . | Medical Care . | Country Income Levels . |
---|---|---|---|---|
Individual | ||||
Survivors do not recognize their own need for care | They just don’t recognize it [mental health problems]. They would rather say I have Malaria or I have fever, but they do not recognize it. (S6, L) A lot of times just survival mode. Like it is…you know…I guess for them it is more like well, as long as I have food on my plate then I’m fine. (S5, LM) | Yes | No | All income levels |
Mistrust of providers and fear their information will not be kept confidential | For the most part, [I observe] just absolute numbness. Just a lack of feeling and trust. They are not going to trust anybody. (S11, H) That is very true. They are very afraid because they don’t understand confidentiality. They are afraid that people will find out. That people will know. (S8, LM) | Yes | Yes | All income levels |
Difficulty affording health care | Not so much when they are in the shelter, but the before and afterward is the associated cost and the fact that most families get into debt. And most of the debt is health associated. (S1, LM) There are psychiatrists and behavioral health specialists, but those are really for paying patients. And there are people who are really good. But they work in private hospitals and the basic person, the immigrant, your average exploited person, doesn’t have access to that. (S4, UM) But when something happens in the country and things become destabilized, they drop off therapy to look for basic needs again. (S44, LM) | Yes | Yes | Low- and middle-income |
Interpersonal | ||||
Providers lack basic training | I gave a Grand Rounds on basic child abuse: sexual abuse and physical abuse. Because even that foundational understanding was lacking. It was very hard to build on. It was very hard to teach them about trafficking…and how to look for and how to treat it and so forth, without them having a basic understanding of how to work up sexual assaults. (S9, LM) But those who work directly with the children, are mostly public workers in need of a job. And the NGOs give them a job. And more absolutely have gathered whatever experience they have, over a small period of time without any professional training. (S12, LM) | Yes | Yes | All income levels |
Providers lack specialized training | Even with our caseworkers…they were the ones providing the informal support, informal counseling, because they just weren’t, you know, enough psychiatrists or psychologists available. (S27, UM) One…I feel that if possible, if proper doctors especially, pediatricians, if they could be on hand for the children, it would be very nice. (S21, L) But then there is that level of understanding. But there, you often have lay people who are volunteering their time, or they don’t get paid very much and they don’t have any kind of mental health understanding or awareness. (S2, LM) | Yes | Yes | Low- and middle-income |
Providers do not understand trauma-sensitive principles | Trauma informed care…[is] really a foreign concept. (S9, LM) I think in general, most of them did not have training. So they are not up on trauma and child rights. That is not what they are thinking about. It doesn’t mean they don’t think about them with respect, but it is not something they are very well skilled in. (S33, H) I think there [are] huge barriers in the health care field regarding a lack of sensitivity. A lack of understanding of the nuances of trauma. (S4, LM) | Yes | Yes | All income levels |
Providers do not understand trafficking | They have no trained officials in the health facilities that can easily handle young people who have been sexually exploited or for sex trafficking purposes. Because the way you handle the general cases, is different from how you handle a victim of trafficking. And with no trainings for health services in that area, it is quite difficult for them to also detect who is the trafficked victim and what kind of care and handling they need. (S6, L) | Yes | Yes | All income levels |
Organizational | ||||
Shortage of available providers and resultant provider burnout | [The doctors are] indifferent. Yeah. That’s a good term to describe it. Because it was…I mean they just had so many people that needed care and they were so understaffed. (S9, LM) The demand is huge and there is not…enough people…And as we say, she is crying at my shoulder and I am crying at her shoulder. (S10, UM) Sometimes they do not have a good attitude. And you can’t blame them so much because of that doctor/patient ratio which is very high. And they [are] having to see the next patient. (S20, LM) | Yes | Yes | All income levels for mental health providers; low- and middle-income levels for physical health providers |
Frequent staff turnover because of burnout, volunteerism, and short-term work | A lot of this is done by volunteers. Often, in some cases, foreign volunteers. So very, very transient type of support. And certainly when you talk to the children, you can see that they sort of feel left hanging. (S13, UM) But now the problem with that is we don’t have doctors going out to the municipalities to become doctors there. They do it only for a short while and then they leave. (S19, LM) Staff turnover here is so great…Because the people can only handle a tiny bit of stress. And in our work there is a lot of stress. Because you are dealing with children who are raped all the time and so, it is our staff…max 2 or 3 years and they are gone. (S30, LM) There is a huge challenge in terms of retaining counselors in organizations. Most of them are, I would say, interns who come in for internship for a short duration of time. And then they are immediately sought after they have the experience, they leave the NGO. That is breaking that entire process of continuity of care for the child. And the child is extremely left out in the changeover. (S12, LM) | Yes | No | Low- and middle-income |
Fragmented care with little coordination resulting in retraumatization | That panel [of service providers] is very seldom together. You know, sometimes there are a lot of pieces that are missing in that panel. And it really usually comes down to check boxes as opposed to really providing holistic support. (S3, LM) But one of the things that children complain about is that they are moved from one group to the next. And one specialist to the next and they have to retell their story. And case management is definitely a weakness there, and information is not shared. So that is what's leading me to say, I think in general, cooperation between different support services is not always very strong. (S13, UM) | Yes | Yes | All income levels |
Limited material resources such as equipment, medications, and testing | And once they get to the health facilities, and there are no drugs, it is very difficult for them to keep coming every day. And then no drugs [medications], no drugs, no drugs. (S6, L) In fact, we had a few patients there in the little emergency department for sexual assault but they had no evidence collection kit. They did a basic exam. If there was an injury they would document that injury. There was no photo documentation and no colposcopy. (S9, LM) You go to the hospital and you are asked to do a laboratory test and the hospital does not have the equipment to test. So you have to go to another private person to do the laboratory test. And they keep rotating. You just move from one place to another. Move from one place to another. And that is also…it is also expensive. (S20, LM) | Yes | Yes | Low- and middle-income |
Shortage of interpreters | And it gets very difficult for translations. So we rely on a person who may know the language. Or a person that is able to speak that particular language. They do not have specific translators. (S6, L) | No | Yes | Low- and middle-income |
Community | ||||
Cultural disconnect and conflicting beliefs in health care practice methods | Like, for example, they do a lot of Cognitive Behavioral Therapy in America…but it is not very effective in traumatized patients anyway. And definitely not in an Asian context where they just don’t talk…But the thing is, a lot of medicine that is being practiced there is just based on Western philosophy. (S4, LM) There is such a cultural connotation of witchcraft in Kenya, I have to be really careful when using an approach like EMDR to make sure that the person doesn’t feel like I’m doing some sort of voodoo. (S44, LM) Honestly, it is interesting because the Monks and the Healers, the Witch Doctors, they all kind of…just do a bit of everything…There was a doctor who came visiting for a while ago and she went into a shelter and she saw that a girl had a great big cut and she couldn’t work out what was in the cut…and they said, “Oh you know, she had that great big cut,” so what they do is they sliced up garlic and put garlic in it. (S1, LM) | Yes | Yes | Low- and middle-income |
Public Policy | ||||
Lack of sustainable funding streams | They are like NGOs who are so dependent on funding, that sometimes they function and sometimes they don't. It is not like a reliable stream really. (S25, LM) I think the government needs to commit to a Victim's Support Fund that pays for support activities that has to do with sex trafficking. For victims. Because I mean you cannot get into hospital or health center unless I am a victim and I am provided the medical care, but I do not have the money to maybe…the victim may be ill but not have money to buy the medication. (S6, L) Money from the government…and that is for the best, 2 y or one year, that has been lacking. You know? We were building this up for at best 5 y, 10 y. And now 1 to 2 y, because of the change of government. And we are having problems again. (S10, UM) | Yes | Yes | All income levels for mental health care; low- and middle-income levels for physical health care |
Lack of legal protections, corruption and minimal enforcement of existing policies | Sadly, because the political system and the legal system moves so slowly, that these kids, you know, there will be horrible stories that you hear of human trafficking that they want to prosecute and it just takes too long for the kids to get through the system. Or they age out. (S26, UM) Oh…the police. When most of them are found…going to be little. When the police catch them. The police sometimes do physical abuse to them. And verbal abuse like his parents. (S38, UM) And the government wasn't supporting with the legal systems. When they went in to present into court, the defense attorney was very rude to them and actually triggered the secondary trauma. And triggered the experiences they had gone through. So this person felt like she really did not want to live anymore and her life was not helped by the system. (S6, L) There is so much corruption…You know? That traffickers, they can bankroll these girl's cases here or pay people off whatever and so these girls end up being prisoners again of the rescue shelter. (S2, LM) Because the barrier also is that if you are illegal, they are afraid they will be found out. Or deported. (S4, UM) | Yes | Yes | Low- and middle-income |
Subject number denoted S#, World Bank classifications denoted L = low, LM = lower middle, UM = upper middle, H = high
“It is the girl's fault…She was the one who got pregnant. She shouldn't have been wearing that slutty outfit, or flirting with those boys. She basically got pregnant because she was acting like she wanted it.” (S9, LM)
Similarly, subject 26 (UM) described how the societal opinion was that survivors “just got into this stuff because they are trouble anyway.”
Many reported that trafficking itself was stigmatizing. They described a loss of position in society, calling CST “highly stigmatizing, highly disempowering” (S28, UM). Subject 26 (UM) described it as “it’s like you are dirty,” whereas subject 2 (LM) shared that it was “like these girls [were] branded.” Another described CST as “the worst thing” (S8, LM).
“Girls are like a piece of cloth. Once it is soiled, it is spoiled forever. A boy is like a piece of gold. If you just wash it clean it's fine again.” (S25, LM)
Participants also felt patriarchal attitudes contributed to stigma against males. Subject 25 (LM) explained that boys were not allowed to reveal weaknesses, “because they need to just brush themselves down and pick themselves up and get on with life.”
“They will be seen as less of a man. Many of those cases go unreported. But it is because of the culture. The mind sets, their attitude is more, ‘it is the weak ones that should go and get medicine.’” (S6, L)
“The boys we work with need care and love and compassion. And they don't get that at the hospital because they are seen as rough around the edges and homeless youth. As delinquents.” (S31, UM)
“There is a strong stigma against being perceived as gay…or ‘obla.’ Literally there is no word for ‘straight’ in Tagalog. The word for straight translates ‘real man.’” (S3, LM)
LGBTQ+ survivors were described as ostracized, and even survivors who did not identify as LGBTQ+ had “fear about does this mean I’m gay,” because they did not want to be additionally stigmatized (S21, L).
“They would be treated differently just because they are not welcomed as a citizen…There is the perception of, like migrants come in and they steal all of this from us.” (S5, LM)
“There is discrimination…if the child is Serbian, or from Albania, Croatia or Hungary…They will say something like they deserve to live like that. Or they want to live like that. Or…they are like gypsy. They are not even like the Roma population.” (S17, UM)
“There are ethnic Vietnamese girls that have been trafficked and gone through the system. And yes, they are treated very differently. They are very much looked down on.” (S1, LM)
Several also shared that socioeconomic status contributed to the multiplicity of stigma: “Trafficking is a crime that preys on the weak and the most poor and impoverished communities.” (S2, LM)
Stigma because of the physical sequalae of exploitation was also highlighted. Subjects described trafficking-related disabilities, sexual and reproductive issues, and gastrointestinal issues as sources of shame. Subject 24 (L) stated, “imagine the child has these issues [STIs], people laugh at her or him.” Another participant described the stigmatization due to the fecal incontinence a survivor was experiencing as “another whole layer of shame” (S25, LM).
“[Mental health] is not something that we appreciate in our culture…actually, if you went into the mental hospital, they will think you are mad. Because people who are just mad or crazy, they are there.” (S6, L)
“In Hinduism there is a belief that whatever condition you have is the result of whatever you did wrong in a past life…If you have any infirmity of any kind, it is because you richly deserved it and earned it in a past life.” (S14, L)
“A lot of times [mental illness] is seen as [demon] possession.” (S44, LM)
Data also revealed that many survivors internalized these sociocultural beliefs, leading to self-stigmatization. Subject 38 (UM) described, “most of them have a self-stigma. They tell themselves I am bad, bad. I cannot be like this.” Participants described how survivors felt worthless and experienced difficulty accepting that they were exploited. They struggled to access services and remained in exploitation.
“The family. Most of their parents speak to them like you are bad. You are not proper to birth in this world. Or you are worthless.” (S38, LM)
Many participants described community rejection and difficulty reintegrating, either from the shame of trafficking itself or from time spent in aftercare facilities: “The community stigmatized them and said ‘you are the kids who went to live with the foreigners.’” (S30, LM). The degree of discrimination varied from shunning to violence, and many described how the community “will blame you and treat you badly” (S38, UM).
“There were many boys in prostitution…The police basically said there was not an issue about the boys. Even though they knew.” (S24, L)
“This boy has been raped. He is bleeding…And all the doctor basically didn't do an exam…then wrote on the report, this boy has not been sexually abused.” (S30, LM)
Interviewees felt that provider discrimination prevented survivors from accessing services: “There are people who don't want to go because of the discrimination that they will face. (S4, UM)
This unique data set provides an in-depth yet global view of CST survivor health inequities through the lens of stigmatization. Current work has explored stigmatization of survivors generally, but few studies address how the stigmatization process weaves its way from individual-level interactions to system-level outcomes, directly affecting health and social well-being. 21 , 22 , 34 – 36
Our themes reveal how stigma drivers like victim blaming and survivor mistrust of providers propel external stigmatization and self-stigmatization. Although self-stigmatization has been described, our study articulates its interaction with external factors and victim blaming in CST survivors with more depth. 37 We also identified several key barriers to care that are stigma facilitators, including providers who lack training in trauma-sensitive techniques and specialized care of survivors, fragmented care, lack of legal protections, and systemic corruption and inequities. Although these barriers have been previously reported, the HSDF sheds light on the influence of stigma on these barriers. 12 Importantly, these barriers are opportunities for destigmatizing interventions, which could include increasing trauma-sensitive and trafficking-specific training for providers, implementation of policies that support bolstering the workforce of providers qualified to work with CST populations, and educating professionals at large on the social and cultural factors that influence stigmatization.
Our participants described an alarming number of intersecting stigmas, including gender bias, LGBTQ+ status, race, refugee or international status, socioeconomic status, and physical and mental illness. Many of these stigmas have been described previously and individually, but separately from their interaction with CST. 37 , 38 This suggests interventions should also address these additional stigmas.
Our data support the HSDF’s assertion that stigma experiences and practices are linked to outcomes affecting survivor well-being. Participants broadly described reduced access to care and paucities of funding, resources, training, and qualified providers. Intuitively, these are directly linked to health and social outcomes, which our participants described as social isolation, difficulty with reintegrating into community, as well as a plethora of physical and mental health problems.
Understanding CST survivor stigmatization via the HSDF makes a very complex social phenomenon concrete. It also highlights how pediatricians, mental health professionals, policymakers, advocates, and other stakeholders may participate in a global public health response. Stigma drivers, facilitators, marking, and manifestations present opportunities for intervention, including avoiding the use of harmful rhetoric, increasing public awareness regarding the intersection of CST and stigma, expanding research on stigma, increasing trafficking-specific and trauma-sensitive training opportunities, supporting funding and polices that are inclusive, and employing culturally sensitive and innovative approaches to empowering CST survivors. The HSDF Outcomes also suggest ways to monitor targeted interventions such as measuring availability and accessibility of services, amount of specific funding, and presence of policies that foster an informed workforce that protects the rights of CST survivors. Ultimately, longitudinal studies that quantify the health and social impacts of stigma reduction interventions would provide strong evidence for addressing CST. Table 3 provides a summary.
Health Stigma and Discrimination Framework-Driven Interventions and Recommendations
Framework Component . | Recommendations . |
---|---|
Stigma drivers | To minimize the stigma drivers of victim blaming and decrease stigmatization of CST survivors as “prostitutes,” and other harmful rhetoric, consider policy-level approaches that treat CST survivors as victims rather than offenders, recognizing the unique vulnerabilities to exploitation associated with age and developmental capacities. Increase public awareness that child involvement in commercial sex stems from a place of extreme vulnerability, rather than desire and truly free choice. Children are exploited, and as such, deserve support and assistance rather than punishment. Educate health professionals and other child-serving professionals on human trafficking dynamics, harmful effects of stigma and bias, the Health, Stigma and Discrimination framework, and the rights-based approach to patient or client care Expand research on the multilayered interactions of stigma related to human trafficking and its measurement. Identify ways to measure stigma to design effective prevention strategies. |
Stigma facilitators | Increase trauma-informed and trafficking-specific training for providers to increase access to optimal health care by trafficked children. Implement policies that support further training of medical and mental health care providers, and prioritize a focus on retaining experts in their home countries. Improve coordinated, holistic care for trafficked children by enacting public policy that facilitates multidisciplinary community collaboration and promotes involvement by health care facilities Educate health professionals on cultural factors affecting views on human trafficking, mental and medical health, and health care. |
Stigma marking | Normalize mental health problems and mental health care through public health education efforts and community-based efforts to affect cultural norms. This should start at an early age and can be done in schools, community centers, clinics, and other key community sites. Support inclusive policies that provide rights and protections for all people regardless of gender, sexual orientation, race, refugee status, or socioeconomic status. These policies should be reflected on all levels of government, from local to international, and within health facilities. Create an organizational culture that does not tolerate bias and discrimination toward patients, and implement a system that allows anonymous patient or staff reporting of such behavior. |
Manifestations | Employ innovative, culturally-sensitive approaches to help build resilience and empowerment among CST survivors. This may include novel strategies such as group therapy, dance therapy, art and music therapy, and a blend of cultural practices. Prioritize funding to research culturally relevant and safe ways to provide comprehensive care for survivors and their families. Educate health professionals on rights-based and trauma-informed care and the health effects of stigma, bias and discrimination Support community-level educational messaging to change the victim-blaming rhetoric around survivors and to understand CST and how to prevent it. |
Outcomes | Monitor the availability and accessibility of centralized trauma-sensitive services to improve care coordination. Monitor sustainable and reliable funding streams from both the private and public sector. Monitor the creation and existence of policies that foster an environment of wellness, provide opportunities for staff to practice self-care, and that support the mental health needs of service providers to help decrease turnover. Monitor the longevity of service providers Monitor for equitable pay and benefits for service providers to decrease reliance on short-term assignments and volunteerism. Monitor support for policies that call for specific protections for survivors to help decrease inequities. All states should consider adopting the United Nations Convention on the Rights of the Child and should actuate the protections called for in the Optional Protocol to the Convention on the sale of children, child prostitution, and child pornography. Further, States should monitor national efforts to effectively protect these protected rights. |
Health and Social Impacts | Conduct longitudinal studies to evaluate the health and social outcomes before and after multilevel stigma reduction interventions. For example, mental illness and physical health diagnoses, accessible and appropriate care, disability and quality-adjusted life years, life expectancy, employability, education attainment, quality of life, family and social community relationships, etc. |
Framework Component . | Recommendations . |
---|---|
Stigma drivers | To minimize the stigma drivers of victim blaming and decrease stigmatization of CST survivors as “prostitutes,” and other harmful rhetoric, consider policy-level approaches that treat CST survivors as victims rather than offenders, recognizing the unique vulnerabilities to exploitation associated with age and developmental capacities. Increase public awareness that child involvement in commercial sex stems from a place of extreme vulnerability, rather than desire and truly free choice. Children are exploited, and as such, deserve support and assistance rather than punishment. Educate health professionals and other child-serving professionals on human trafficking dynamics, harmful effects of stigma and bias, the Health, Stigma and Discrimination framework, and the rights-based approach to patient or client care Expand research on the multilayered interactions of stigma related to human trafficking and its measurement. Identify ways to measure stigma to design effective prevention strategies. |
Stigma facilitators | Increase trauma-informed and trafficking-specific training for providers to increase access to optimal health care by trafficked children. Implement policies that support further training of medical and mental health care providers, and prioritize a focus on retaining experts in their home countries. Improve coordinated, holistic care for trafficked children by enacting public policy that facilitates multidisciplinary community collaboration and promotes involvement by health care facilities Educate health professionals on cultural factors affecting views on human trafficking, mental and medical health, and health care. |
Stigma marking | Normalize mental health problems and mental health care through public health education efforts and community-based efforts to affect cultural norms. This should start at an early age and can be done in schools, community centers, clinics, and other key community sites. Support inclusive policies that provide rights and protections for all people regardless of gender, sexual orientation, race, refugee status, or socioeconomic status. These policies should be reflected on all levels of government, from local to international, and within health facilities. Create an organizational culture that does not tolerate bias and discrimination toward patients, and implement a system that allows anonymous patient or staff reporting of such behavior. |
Manifestations | Employ innovative, culturally-sensitive approaches to help build resilience and empowerment among CST survivors. This may include novel strategies such as group therapy, dance therapy, art and music therapy, and a blend of cultural practices. Prioritize funding to research culturally relevant and safe ways to provide comprehensive care for survivors and their families. Educate health professionals on rights-based and trauma-informed care and the health effects of stigma, bias and discrimination Support community-level educational messaging to change the victim-blaming rhetoric around survivors and to understand CST and how to prevent it. |
Outcomes | Monitor the availability and accessibility of centralized trauma-sensitive services to improve care coordination. Monitor sustainable and reliable funding streams from both the private and public sector. Monitor the creation and existence of policies that foster an environment of wellness, provide opportunities for staff to practice self-care, and that support the mental health needs of service providers to help decrease turnover. Monitor the longevity of service providers Monitor for equitable pay and benefits for service providers to decrease reliance on short-term assignments and volunteerism. Monitor support for policies that call for specific protections for survivors to help decrease inequities. All states should consider adopting the United Nations Convention on the Rights of the Child and should actuate the protections called for in the Optional Protocol to the Convention on the sale of children, child prostitution, and child pornography. Further, States should monitor national efforts to effectively protect these protected rights. |
Health and Social Impacts | Conduct longitudinal studies to evaluate the health and social outcomes before and after multilevel stigma reduction interventions. For example, mental illness and physical health diagnoses, accessible and appropriate care, disability and quality-adjusted life years, life expectancy, employability, education attainment, quality of life, family and social community relationships, etc. |
Although this qualitative study is in-depth, it is impossible to ascertain generalizability. Though we gathered information from a broad and diverse environment, the sample size was limited and all participants were English-speaking. Representation from a given country varied from 1 to 5 subjects. However, the remarkable thematic consistency suggests that we were able to identify critical dynamics of stigma in CST survivors globally.
Several barriers to health and mental health care were identified by participants in low- and middle-income countries only, despite abundant anecdotal evidence of their prevalence in high-income countries. This may be because of insufficient sampling or differences in perceived priorities among experts.
Although this study reflects the perspectives of experts, we recognize that these are not the perspectives of survivors. Because of the global nature of the study, we had ethical concerns about the ability to uniformly verify and monitor the capacities of each locale to support a vulnerable child being interviewed about a traumatizing subject in a resource-limited setting. Nonetheless, the perspectives of experts uniquely include the collective experience of the myriads of children they have served, providing valuable guidance on trends, issues, and priorities.
Finally, the use of the HSDF as a basis for intervention should be accompanied by appropriate cultural contextualization, as exploration of the nuances of each regional-specific culture was beyond the scope of the study.
Survivors of CST experience many health and social consequences as a result of stigma, discrimination, and barriers to health care. Stigmatization of survivors is complex and interacts with barriers to care across all socioecological levels. Evaluating the stigmatization process within the HSDF framework helps to prioritize how barriers should be addressed within interventions along each step of the stigmatization process, and how to monitor for change. Next steps should include further exploration of intersecting stigmas and testing of stigma-based interventions by measuring stigma reduction and psychosocial, mental, and physical wellbeing.
Dr Wallace conducted analysis and interpretation of the data, drafted the initial manuscript, and revised and reviewed the manuscript; Dr Greenbaum conceptualized and designed the study, conducted data acquisition, and revised and reviewed the manuscript; Dr Albright conceptualized and designed the study, supervised and conducted analysis and interpretation of the data, and revised and reviewed the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: This study was supported by the International Centre for Missing and Exploited Children.
CONFLICT OF INTEREST DISCLOSURES: Dr Greenbaum is employed by the International Centre for Missing and Exploited Children (ICMEC). The other authors have no conflicts of interest to disclose.
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Health Stigma and Discrimination Framework
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Impacts of trafficking on children, how trafficking is connected to child abuse and neglect, child abuse prevention.
Child abuse is one of the greatest social problems affecting the world today. It involves any act that harms a minor’s physical or emotional well-being. On the other hand, neglection is the deprivation of a child’s basic needs, including food, clothing, healthcare, shelter, and education. Trafficking is one of the major causes of child abuse and neglect. It involves the illegal procurement and relocation of children with the intention of exploiting them. A study indicates that children constitute a third of all trafficking victims (Ottisova et al., 2018). Minors may be trafficked for various reasons, such as labor or sexual exploitation, organ harvesting, and illegal adoption (Wood, 2020). All children, regardless of gender, age, nationality, and socio-economic factors are at risk of being targeted for this trade. However, war, political instability, poverty, and parental rejection increase the probability of children being trafficked (Wood, 2020). Trafficking exposes minors to physical and mental abuse and deprives them of basic needs.
Trafficking poses devastating effects on a child’s physical health, predisposing them to health complications. A significant number of trafficked children are exploited for labor which entails working in factories, agricultural plantations, or as domestic servants (Wood, 2020). As a result, these juveniles may develop severe injuries, which, if left untreated, may adversely affect their physical well-being. In addition, research shows that 24- 56% of the victims of child trafficking are subjected to physical violence (Ottisova et al., 2018). In this case, the traffickers may use beatings to control the minors, resulting in internal injuries, bruises, and fractures. Furthermore, teenagers trafficked for commercial sex exploitation (CSE) experience high incidences of sexual violence. Their physical health is also threatened by unsafe sex, which may result in unwanted pregnancies leading to unsafe abortions. Not to mention, CSE victims may contract sexually transmitted infections, such as HIV/AIDS, which, if left untreated, may result in immune suppression and other health complications (Greenbaum, 2017). Therefore, exposure to environmental hazards, physical violence, and sexual assault negatively affect the physical health of trafficked children.
The victims of trafficking may often suffer severe psychological trauma. Keeping children away from their families may result in mental distress because they may feel unloved or unwanted. Similarly, exposing them to environments characterized by physical assault, sexual abuse, and limited freedom predisposes them to various mental disorders, including depression, post-traumatic stress disorder (PTSD), and anxiety (Zimmerman & Kiss, 2017). The sexual and physical assaults may make the trafficked children experience feelings of shame and hopelessness, further impacting their emotional well-being. In addition, the negative remarks that the minors receive from their traffickers or pimps can adversely affect their self-worth resulting in low self-esteem and guilt (Wood, 2020). Equally important, experiencing or witnessing verbal, physical, or sexual abuse combined with long-term isolation may lead to cases of self-harm or suicidal ideation among trafficked adolescents (Kiss & Zimmerman, 2019). Thus, dissociating children from their families and exposing them to environments marred with physical, verbal, and sexual abuse may adversely affect their emotional well-being resulting in severe mental ailments such as depression and PTSD.
Trafficking may lead to the development of substance use disorders among children. Most traffickers, especially those dealing with CSE, use drugs and other substances to maintain control over their victims (Reid et al., 2019). Frequent use of illicit substances results in addiction, making the victims vulnerable to more abuse and unable to escape, resulting in more financial incentives for the traffickers. However, in some cases, some youth may begin using illicit substances as a coping mechanism for their traumatic experiences and harsh realities. Hence, trafficking may expose children to illegal substances whose prolonged use may result in various health complications.
The physical and psychological trauma associated with trafficking may trigger behavioral problems among minors. The dissociation of children from their families and the exposure to intense trauma they are subjected to during and after trafficking may cause the minors to have attachment problems (Wood, 2020). In addition, the verbal, sexual, and physical assault that trafficked juveniles experience from the pimps may result in the mistrust of adults. Moreover, since most victims of trafficking are often isolated, this may lead to anti-social traits and challenges relating to other people. Furthermore, minors involved in CSE may engage in prostitution mainly because they feel worthless and guilty. These adolescents may often think that their lives have been ruined, leading to increased cases of self-harm and suicide ideations (Kiss & Zimmerman, 2019). Therefore, the separation of minors from their families and the trauma they experience from the traffickers predispose them to severe behavioral problems.
Trafficking involves several forms of child abuse that adversely affect their well-being. Research indicates that trafficked minors are subjected to physical assault, sexual abuse, and emotional distress, exposing them to various health complications (Wood, 2020). According to Zimmerman and Kiss (2017), the victims of trafficking experience a lot of violence from their perpetrators resulting in acute injuries, such as lost limbs. The authors also link trafficking to the symptoms of anxiety and depression disorders reported among the victims. These findings are mirrored in the Ottisova et al. (2018) study, which indicates that approximately 21-51% and 24-56% of trafficked minors are subjected to sexual abuse and physical assault, respectively. Exposure to these mistreatments results in mental disorders such as depression and PTSD. Furthermore, Reid et al. (2019) research shows that victims of child trafficking, especially those exploited for sex, record high cases of sexually transmitted infections, physical injuries, and substance use within the healthcare system. Therefore, it is evident that trafficking inflicts a lot of bodily and psychological harm on minors.
In most cases, trafficking deprives children of their basic needs, hindering healthy growth and development. Wood’s (2020) study stresses that trafficked juveniles live in unhygienic environments where they are provided with inadequate food and water, leading to poor health outcomes. Similar findings are drawn from Zimmerman and Kiss’s (2017) research which indicates that trafficked victims are exposed to deplorable living conditions which are unsafe, unhygienic, and overcrowded. They also lack proper nutrition and access to clean water. This proves that trafficking deprives minors of basic hygiene, appropriate clothing, shelter, clean water, and a balanced diet, negatively affecting their developmental process. The authors further suggest that trafficked persons work for extensive hours with low payment. In this case, trafficking denies minors their right to education, resulting in delayed cognitive, language, and memory development. Not to mention, due to the isolation and confinement nature of trafficking, minors may be deprived of critical healthcare services leading to a deterioration in health or death (Zimmerman & Kiss, 2017). Hence, it is apparent that trafficking denies children essential needs, including shelter, proper nutrition, education, and healthcare services resulting in developmental problems.
Although trafficking can target minors regardless of age, socio-economic status, or nationality, most traffickers target vulnerable children. This may include teenagers living in poverty or those displaying problem behaviors, such as fleeing home. Such populations can easily be lured with promises of a better life or other rewards. However, due to the clandestine nature of child trafficking, detecting such cases in their earlier stages is challenging. In this case, there is a need to create awareness about the potential markers of trafficking among healthcare providers to enable them to stop child abuse (Greenbaum, 2017). This is because trafficked minors may visit healthcare institutions in the company of traffickers if they become ill. Therefore, healthcare providers should be able to detect the presence of trafficked children and collaborate with law enforcement and other relevant agencies to stop the abuse. In addition, heightened awareness is also required in the criminal justice system to identify the signs of trafficked juveniles and effectively intervene (Reid et al., 2019). Trafficked children have increased chances of being arrested in relation to prostitution, drug use, and pickpocketing. Hence, earlier identification of trafficked victims may prevent further abuse.
In conclusion, trafficking has detrimental effects on a child’s well-being. It exposes minors to physical violence, psychological distress, and sexual abuse. In addition, it deprives children of basic necessities, including shelter, clothing, proper nutrition, clean water, education, and healthcare services. Consequently, these teenagers may suffer injuries and fractures or develop diverse mental health complications, including PTSD and depression. Similarly, the separation from families at a tender age and exposure to an environment characterized by violence may make a minor develop attachment problems, mistrust, and anti-social traits. Healthcare providers are best placed to identify and stop child abuse linked to trafficking.
Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLOS Medicine , 14 (11), e1002439.
Kiss, L., & Zimmerman, C. (2019). Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses. PLOS Medicine , 16 (1), e1002740.
Ottisova, L., Smith, P., Shetty, H., Stahl, D., Downs, J., & Oram, S. (2018). Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services . PLOS ONE , 13 (3), e0192321.
Reid, J. A., Baglivio, M. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2019). No youth left behind to human trafficking: Exploring profiles of ris k. American Journal of Orthopsychiatry , 89 (6), 704–715.
Wood, L. C. (2020). Child modern slavery, trafficking and health: A practical review of factors contributing to children’s vulnerability and the potential impacts of severe exploitation on health . BMJ Paediatrics Open , 4 (1), e000327.
Zimmerman, C., & Kiss, L. (2017). Human trafficking and exploitation: A global health concern. PLOS Medicine , 14 (11), e1002437.
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Long Essay on Child Trafficking 500 Words in English. Long Essay on Child Trafficking is usually given to classes 7, 8, 9, and 10. People around the world have become so greedy that they are ready to trade children like commodities to trade and use them for labour. Cheap labour has made child trafficking more prevalent in our country and the ...
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The UNODC Anti-Human Trafficking Unit can be contacted at [email protected], telephone (+43-1) 26060-5687. For further information regarding UNODC's work to combat trafficking in persons and the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention
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Get a custom essay on Child Trafficking and Sexual Exploitation. Trafficking in children is a global problem that has serious consequences to the present and future generations. An estimated number of 1 to 1.2 million children is trafficked globally annually (Beyrer 2004). The global trafficking industry is estimated to have a turnover of more ...
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Aftercare services for child victims of sex trafficking: A systematic review of policy and practice. Trauma, Violence, & Abuse, 17(2), 204-220. Crossref. PubMed. Web of Science. Google Scholar. Murphy L. T. (2016). Labor and sex trafficking among homeless youth: A ten-city study full report. Modern Slavery Research Project.