Human Trafficking: The Role of the Health Care Provider

Tiffany Dovydaitis, RN, WHCNP


J Midwifery Womens Health. 2010;55(5):462-467. 

In This Article

The Scope of the Problem

The International Labor Organization estimates human trafficking to be a $32 billion per year industry.[10] Human trafficking is the third largest source of income for organized crime, and there are twice as many people enslaved today as during the African slave trade.[11–13] Human trafficking involves forced labor, bonded labor, debt bondage among migrant laborers, involuntary domestic servitude, forced child labor, child soldiers, and sex trafficking.[14] Individual victims suffer from numerous physical and psychological problems, but trafficking undermines the health, safety, and security of all nations it touches.[5,14]

With the onset of a global financial crisis, there has been a shrinking global demand for labor and a growing supply of workers willing to take additional risks for employment. These trends will likely increase the numbers of persons trafficked in the coming year. The two largest source countries for trafficked persons in the United States are Mexico and East Asia, but victims also come from South Asia, Central America, Africa, and Europe.[14] Box 1 lists common ways that girls and women become victims of trafficking.

One of the most common questions that are asked about trafficking victims is, "Why do they stay?" Although there are certainly instances when traffickers forcibly hold victims captive, more commonly victims appear able to walk away at any time. Debt bondage, control of the victim's money, and confiscation of passports, visas, and identifying documents are common ways that traffickers maintain control.[15] For example, a woman might promise to pay a coyote to smuggle her across the border to the United States from Mexico. When she arrives in the country, she will be thousands of dollars in debt and must "work off" her debt in agricultural, hospitality, housekeeping, or other types of work. It is likely that a large portion of her wages will go to the trafficker during her first year in the United States or longer. Until she is able to pay, she may face physical threats against herself and her family, sexual harassment and assault, housing in squalid conditions, restriction of movement, and threats of deportation if she tries to escape. Traffickers may charge exorbitant interest and fees, making it difficult for her to ever pay her debt. Because she is in the United States illegally, it is unlikely that she will report any exploitation by her employer and/or trafficker, for fear of deportation.[16]

Traffickers also use isolation from family, friends, and the public to keep their victims in captivity. Limiting contact with outsiders and ensuring that any contact is superficial in nature will ensure that the victim does not begin to build any social support networks in the community. Also, moving victims from place to place decreases the likelihood that the victim will form relationships and/or be recognized.[15] Perhaps most insidious, the victims are almost always subjected to harsh psychological and physical abuse, including repeated rape, in order to keep the victim submissive.[17] According to one study, trafficking victims generally only see three ways of escape from their situation: 1) to become unprofitable because of trauma, emotional breakdown, or advanced pregnancy; (2) to be helped by a client; or (3) death.[18]


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