Trafficking, exploitation and forced marriage

Overview & Definition

Picture a fifteen-year-old who presents to your emergency department late at night with a sexually transmitted infection, brought in by an older man who answers every question for her and holds her passport. She is withdrawn, fearful, and cannot tell you where she goes to school. Nothing about her primary complaint is exotic — but the constellation should stop you. Trafficking, exploitation and forced marriage hide inside the everyday, and the clinician who recognises the pattern can change a child's trajectory. [5] [8]

The international legal anchor is the United Nations Palermo Protocol, which defines trafficking in persons as the recruitment, transportation, transfer, harbouring or receipt of a person by means of threat, force, coercion, abduction, fraud, deception, or abuse of power or of a position of vulnerability, for the purpose of exploitation. Exploitation includes the prostitution of others, sexual exploitation, forced labour or services, slavery, servitude, and the removal of organs. [10] [11]

For children the definition carries one crucial simplification. When the victim is under eighteen, the means element — force, fraud, or coercion — is not required. Any child recruited and moved for the purpose of exploitation is a victim of trafficking, and any child involved in commercial sex is a victim of trafficking regardless of how they got there or whether they say they consented. This is the single most testable principle, and it is the lens for every assessment that follows. [5] [7]

Forced marriage sits alongside trafficking as a related but distinct harm. A forced marriage is one in which one or both spouses do not, or cannot, consent, and coercion is involved; it differs from an arranged marriage, where the family takes the lead but both parties freely consent. Child marriage — any marriage before eighteen — is treated as a form of forced marriage and a form of child abuse, because a child is judged unable to give full, free and informed consent. [15] [16]

The work of Wood reframes the whole field for paediatricians: child modern slavery is a child-protection problem with a health front door, and the factors that make a child vulnerable are the same factors that surface in clinics every day. Poverty, displacement, family instability, disability, being in care, and being unaccompanied are not background noise — they are the mechanism of entry. [1]

[1] [5]

References16Show ledgerHide ledger

1. [1]Wood LCN 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, 2020.PMID 32537521
2. [2]Hemmings S, Jakobowitz S, Abas M, et al Responding to the health needs of survivors of human trafficking: a systematic review BMC Health Services Research, 2016.PMID 27473258
3. [3]Cannon AC, Arcara J, Graham LM, et al Trafficking and Health: A Systematic Review of Research Methods Trauma, Violence, & Abuse, 2018.PMID 27189733
4. [4]Wallace C, Greenbaum J, Albright K Global Perspectives on the Health and Social Impacts of Child Trafficking Pediatrics, 2022.PMID 36120743
5. [5]Greenbaum J, Crawford-Jakubiak JE Child sex trafficking and commercial sexual exploitation: health care needs of victims Pediatrics, 2015.PMID 25713283
6. [6]Greenbaum J Child Sex Trafficking and Commercial Sexual Exploitation Advances in Pediatrics, 2018.PMID 30053930
7. [7]Greenbaum J, Kaplan D, Young J, et al Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients Pediatrics, 2023.PMID 36827522
8. [8]Greenbaum J Child Labor and Sex Trafficking Pediatrics in Review, 2021.PMID 34850175
9. [9]Le PD, Ryan N, Rosenstock Y, et al Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review Behavioral Medicine, 2018.PMID 30020867
10. [10]Zimmerman C, Kiss L Human trafficking and exploitation: A global health concern PLoS Medicine, 2017.PMID 29166396
11. [11]Kiss L, Zimmerman C Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses PLoS Medicine, 2019.PMID 30695040
12. [12]Chisolm-Straker M, Singer E, Strong D, et al Validation of a screening tool for labor and sex trafficking among emergency department patients Journal of the American College of Emergency Physicians Open, 2021.PMID 34667976
13. [13]Wright N, Jordan M, Lazzarino R Interventions to support the mental health of survivors of modern slavery and human trafficking: A systematic review International Journal of Social Psychiatry, 2021.PMID 34431379
14. [14]Coughlin CG, Greenbaum J, Titchen K Educating paediatric health-care providers about human trafficking Journal of Paediatrics and Child Health, 2020.PMID 32815607
15. [15]Pettoello-Mantovani M, Cokugras H, Ferrara P, et al Child Brides and Forced Marriages: An Aspect of Child Abuse and Neglect The Journal of Pediatrics, 2022.PMID 35940291
16. [16]McFarlane J, Nava A, Gilroy H, et al Child Brides, Forced Marriage, and Partner Violence in America: Tip of an Iceberg Revealed Obstetrics & Gynecology, 2016.PMID 26959211