essay on child trafficking

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The Fight Against Child Trafficking

Child trafficking is a crime – and represents the tragic end of childhood.

Child trafficking refers to the exploitation of girls and boys, primarily for forced labor and sexual exploitation. Children account for 27% of all the human trafficking victims worldwide, and two out of every three child victims are girls[i].

Sometimes sold by a family member or an acquaintance, sometimes lured by false promises of education and a "better" life —  the reality  is that these trafficked and exploited children are held in slave-like conditions without enough food, shelter or clothing, and are often severely abused and cut off from all contact with their families.

Children are often trafficked for commercial sexual exploitation or for labor, such as domestic servitude, agricultural work, factory work and mining, or they’re forced to fight in conflicts. The most vulnerable children, particularly  refugees  and migrants, are often preyed upon and their hopes for an education, a better job or a better life in a new country.[ii]

Every country in the world is affected by human trafficking, and as a result, children are forced to drop out of school, risk their lives and are deprived of what every child deserves – a future.

Help Children Now

Child Trafficking: Myth vs. Fact

Child trafficking affects every country in the world , including the United States. Children make up 27% of all human trafficking victims worldwide, and two out of every three identified child victims are girls[i].

Trafficking, according to the United Nations, involves three main elements[ii]:

• The act: Recruitment, transportation, transfer, harboring, or receipt of persons.
• The means:  Threat or use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to a person in control of the victim.
• The purpose:  For the purpose of exploitation, which includes exploiting the prostitution of others, sexual exploitation, forced labor, slavery or similar practices and the removal of organs.

There is much misinformation about what trafficking is, who is affected and what it means for a child to be trafficked. Read on to learn more about the myths vs. facts of child trafficking.

MYTH: Traffickers target victims they don’t know

FACT: A majority of the time, victims are trafficked by someone they know, such as a friend, family member or romantic partner.

MYTH: Only girls and women are victims of human trafficking

FACT: Boys and men are just as likely to be victims of human trafficking as girls and women. However, they are less likely to be identified and reported. Girls and boys are often subject to different types of trafficking, for instance, girls may be trafficked for forced marriage and sexual exploitation, while boys may be trafficked for forced labor or recruitment into armed groups.

MYTH: All human trafficking involves sex or prostitution

FACT: Human trafficking can include forced labor, domestic servitude, organ trafficking, debt bondage, recruitment of children as child soldiers , and/or sex trafficking and forced prostitution.  

MYTH: Trafficking involves traveling, transporting or moving a person across borders

FACT: Human trafficking is not the same thing as smuggling, which are two terms that are commonly confused. Trafficking does not require movement across borders. In fact, in some cases, a child could be trafficked and exploited from their own home. In the U.S., trafficking most frequently occurs at hotels, motels, truck stops and online.

MYTH: People being trafficked are physically unable to leave or held against their will

FACT: Trafficking can involve force, but people can also be trafficked through threats, coercion, or deception. People in trafficking situations  can be controlled through drug addiction, violent relationships, manipulation, lack of financial independence, or  isolation from family or friends, in addition to physical restraint or harm.

MYTH: Trafficking primarily occurs in developing countries

FACT: Trafficking occurs all over the world, though the most common forms of trafficking can differ by country.  The United States is one of the most active sex trafficking countries in the world, where exploitation of trafficking victims occurs in cities, suburban and rural areas. Labor trafficking occurs in the U.S., but at lower rates than most developing countries.

Does child trafficking happen in the United States?

Yes, children are targeted for trafficking in the U.S. and are trafficked into the country from around the world. Often, children are trafficked from developing to developed countries. Victims are trafficked under various circumstances, including prostitution, online sexual exploitation, the illegal drug trade and forced labor.

In the U.S., 60% of child sex trafficking victims have a history in the child welfare system[iv]. Foster children in particular are vulnerable to being victimized by child trafficking[iiv]. Children in the foster care system often live in of the poorest communities in America, where Save the Children works to break the cycle of poverty and ensure that every child gets a healthy start, a quality education, and is protected.

How many children are victim to child trafficking?

An estimated 1.2 million children are affected by trafficking at any given time [iiv] . Around the world, most children who are victims of trafficking involved in forced labor. Worldwide:

• 168 million children are victims of forced labor [iv]
• 215 million children are engaged in child labor  [iii]
• 115 million of those children are involved in hazardous work  [iii]

How does trafficking differ from smuggling?

Trafficking and smuggling are terms that are commonly mixed up or considered synonymous. They both involved transporting another individual, but there are some critical differences.

Smuggling  involves the illegal entry of a person into a state where he or she is not a resident.

There are three key differences between trafficking and smuggling [iv] :

• Consent  – Individuals involved have consented to the smuggling. Trafficking victims either have not consented or have been coerced into consent.
• Exploitation  – When the smuggled individual arrives at their destination, the smuggling ends. Trafficking is the continuous exploitation of a victim to generate profit for the traffickers.
• Transnationality  – A person who is smuggled is always brought from one state to another. Trafficking can occur either within or between states.

How is Save the Children helping victims of child trafficking?

Save the Children works to combat child trafficking through prevention, protection, and prosecution. In order to maximize our efforts, we work with communities, local organizations and civil society, and national governments to protect children from being exploited – and to help restore the dignity of children who have survived.

Save the Children takes a holistic approach to tackle the root causes of child trafficking and involves children in the design and implementation of solutions.

Working alongside communities and local and national governments Save the Children supports:

• Preventing trafficking at the community level by creating awareness of the risks of migration
• Providing support to children who have been trafficked and help them return home and reintegrate into their communities
• Improving law enforcement and instigate legal reform to protect survivors of trafficking.

By supporting livelihoods, we help families avoid the need for their children to work. By raising awareness of trafficking, we reduce the number of children being trafficked. By helping rehabilitate survivors, we empower them to rebuild their lives. By protecting unaccompanied refugee children, we keep them from the clutches of traffickers.

We Launch Anti-Trafficking Advocacy Campaigns With all the excitement that led up to the South Africa World Cup 2010, it is easy to forget that such a major sporting event can lead to child trafficking and unsafe child migration. To help protect children during this time, and raise community awareness of the dangers, Save the Children in Mozambique launched an advocacy campaign called "Open Your Eyes" with radio and television programs, interviews, posters and postcards that reached 250,000 people

The former national team captain, Tico-Tico, even volunteered his own time to appear in several advertisements highlighting the problem of child trafficking. Even after the World Cup was over, this advocacy worked to help protect vulnerable children from exploitation

We Support Public Policy and Training One reason trafficking and exploitation of children flourish is because of inadequate laws and policies against it. In El Salvador, Save the Children focused on Mejicanos, one of the most frequent areas for trafficking of children, and supported the municipal council in drafting the first-ever ordinance to prevent child trafficking, and monitor its implementation.

Save the Children also conducts awareness training in schools, so children can learn how to keep safe, as well as how and where to report any suspicious activity. Now the majority of Mejicanos are working with Save the Children to share this experience and replicate its success throughout El Salvador.

We Use Research in Creative Ways to Protect Children from Child Trafficking “Positive deviance” – an innovative approach pioneered by Save the Children and well-documented in improving children’s health and nutrition, is also being used to fight child trafficking. Save the Children used this approach in two child protection programs — one to prevent trafficking in girls for commercial sex work in Indonesia, and the other to reintegrate girls who were abducted by the Lord's Resistance Army (LRA) and girl mothers into their communities in Uganda.

When is World Trafficking Day?

In 2013, the United Nations passed a resolution designating July 30 as World Day Against Trafficking in Persons to raise awareness about the growing issue of human trafficking and the protection of victims and their rights.

Who can I contact if I witness or suspect child trafficking?

The Childhelp® National Child Abuse Hotline – Professional crisis counselors will connect you with a local number to report abuse. Call: 1-800-4-A-CHILD (1-800-422-4453)

The National Center for Missing & Exploited Children® (NCMEC) – Aimed at preventing child abduction and exploitation, locating missing children, and assisting victims of child abduction and sexual exploitation. Call: 1-800-THE-LOST (1-800-843-5678)

National Human Trafficking Resource Center – A 24-hour hotline open all day, every day, which helps identify, protect, and serve victims of trafficking. Call: 1-888-373-7888.

How Girls Are Affected By Trafficking

Tragically, both girls and boys are vulnerable to child trafficking. However, girls are disproportionally targeted and must deal with the life-long effects of gender inequality and gender-based violence .

Often, girls around the world are forced to drop out of school or denied access to income-generating opportunities. This resulting social exclusion can trap girls in a cycle of extreme poverty, as well as increased vulnerability to trafficking and exploitation.

Child Trafficking in Conflict Zones

Because child trafficking is often linked with lucrative criminal activity and corruption, it is hard to estimate how many children suffer, but trafficking and exploitation is an increasing risk as more children around the world live in conflict.

Globally,  426 million children live in conflict zones today . That’s nearly one-fifth of the world’s children. Living amidst conflict increases children’s exposure to grave human rights violations, which include child trafficking and gender-based violence. 

Frequently Asked Questions About Child Trafficking

What is child trafficking.

Child trafficking is a type of human trafficking.  According to the United Nations, trafficking involves three main elements [iv] :

• The act  - Recruitment, transportation, transfer, harboring, or receipt of persons.
• The means  - Threat or use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to a person in control of the victim.
• The purpose  - For the purpose of exploitation, which includes exploiting the prostitution of others, sexual exploitation, forced labor, slavery or similar practices and the removal of organs.

National Human Trafficking Resource Center – A 24-hour hotline open all day, every day, which helps identify, protect, and serve victims of trafficking. Call: 1-800-373-7888.

[i] Give Her a Choice: Building A Better Future For Girls (Save the Children)  [ii]  U.S. Department of Health and Human Services (HHS) Child Victims of Human Trafficking: Fact Sheet [iii]  The Many Faces of Exclusion: 2018 End of Childhood Report [iv]  United Nations Office on Drug and Crime [v]  United Nations: World Day Against Human Trafficking [iv]  National Foster Youth Institute [vii] Child Trafficking Essentials

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Child trafficking

Combating child trafficking.

Each year, more than 10,000 people are identified as victims of trafficking around the world. Of these victims, 13% are girls and 9% boys (UNODC, 2009). These figures only represent a small proportion of the victims identified. Closely linked to child labour , child trafficking is present in all regions of the world . In particular, it responds to demands for cheap or free labour and leads to various forms of child exploitation, such as forced marriage, prostitution, and begging, thus depriving children of their fundamental rights .

Definition of child trafficking

Child trafficking is the process of exploiting a child through the recruitment, transportation, transfer, harbouring or receiving of a child (International Labour Office, 2011). Under international law, child trafficking is a crime and a violation of children’s rights . In particular, the 1989 International Convention on the Rights of the Child stipulates that “the illicit transfer and non-return of children” are prohibited.

Child trafficking is also characterised by the practice of illicit acts, namely, the use of force or coercion:(by abduction, deception, fraud or abuse of authority) or the offer of payments or benefits: to the victim or to a person having authority over them. Child victims of trafficking suffer abuse and are also, for the most part, deprived of their fundamental rights such as the right to education , the right to health or the right to protection , which are necessary for fulfilled growth (UN Info, 2015).

According to UNICEF, “some 8.4 million young people are involved in the worst forms of child labour, including prostitution. Many are enslaved: forced to work to pay off a debt, they live in a situation similar to that of slavery” (UNICEF, 2005). According to the ILO, a child trafficker is defined as “any person who contributes to any element of the trafficking process with the intention of exploiting the child. This includes those who are not active in any phase of the process, such as recruiters, intermediaries, document providers, transporters, corrupt officials, service providers, and unethical employers” (International Labour Office, 2011).

Forms of exploitation

Trafficked children are used in various ways depending on their age and sex (Terre des Hommes, 2004), as described below.

Sexual exploitation  

It is mainly adolescent girls who are used for prostitution or the production of child pornography. These practices are particularly widespread in sex tourism destinations. Teenage girls are generally sold in other countries and travel under false identity papers. According to UNODC, sexual exploitation accounts for 79% of human trafficking (UNODC, 2009).

Although sex tourism has largely declined since the Covid crisis, a new form of sexual exploitation of children is booming: child pornography. In the Philippines, around one child in five, or almost 2 million children, are at risk of being sexually exploited. 

Extreme poverty and broadband access in regions of extreme poverty are factors in this phenomenon. In order to improve their living conditions, parents exploit their children as merchandise by sending child pornography to people abroad in return for payment (Bicker, 2022).

Forced marriage 

Forced marriage of teenage girls, although on the decline, still exists in various forms, such as arranged marriages and kidnappings. This practice is particularly widespread in China due to the shortage of women resulting from the “one-child family” policy. It is often carried out by “marriage brokers” and is spreading internationally. According to UNICEF, more than 80 million girls worldwide are married before the age of 18 (UN Info, 2015). 

As with most forms of child exploitation, adoption has been turned into a profitable business by traffickers. This concerns babies and young children, particularly from Latin America to North America and from Eastern Europe to Western Europe. 

While some parents are paid to sell their baby or young child, there are also cases of corruption in hospitals, where mothers are told that their baby is stillborn. These recruitments are supported by falsified documents and bribery. Barbara Hintermann, Executive Director of Terre des Hommes, reported in June 2022 that 350,000 Ukrainian children had been deported and put up for adoption by Russian families since the start of the conflict in Ukraine in February 2022 (Hintermann, 2022).

Slavery is one of the worst forms of child labour . It means that children cannot leave their employer, are under the minimum working age or work for low wages (Terre des Hommes, 2004). Also, parents sometimes accept payment in advance for their child’s work, for a fixed or indefinite period. In addition, child domestic labour is a form of exploitation that has increased over the last two decades. Children are sent to live and work as domestic servants with families abroad. Traffickers take advantage of parents’ ignorance and exploit the vulnerability of working children.

In addition, although some children beg for themselves or their families , there are many cases of children being recruited and exploited to “take advantage of the public’s inclination to give charity, particularly when it is seen as a religious duty” (Terre des Hommes, 2004). Apart from this, some children are exploited to carry out illicit activities, such as burglaries, on behalf of adults who control them.

In addition, some employers take advantage of the illegal status of trafficked children to make them do dangerous work . For example, for many years, trafficked boys have been employed as camel jockeys in the Gulf States.

Finally, it is estimated that organ trafficking accounts for between 5 and 10% of kidney transplants carried out each year worldwide (Busuttil, 2012). Although there are many accounts and testimonies of this trafficking of children’s organs, there are no official sources recording such acts.

Socio-economic factors leading to child trafficking

The children most vulnerable to trafficking often come from poor backgrounds or regions at war, in political conflict and/or experiencing economic uncertainty. Indeed, these environments are much more sensitive to the economic gains linked to child trafficking. Children with little education are also vulnerable targets. Child labour is particularly associated with school drop-out. 

According to the International Labour Organisation, “More than a quarter of children aged 5 to 11 and more than a third of children aged 12 to 14 in child labour are out of school” (International Labour Organisation, 2022). Finally, children who are victims of discrimination, persecution or former victims of trafficking are more likely to (again) become victims of trafficking, as they are unaware of their fundamental rights .

On the other hand, recourse to child trafficking can be explained by various socio-economic factors such as the demand for cheap or free labour in certain sectors to reduce production costs and thus selling prices. 

Inequalities between countries in terms of education and employment, as well as a lack of equal opportunities, discrimination and abuse, also encourage child trafficking, since many people from poor countries find it difficult to find a job that will allow them to live properly, particularly if they emigrate to richer countries.  

Ways of combating child trafficking

In order to combat child trafficking, 3 major areas need to be addressed (Northern Ireland Department of Justice, 2021):

• Prosecute the perpetrators of these practices through detection, investigation and conviction in order to dismantle child trafficking organisations (Northern Ireland Department of Justice, 2021);
• Protect children from trafficking and slavery by improving the identification of and support for child victims and by supporting them to reduce the harm caused by trafficking and slavery (Northern Ireland Department of Justice, 2021);
• Prevent child trafficking in the long term by tackling socio-economic inequalities around the world, reducing the demand for trafficked and enslaved children, and making trafficking and slavery practices unprofitable. It is also important to improve public and professional understanding of the issue through awareness-raising (NSPCC, 2021).

Here are a few factors that can help everyone identify trafficked children (NSPCC, 2021):

• If a child spends a large part of his or her time doing household chores and has no time to leave the house or even to play;
• If a child is orphaned or separated from his or her family, while living in poor-quality housing;
• If a child is not enrolled in school or a GP’s surgery;
• If a child is present in inappropriate places such as brothels or factories;
• If a child is reluctant to share personal information, where they live and tells a story that seems prepared in advance.

If you are concerned about a child, contact Humanium’s legal helpline , the police and/or the relevant local child protection authorities.

Written by Marie Cuvelier

Translated by Emily Kitchen

Proofread by Sharon Rees

Last updated on 21 March 2023

Bibliography:

Bicker, L. (2022, Décembre 10). Pourquoi les cas de pédophilie sont-ils en hausse aux Philippines ? Consulté le 15 Mars 2023, sur BBC News Afrique: https://www.bbc.com/afrique/articles/c84p1lvzqy0o .

Bureau International du Travail. (2011, Avril 01). Traire des enfants – Points essentiels. Consulté le 15 Mars 2023, sur ilo.org: https://www.ilo.org/ipecinfo/product/viewProduct.do?productId=16596 .

Busuttil, F. (2012, Décembre 16). Trafic d’enfants. Consulté le 01 Mars 2023, sur Humanium: https://www.humanium.org/fr/trafic-enfants/ .

Département de la Justice de l’Irelande du Nord. (2021). Modern Slavery and human trafficking strategy 2021-22. Consulté le 25 Avril 2023, sur www.justice-ni-gov.uk: https://www.justice-ni.gov.uk/sites/default/files/publications/justice/modern-slavery-strategy-27-05-v2_0.pdf .

Hintermann, B. (2022, Juin 22). letemps.ch. Consulté le 25 Avril 2023, sur letemps.ch: https://www.letemps.ch/opinions/forces-captures-deportes-scandale-enfants-dukraine .

NSPCC. (2021, Juin 14). Protecting children from trafficking and modern slavery . Consulté le 25 Avril 2023, sur learning.nspcc.org.uk: https://learning.nspcc.org.uk/child-abuse-and-neglect/child-trafficking-and-modern-slavery#article-top .

OIT. (2009, Juillet 01). Manuel de formation sur la lutte contre la traite des enfants à des fins d’exploitation de leur travail, sexuelle ou autres formes – Action politique de sensibilisation contre la traite des enfants. Consulté le 15 Mars 2023, sur ilo.org: https://www.ilo.org/ipec/Informationresources/WCMS_IPEC_PUB_10772/lang–en/index.htm .

ONU Info. (2015, Décembre 14). Des centaines de millions d’enfants exclus et “invisibles”, dénonce l’UNICEF dans son rapport annuel. Consulté le 15 Mars 2023, sur News.un.org: https://news.un.org/fr/story/2005/12/84342 .

Organisation Internationale du Travail. (2022, Avril 15). Travail des enfants – estimations mondiales 2020, tendances et chemin à suivre, résumé. Consulté le 25 Avril 2023, sur ilo.org: https://www.ilo.org/wcmsp5/groups/public/—ed_norm/—ipec/documents/publication/wcms_800300.pdf .

Terre des Hommes. (2004, Mai). Les enfants, une marchandise ? Agir contre la traite des enfants. Consulté le 15 Mars 2023, sur Terre des Hommes: https://www.tdh.ch/sites/default/files/tdh_enfants_marchandise-fr.pdf .

UNICEF. (2005). La situation des enfants dans le monde 2006 – exclus et invisibles. Consulté le 15 Mars 2023, sur UN-iLibrary: https://www.un-ilibrary.org/content/books/9789210597869/read .

UNODC. (2009, Février). Global Report on Trafficking in Persons – Human Trafficking a crime that shames us all. Consulté le 15 Mars 2023, sur UNODC: https://www.unodc.org/documents/Global_Report_on_TIP.pdf .

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Data collection, data analysis, health and social impacts, barriers to services as stigma drivers and facilitators, stigma manifestations, and stigma outcomes, stigma drivers: victim blaming, intersecting stigmas: stigma associated with cst, intersecting stigmas: gender, intersecting stigmas: lgbtq+ status, intersecting stigmas: international or refugee status, race and ethnicity, and socioeconomic status, intersecting stigmas: physical illness, intersecting stigmas: mental illness, stigma manifestations: stigma experiences: self-stigmatization and shame, stigma manifestations: stigma experiences: family and community discrimination and shaming, stigma manifestations: stigma practices: service providers discriminate, limitations, conclusions, global perspectives on the health and social impacts of child trafficking.

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Carmelle Wallace , Jordan Greenbaum , Karen Albright; Global Perspectives on the Health and Social Impacts of Child Trafficking. Pediatrics October 2022; 150 (4): e2021055840. 10.1542/peds.2021-055840

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Survivors of child sex trafficking (CST) experience many health and social sequelae as a result of stigma, discrimination, and barriers to health care. Our objective was to obtain a cross-cultural understanding of these barriers and to explore the relationship between stigmatization and health outcomes through application of the Health Stigma and Discrimination Framework (HSDF).

In-depth, semistructured interviews were conducted with 45 recognized CST expert service providers. Interview data were analyzed using established content analysis procedures and applied to the HSDF.

Barriers to medical and mental health services span each socioecological level of the HSDF, indicating the various contexts in which stigmatization leads to adverse health and social outcomes. Stigmatization of CST survivors is a complex process whereby various factors drive and facilitate the marking of CST survivors as stigmatized. Intersecting stigmas multiply the burden, and manifest in stigma experiences of self-stigmatization, shame, family and community discrimination, and stigma practices of provider discrimination. These lead to reduced access to care, lack of funding, resources, and trained providers, and ultimately result in health and social disparities such as social isolation, difficulty reintegrating, and a myriad of physical health and mental health problems.

The HSDF is a highly applicable framework within which to evaluate stigmatization of CST survivors. This study suggests the utility of stigma-based public health interventions for CST and provides a global understanding of the influence and dynamics of stigmatization unique to CST survivors.

Survivors of child trafficking experience health and social impacts, including barriers to health care and social stigma and discrimination. Less is known about the complex socioecological interplay of these factors and how they may be addressed to improve survivor care.

We explore in-depth the multiplicity of stigma and discrimination experienced by survivors and provide a concrete framework for understanding the health and social impacts. This framework provides a basis for physicians, service providers, policymakers, and others who work with survivors.

Child sex trafficking (CST) is a global health crisis. The United Nations defines CST as “the recruitment, transportation, transfer, harboring, or receipt of a child (<18 years) for the purposes of a commercial sex act.” 1   There are ∼1 million CST survivors annually. 2 , 3  

Marginalized children are particularly vulnerable. Risk factors include poverty; housing insecurity; previous abuse; substance misuse; and lesbian, gay, bisexual, transgender, queer (LGBTQ+) identity. 4   Societal issues such as gender bias, systemic violence, and corruption further exacerbate vulnerability. 4   Survivors experience health consequences, including injury, infections, substance misuse, anxiety, depression, and posttraumatic stress disorder (PTSD). 5 – 9   They also experience significant barriers to health care, 10 , 11   including fear of arrest, deportation, and trafficker retaliation; discrimination; confidentiality concerns; difficulty navigating the system; social instability; and resource constraints. 12   These health care barriers exist across the socioecological spectrum from individual, interpersonal, organization, community to policy levels and are the context within which CST survivors experience stigma.

Stigma was first described as an “attribute that is deeply discrediting,” resulting in “disqualification from full social acceptance.” 13   Research has further elaborated stigmatization as a social process enabled by cultural, economic, and structural influences that label, stereotype, and exclude the affected person or group. The result is discrimination or unfair and unjust treatment on the basis of an attribute or status.

Global research demonstrates a significant connection between stigma and poor health outcomes. 14   Understanding stigma, therefore, is pivotal in mitigating the health outcomes of marginalized populations. Previous stigma research exists on HIV, obesity, and mental illness. 15 – 20   However, stigma research on trafficking is limited. Research has described stigmatization in adult trafficking survivors in a single geographical location, but none evaluate stigma in CST survivors globally. 10 , 11 , 21 – 23  

We designed a qualitative study to obtain an in-depth, cross-cultural, and global understanding of the barriers to health care experienced by CST survivors, and to explore the process of stigmatization and its effect on health. We did so through the application of the Health Stigma and Discrimination Framework (HSDF). The HSDF is well suited to this purpose for several reasons. It was derived by a globally recognized consortium of diverse stigma research experts including United Nations, international, and nongovernmental organization (NGO) affiliates. 24   It was then rigorously tested through a multicenter study that demonstrated reduction in HIV-associated stigma. 25   Although not validated in CST survivors, patients with HIV have similar vulnerabilities, and these populations often overlap. Finally, in contrast to previous stigma frameworks that focus on individual and interpersonal interactions, the HSDF evaluates stigma as a socioecological process that is influenced by organizational, community, and public policy factors. This makes the framework constructive for planning public health interventions the recommended approach to addressing trafficking. 26   A public health approach removes the focus on the individual who is the victim, shifting the weight onto the socioecological forces at play.

A detailed explanation of the HSDF has been published elsewhere. 27   Briefly, the HSDF categorizes the causes of stigma into stigma drivers, which are inherently negative perceptions that drive stigmatization, and stigma facilitators, which are positive or negative external influences such as policies and social norms ( Fig 1 ). Drivers and facilitators determine whether stigma marking occurs, wherein negative attributes are applied to the individual or group. Intersecting stigmas refer to additional coinciding stigmas that may be applied. Marking manifests in stigma experiences, defined as the stigma and discrimination experienced by the person, and stigma practices, which describe societal stereotypes, prejudices, stigmatizing behavior, and discriminatory attitudes. The HSDF surmises that these manifestations influence outcomes within the population and institutions interacting with them, ultimately leading to health and social impacts.

The Health Stigma and Discrimination Framework. 1   Used with permission. 1 Stangl AL, Earnshaw VA, Logie CH, et al. The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine . 2019;17(1):18-23.

In-depth interviews were conducted with global CST experts and service providers working directly with survivors. Interviewees were initially recruited through professional networks, then referred and enrolled purposively to seek variance in the populations served and representation from all World Health Organization (WHO) regions and World Bank country income classifications. All participants were English-speaking.

A semistructured interview guide was used covering several domains, including health care needs, services, and barriers to care. Interviews were conducted through a secure Skype call, lasted 45 to 60 minutes, and were audio recorded then transcribed. Children’s Health Care of Atlanta institutional review board approved the protocol.

Analysis occurred in an iterative process using established content analysis procedures and reflexive team analysis. 28 , 29   Transcripts were independently read multiple times by 2 analysts to achieve immersion. Codes were then inductively derived and independently applied by each analyst to 10% of the transcripts. Intercoder reliability was assessed and disagreements resolved through consensus. The remaining transcripts were coded using the final coding schema. 30   Axial coding was also employed to group codes and elucidate trends. Throughout the analysis, team members met regularly to discuss emergent themes. 31   ATLAS.ti v8.3.1 software was used.

Forty-five experts were interviewed, representing all WHO regions and World Bank classifications. 32 , 33   Interviewees included direct service providers such as physicians, psychologists, and social workers as well as researchers and NGO leaders ( Table 1 ). Themes were synthesized by using the HSDF and are presented in Fig 2 . 27   Each aspect of the stigma schema was explored in-depth and is presented below (subject number denoted S#, World Bank classifications denoted L= low, LM = lower middle, UM = upper middle, H = high).

Interview themes organized within the Health Stigma and Discrimination Framework. Overlapping themes are italicized for emphasis on the intersectionality.

Participant Demographics

https://www.who.int/healthinfo/global_burden_disease/definition_regions/en/ .

https://databank.worldbank.org/home.aspx .

Several participants had 2 roles.

Participants did not specifically denote if their primary clients or patients identified as LGBTQ+ but several alluded to working with the LGBTQ+ population, and thus are implicitly included.

Several participants have worked with organizations with multiple programs or have worked with multiple organizations.

Participants reported that CST survivors experience a litany of health and social impacts. They reported social isolation, difficulty reintegrating into the community, sexually transmitted infections, reproductive health issues, seizures, malnutrition, untreated injuries, depression, anxiety, PTSD, eating disorders, and substance misuse ( Fig 2 ).

Themes describing barriers to services spanned each socioecological level of the HSDF, providing rich descriptions of the individual, interpersonal, organizational, community, and policy contexts in which stigmatization occurs ( Table 2 ). Most barriers were described in countries from all income levels. They were reflected in the model as stigma drivers, facilitators and manifestations, as well as outcomes leading to health and social impacts. Overlapping themes spanning multiple components of the model are italicized to emphasize pervasiveness ( Fig 2 ).

Barriers to Medical and Mental Health Care Presented Within Socio-Ecological Levels per HSDF With Notable Country Income Level Trends

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

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.

child sex trafficking

Health Stigma and Discrimination Framework

lesbian, gay, bisexual transgender, queer

nongovernmental organization

posttraumatic stress disorder

World Health Organization

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I Was Trafficked as a Teen. Here’s What I Want People to Understand

W hen I talk about being trafficked as a teenager, people ask two questions: How did it happen, and how did nobody know it happened? For most of my life, these conversations happened with the few friends, and then recently it happened more frequently after the release of my novel, The Lookback Window , which is about recovering from sex trafficking and pursuing justice in the wake of New York’s Child Victims Act. Sex trafficking isn’t dinner conversation, and the instances where it makes the news often revolve around paranoid fantasies of the alt-right. Recently, this manifested as Sound of Freedom , the terrible, white savior film starring Jim Caviezel, which doubles as a biopic of Tim Ballard and a false charity.

Tim Ballard is a conservative multi-hyphenate who created Operation Underground Railroad, an anti-child trafficking organization, after witnessing the horrific commercial sex trade from his work in the Department of Homeland Services’ Internet Crimes Against Children task force. This is the subject of the film, his heroic origin story. Nowhere in this biopic do you ever understand anything, really, but the notes of the film feel familiar enough, as if they have been recycled from another story, another fiction, another con. In October 2023, Ballard was accused of grooming and sexually harassing women, allegedly using his work with Operation Underground Railroad as a narrative cover, asking women how far they would go to help the cause. Would they pose as his wife, sleep with him, do what it takes to save the children?

At some point in the film, Caviezel says, “Nobody cares.” The dominant narrative has been that nobody cares because no one understands how the practice exists around them. It’s a lonely feeling and a sentiment that I have felt at times in my recovery. Media like this doesn’t do much but exacerbate this feeling. It preys on the right’s xenophobia, conspiracists, and religious fanaticism under the guise of saving the children.

But the problem is that the international commercial sex trade doesn’t just exist—it persists. In fact, it lives here, in America, all around us. And by sharing what happened to me, I hope that other victims will have an easier time speaking up and advocating for justice.

When I was 14, I got a message on MySpace from a 19-year-old who also lived in my same city in Westchester, telling me that he thought I was attractive. He lived across the street from my high school and asked if I wanted to go on a date. I didn’t respond at first, but I showed a friend of mine the message, and she told me she knew him. He was a family friend. I was lonely, had a difficult relationship with my parents, and was closeted. So, I responded to the message. 

When we met, he kissed me on the lips, asked my age, and then asked if I had ever smoked a blunt. I got so high I thought I was having a stroke. He asked me to be his boyfriend and then raped me in his bedroom and told me he loved me. When I was bleeding after, he said the same thing happened to him the first time he had sex, and that it was normal to bleed. I trusted him.

He’s what’s known as a “Romeo,” a pimp who lures a vulnerable person using the structure of a romantic relationship. He would give me a ring to wear, promising to marry me when I turned 18, too. He picked out a wedding date and wrote it on his wall. I don’t have many pictures from that era because my stomach turns if I’m reminded of how young I really looked, knowing what happened to me. But my family took a trip to Colorado that year and that friend who knew my rapist came along. She took pictures of the two of us, and if you look at my hand you could see the ring. I thought my boyfriend loved me.

There are other types of pimps: gorilla pimps whose main method of control is violence, CEO pimps who promise money, and familial pimps who sell the people in their family. Nothing is ever so separate, and when you’re being groomed you don’t realize what’s happening to you. He started out by telling stories of what he had done when he had been my age. They started out as cool, funny stories of hooking up with older men. The drugs he had done. Fights he had been in. That he had burned down part of his house when he was younger. (Later, after years had passed, I found out that he had been in-and-out of jail for various assaults.) He came up with a story that he was 16, if anyone asked, and that I couldn’t tell anyone about us or he could go to jail, and if I were talking about him to use a fake name.

Read More: She Survived Sex Trafficking. Now She Wants to Show Other Women a Way Out

I would skip school and walk to his house. On the weekends, I would tell my parents I was sleeping over at a different friend’s place, where he would get me high or drunk, and then post the ads on Craigslist with naked pictures of me that he had taken. Old men would reply and come over, give him money or drugs or both, and rape me in his bedroom. Some had wedding rings, some would force other drugs into me, and all of them asked how old I was. Sometimes he would drive me to their house. He would give me pills to calm me down the next day, buy me food, tell me details about the wedding. He would give me hickeys and teach me how to cover up bruises, and then by the time the older men hurt me I knew how to cover up bruises on my own. He bought me jockstraps and short shorts, and he had once casually joked about taking child porn in conversation to my friend who came to Colorado. I only know this detail because when I eventually went to the police, that friend had written it down in her diary, which was dated, and given over to the detective.

I failed classes and missed so much school my parents were alerted. I was rail thin, depressed, and was put on benzos by a psychiatrist. I was caught hanging out with this other older guy with a fake name. I wore very short shorts, tight shirts, and fell asleep during the day since I could barely sleep at night. I didn’t have many friends. All of these are considered signs that point to a risk factor.

He “broke up” with me when I was 17. I stopped looking as young as I once looked. No longer did I have braces. I went through puberty. One of the last times I saw the man who pimped me out, I told him how much he had hurt me and that I thought about going to the police. He threw my phone against the wall, beat me, and warned me what would happen if I ever told anyone. I overdosed on pills later that year, wanting to end the panic attacks, depression, and fear, but I was too young to know what had happened to me—that I was dealing with complex PTSD, and the extent of the violence.

The day after I graduated high school, I moved to San Diego without knowing anyone because I could not stomach being near the scene of the crimes. It was the farthest place away I could find. I have been in recovery for almost two decades now, and finally got the proper help I needed once I started telling people what happened. I was referred to the Crime Victims Treatment Center, a place where I could actually learn how to deal with living as someone who had once been trafficked. I could have had an easier time had I spoken more about what happened, had I known there are real treatments, had I not only thought of trafficking as something that happens far away from New York. If I had the language for what happened to me earlier, I could have saved myself years of private shame and self-destruction.

What is the sound of freedom? It’s what wakes my husband in the middle of the night as I scream in my sleep, 17 years later, and the softness of his voice telling me I’m safe. Or a notification from Instagram as a stranger who read my book tells me: “I was also trafficked as a teenager and our stories are super similar.” And the crowd asking questions about vengeance and justice at Strand Books where I talk with a friend about how angry I am and the solace I’ve found in being open. The practice of liberation requires creating room for the speech of victims. When I finish my events, I have a moment of silence for others to raise their hands, to talk after the event, to send a message. You are free to say what you need.

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United Nations

Office on drugs and crime, unodc shines spotlight on causes and impact of child trafficking.

Vienna (Austria) – 20 September 2023 - Children as young as six are forced to work extensive hours in dangerous settings in quarries, mines and factories.

Others toil in extreme weather and inhumane conditions on plantations and fishing boats or work, without pay, as domestic servants.

Some are sexually abused in brothels, bars, private homes and online or forced into marriage. All these children are victims of human trafficking.   

“They’re not only exploited, but may also be raped, beaten, humiliated, deprived of liberty, and forced to live in squalor - their childhoods are stolen,” says Mukundi Mutasa, a UNODC crime prevention expert.

“Many are physically and psychologically scarred for life, while others do not survive their trafficking ordeal,” he adds.  

Research, conducted by UNODC, shows that some traffickers use their child victims to commit crimes, such as theft, illegal drug production, and even acts of terrorism, for which they are sometimes arrested, deported or imprisoned.

Next month, delegates from around 120 countries will meet in Vienna, Austria, and online, to discuss how to better counter child trafficking.

The discussion forms part of the annual meetings of the intergovernmental  Working Group on Trafficking in Persons  and centres around an in-depth  paper on this topic produced by UNODC’s Human Trafficking and Migrant Smuggling Section.

Children at risk

UNODC’s latest report on global human trafficking trends shows that around 35 percent, or one in three, of detected victims of trafficking are children.

While cases of child trafficking are detected in all regions and in most countries in the world, in Central America and the Caribbean, North Africa and the Middle East, and Sub-Saharan Africa, children account for the majority of identified victims.

Children are particularly vulnerable to human trafficking for several reasons, including  poverty, lack of access to education, humanitarian crises, or the lack of support networks.  

“Traffickers are known to prey on children in vulnerable situations, especially when their parents or guardians struggle to support their households. This places children under pressure to contribute to the family’s income,” explains Mutasa. 

The UNODC anti-trafficking expert says, in many cases, the traffickers are known to the child’s family and guardians or they target children without parental care, including those in orphanages and foster homes.

Criminals take advantage of these situations to deceive children and the adults who care for them with “fake promises of better opportunities”.

“In some cases, family members even play a role in the trafficking process, especially in the initial stages. Our research suggests that the extent of family involvement in cases of child trafficking is up to four times higher than in cases of adult trafficking,” he says.

Essential training  

UNODC’s anti-trafficking experts train relevant authorities how to identify cases of human trafficking, including those that involve children, and to take the necessary steps to support the child and prosecute the traffickers.

A recent case of forced ‘marriage’ in Malawi shows the impact of this work. A female child was trafficked by her uncle and forced to live with a man she had never met before. This man had paid her uncle money for a ‘wife’.

Over a period of eight months, he would repeatedly rape, beat and abuse her. Her ordeal came to an end when neighbours heard her crying and reported this to the authorities.  

Police officers trained by UNODC rescued the girl and identified the signs of trafficking for the purpose of forced marriage.

With the cooperation of UNODC’s office in Malawi, the girl is being supported by two non-profit organisations. Her uncle and her abuser are both in prison.

Impact of crises on child trafficking

According to UNODC data, existing risks for child trafficking are worsened further during times of emergency.

Natural disasters, such as floods, droughts and typhoons, and armed conflicts force children to flee their homes often unaccompanied by or, at times, separated from parents or guardians.   

Deprived of opportunities and protection, the displaced, migrant or asylum-seeking children are easy targets for traffickers.

Low levels of detection

Statistics collected by UNODC indicate that in 166 countries, over 18,000 child victims of trafficking were identified in 2020.

However, anti-human trafficking experts fear the rates do not reflect the full extent of the problem, due to the clandestine nature of this crime and the lack of data collection in many parts of the world.

The Working Group will also look at issues concerning the protection of child victims, their access to justice, and the long-term impact on their well-being and health, as well as their opportunities for rehabilitation and reintegration, and the risks of re-exploitation.

“It’s the first time this expert meeting has focussed on child trafficking,” says Mukundi Mutasa.  

Further information:

The Working Group on Trafficking in Persons is the principal forum within the UN system for discussion about human trafficking. It was established to facilitate exchange between crime prevention and criminal justice experts from the countries that have committed themselves to implement the UN’s Trafficking in Persons Protocol . More than ninety percent of States globally are implementing  this international instrument.

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Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services

Livia ottisova.

1 King’s College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Patrick Smith

Hitesh shetty.

2 South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom

Daniel Stahl

3 King’s College London, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Johnny Downs

4 King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

5 King’s College London, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Associated Data

BRC Case Register (CRIS) provides a means of analysing anonymised data from the South London & Maudsley Foundation NHS Trust (SLAM) electronic case records. Access to clinical information is clearly a sensitive issue and a security model was developed which has been considered and approved by the SLAM Caldicott Guardian and the Trust Executive, as well as forming part of the ethics application. We are unable to report individual-level data in the public domain because these comprise patient information, but these have been aggregated and proportions reported in full in the present paper. Researchers may apply for approval to access these or other CRIS data. Individuals wishing to apply for access to CRIS data can contact the NIHR Maudsley Biomedical Research Centre (BRC) Manager, Dr. Saliha Afzal, on ku.ca.lck@yelsduamu-crb or Tel: +44 (0)20 7848 5485. More information is available at http://brc.slam.nhs.uk/about/core-facilities/cris .

Child trafficking is the recruitment and movement of people aged younger than 18 for the purposes of exploitation. Research on the mental health of trafficked children is limited, and little is known about the use of mental health services by this group. This study aimed to investigate the mental health and service use characteristics of trafficked children in contact with mental health services in England.

Methods & findings

The study employed an historical cohort design. Electronic health records of over 250,000 patients were searched to identify trafficked children, and a matched cohort of non-trafficked children was randomly selected. Data were extracted on the socio-demographic and clinical characteristics, abuse history, and trafficking experiences of the trafficked children. Logistic and linear random effects regression models were fitted to compare trafficked and non-trafficked children on their clinical profiles and service use characteristics. Fifty-one trafficked children were identified, 78% were female. The most commonly recorded diagnoses for trafficked children were post-traumatic stress disorder (PTSD) (22%) and affective disorders (22%). Records documented a high prevalence of physical violence (53%) and sexual violence (49%) among trafficked children. Trafficked children had significantly longer duration of contact with mental health services compared to non-trafficked controls (b = 1.66, 95% CI 1.09–2.55, p<0.02). No significant differences were found, however, with regards to pathways into care, prevalence of compulsory psychiatric admission, length of inpatient stays, or changes in global functioning.

Conclusions

Child trafficking is associated with high levels of physical and sexual abuse and longer duration of contact with mental health services. Research is needed on most effective interventions to promote recovery for this vulnerable group.

Introduction

Child trafficking is a significant public health problem and human rights violation affecting millions of children worldwide. Child trafficking is defined as the recruitment, transportation, transfer, harbouring or receipt of young people for the purpose of their exploitation [ 1 ]. Globally, it is estimated that 20.9 million people are in situations of forced labour as a result of human trafficking, and that 5.5 million of these are children [ 2 , 3 ]. Children make up an increasingly large share of the total number of victims of human trafficking and comprise one third of all identified trafficked people [ 4 ].

Human trafficking is believed to affect all countries throughout the world, and these can serve as places of origin, transit and destination of trafficked individuals. Key socioeconomic drivers of human trafficking include poverty and socioeconomic inequality [ 5 ]. Children can become further vulnerable to exploitation due to illness or death of a family member or separation from the family in the context of forced migration, natural disasters, and civil unrest [ 4 , 5 ].

Given the illegal and clandestine nature of human trafficking, the exact numbers of trafficked children are unknown. Whilst official statistics on detected victims provide some information about general trends in trafficking, estimating the number of undetected victims remains a challenge [ 4 ]. Emerging research from the United Kingdom as well as national statistics indicate that children are trafficked into a range of industries, including sex work, forced marriage, domestic servitude, agricultural labour, car washing, factory labour and criminal exploitation, such as cannabis cultivation [ 6 , 7 ].

Children can experience extreme forms of exploitation and abuse in the context of human trafficking. Emerging research suggests that 24–56% of trafficked children experience physical violence and 21–51% experience sexual abuse [ 8 – 10 ]. A large body of evidence from other child populations attests to the adverse effects of physical and sexual violence on children’s physical health and wellbeing. Child physical and sexual abuse are also causally associated with a range of mental disorders, substance abuse, and suicide attempts [ 11 , 12 ]. Previous research with adults has found trafficking to be associated with high rates of posttraumatic stress disorder (PTSD), depression, and anxiety disorders [ 9 , 13 – 15 ]. However, research on the health needs and experiences of trafficked children is scarce. Three studies conducted with victims of child trafficking provided preliminary evidence of high rates of depression, PTSD, and anxiety disorders, as well as self-harm and suicide risk [ 8 – 10 ]. However, relatively little is known about the mental health needs of trafficked children, and even less is known about those with serious mental illnesses.

The only study to date conducted with a clinical population of trafficked people in contact with mental health services found that trafficked adults were significantly more likely to be compulsorily admitted as inpatients and had longer admissions than matched non-trafficked controls. However, whether or how the mental health needs of trafficked children in contact with services differ from those of non-trafficked children is currently not known.

This study aimed to investigate the sociodemographic and clinical characteristics of trafficked children in contact with secondary mental health services, and compare their pathways into services and current care with those of matched non-trafficked children. It was hypothesised that trafficked children, as compared to non-trafficked controls, would be (1) significantly more likely to have adverse pathways into care, defined as having first contact with secondary mental health services via the emergency department or police; (2) significantly more likely to be compulsorily admitted for psychiatric treatment (i.e. admitted for care under the Mental Health Act (MHA)); (3) have longer total length of contact with secondary mental health services and (4) longer inpatient admissions; and (5) would have significantly worse clinical outcomes as evidenced by less improvement in measures of global functioning.

An historical matched cohort design of trafficked and non-trafficked children in contact with secondary mental health services in South East London (UK) between 1 January 2006 and 21 November 2014. Data were obtained from the NIHR Biomedical Research Centre Clinical Record Interactive Search (CRIS) system, which provides access to electronic mental health records from South London and Maudsley (SLaM) NHS Foundation Trust, the largest provider of secondary mental health care in Europe. The CRIS database converts electronic mental health records into research-accessible datasets, preserving anonymity through technical and procedural safeguards [ 16 , 17 ]. CRIS allows for the search of over 250,000 anonymised full patient records of individuals referred to SLaM services, including over 46,000 children and adolescents (hereafter collectively referred to as children ). CRIS electronic records include all clinical and socio-demographic information recorded during patients’ contacts with SLaM services. Relevant records can be retrieved using search terms for structured fields (e.g. diagnosis) or free text (e.g. clinical event notes).

Participants

The sample consisted of trafficked and matched non-trafficked children in contact with SLaM services. Children were included in the trafficked group if they were less than 18 years old at first contact with SLaM services and their mental health records indicated that they were victims of human trafficking. Trafficking was defined in accordance with the United Nations protocol [ 1 ] as the recruitment or movement of people aged younger than 18 for the purposes of exploitation, and included international and domestic trafficking. Trafficking terms such as “trafficked” “domestic servitude” and “sexual exploitation” were used to search clinical notes and correspondence of children who had accessed care within SLaM since 1 January 2006–21 November 2014 (search upper date limit; see full list of search terms in S1 File ). Records that included one or more trafficking terms were screened for eligibility. Inclusion criteria for the trafficking group were met if clinical records suggested a child’s care team believed they had been trafficked, either based on information consistent with the definition of human trafficking given directly by the child, or because of access to third party information (e.g. ongoing police or social services investigation of allegations the child had been trafficked). Cases where trafficking was suspected but not confirmed during the course of contact with services were included in order to arrive at as comprehensive a sample as possible. Cases where trafficking exposure was unclear were resolved by consensus with reference to a second reviewer. Due to the limitations of clinical data we were unable to reliably assess whether all children were free from their traffickers while in contact with SLaM services (i.e. having escaped or been rescued from or having been abandoned by their traffickers) or whether some children were in contact with or returned to their traffickers during or after accessing mental healthcare.

The control group consisted of SLaM service users matched to cases for primary diagnosis, gender, age (+/- 1 year), type of initial care (inpatient or outpatient), and year of most recent service contact. The matched cohort was selected using a computer-generated random sample from all potential controls that met the matching criteria for each case, aiming for a case—control ratio of 1:4.

All data were collected as part of routine assessment and treatment of individuals in contact with SLaM services. Data were extracted from structured fields (e.g. dates, outcome scores) and by targeted searches of free-text clinical notes and correspondence using keywords and wildcards, which allowed searching for terms anywhere within a phrase.

Socio-demographic characteristics

Gender, country of origin, and living arrangements at first contact were extracted from structured fields and supplemented by hand searching free-text notes. Age at first contact was calculated by subtracting the date of birth from the date of first contact with services, both of which are routinely recorded.

Pre-trafficking and trafficking characteristics

Information about the absence or death of one or both parents and whether exploitation took place prior to arrival in the UK and/or in the UK was extracted from free-text clinical notes. Details about the type of exploitation were extracted from free-text clinical notes and coded as Sexual exploitation, Domestic servitude, Factory labour, Restaurant labour, Road construction, Laundry labour, Unspecified labour, Child soldier, Fraud, or Unknown. Due to small cell counts these were later re-categorised into Sexual exploitation, Domestic servitude, Other, or Unknown. As some children experienced multiple forms of exploitation, all types of exploitation were coded. Reports of sexual violence and physical violence whilst trafficked, pregnancy at the time of escaping the trafficking situation, and a history of terminations of pregnancy were extracted from free text clinical notes.

Clinical characteristics

Primary ICD-10 diagnosis is routinely recorded in a structured field. Data extraction was supplemented with free-text searches of notes when this was missing (n = 5). For children whose diagnosis changed over time, the diagnosis at most recent contact was used. As primary diagnosis was one of the matching criteria, where this field was missing for trafficked children (n = 10), clinical records were independently reviewed by a consultant child psychiatrist (JD) and a consultant clinical psychologist (PS) and a diagnosis assigned. Initial inter-rater agreement was found for 7/10 cases; consensus diagnosis was reached for the remaining 3/10 cases.

Clinical outcomes were investigated using the Children’s Global Assessment Scale (CGAS) scores. The CGAS is a clinician-rated measure of children’s adaptive functioning in the domains of home, school and with peers during the previous month. It is rated on a 100-point scale with 1 being most impaired and 100 being least impaired, with descriptors given for each 10-point interval. CGAS ratings are routinely recorded in clinical notes at first contact and discharge. The difference between the initial and final CGAS score was used to assess clinical change during contact with services.

Participants were coded as having had prior contact with secondary mental health services and prior psychiatric admissions where this was indicated in their free text clinical notes. Data about history of deliberate self-harm, prior suicide attempt, and current or historical substance misuse were extracted from structured risk assessments and supplemented with information from free text clinical notes.

Service use characteristics

Route of entry into care is a structured field and was routinely recorded in clinical notes. An adverse pathway into care was defined as first referral to SLaM services via the emergency department or police. Admission and discharge dates were used to identify episodes of inpatient care and the total duration of inpatient admissions with SLaM. To establish whether a child was an inpatient at first contact with the Trust, the date of acceptance of the first referral to SLaM was compared to the date of the first inpatient episode. Details of the use of Section 136 of the Mental Health Act, used in the UK by police to take individuals to a place of safety if they are in crisis, were found using structured fields on the use of the Mental Health Act and searches of free text notes. Compulsory psychiatric admissions were measured using structured fields recording the use of Section 2 or 3 of the Mental Health Act 1983, which in the UK are used to detain patients in hospital for assessment and/or treatment. Total duration of SLaM care was calculated by comparing the date of first referral and the date of last contact or discharge, excluding any periods in between different episodes of care (upper date limit 17 December 2015).

Abuse experiences

Information about experiences of physical and sexual childhood abuse was extracted from free text notes. When history of abuse was not explicitly mentioned in clinical notes it was coded as ‘not present’, yielding a conservative estimate of the likely true prevalence.

Data analysis

All statistical analyses were conducted in Stata 12. Socio-demographic and clinical characteristics were described using descriptive statistics (proportions for categorical variables and means and SDs for continuous variables). Tests of normality showed that duration of contact with SLaM services and duration of SLaM inpatient admissions were not normally distributed. These were subsequently transformed by taking the natural logarithm to ensure a more normal distribution; the transformed variables were used in all subsequent analyses.

Random intercept logistic and linear regression models were fitted using trafficking status as a categorical independent variable (1 = trafficked, 0 = not trafficked) to compare characteristics of trafficked and matched non-trafficked children. A matching identifier representing clusters of matched individuals was included as a random factor in all regression models to account for possible non-independence of matched individuals. Prior contact with secondary mental health services, history of psychiatric admission, history of childhood abuse, substance misuse problems, and total duration of contact with SLaM were investigated as potential confounders and entered simultaneously into regression models. Because the regression coefficients for log-transformed outcome variables are difficult to interpret, we present the estimates of the fixed effects as the percentage of change between trafficked and non-trafficked children by using the formula 100 x (exp(b)- 1).

Ethics approval

Ethics approval for the research use of CRIS-derived anonymised databases was granted by an independent Research Ethics Committee (Oxfordshire C, reference 08/H0606/71). Approval for this study was granted by the Oversight Committee that reviews all applications to use CRIS (11/025). The terms of the oversight committee approval require some restrictions on reporting to maintain anonymity, for instance on reporting a cell count of less than 10 people. The committee reviewed the results reported below and gave permission to present low cell counts where shown.

The CRIS database searches identified 158 children whose records included one or more trafficking search terms; 103 of these were excluded, for instance because the term was used in relation to drug trafficking, or because the child was referred to but never formally assessed by services. Four cases in which trafficking exposure was unclear were discussed with a second reviewer; two of these were included and two were excluded after discussion. The final sample included 51 trafficked children.

Socio-demographic and clinical characteristics of trafficked children in contact with secondary mental health services

The socio-demographic characteristics of the trafficked children and information about their experiences of exploitation are described in Table 1 . Seventy-eight percent of the sample was female, and 53% fell in the 16–17 age range (mean 14.0 years, SD = 3.1, range 5–17). Children came from 21 countries, with the most commonly recorded countries of origin being Nigeria (13 children [25%]), Albania (4 [7.8%]) and the Democratic Republic of Congo (4 [7.8%]).

a Some percentages do not add up to 100 due to rounding error.

b Other types of trafficking recorded included restaurant and laundry labour and for the purposes of fraud.

Children were most commonly trafficked for sexual exploitation (21 children [41%]) and domestic servitude (13 [25%]), as well as other forms of labour including restaurant work and laundry (4 children [8%]). Information regarding the type of exploitation was not recorded for 13 trafficked children (25%). Physical violence during trafficking was reported by 27 children (53%), sexual violence by 25 (49%), and 38 children (74%) reported physical or sexual violence.

Clinical characteristics of the trafficked children are reported in Table 2 . The most frequently recorded clinical diagnoses were PTSD (11 children [22%]), mood disorders (e.g. depression) (11 [22%]) and reaction to severe stress and adjustment disorders (7 [14%]). Ten children (20%) had non-specific diagnoses including ‘mental disorder, not otherwise specified’ and ‘childhood emotional disorder, unspecified’, and these were grouped under the category ‘Other childhood emotional disorder’. Seventeen children (33%) had deliberately self-harmed prior or during contact with SLaM services and 14 (27%) had attempted suicide. Six individuals (12%) had been in contact with secondary mental health services prior to SLaM and 3 (6%) had previously been admitted as psychiatric inpatients (not shown). Substance misuse problems were recorded for 9 individuals (18%).

a Variable includes self-injury and suicide attempt

Children were referred to SLaM services by a variety of sources including child protection services, primary care physicians, paediatricians, and law enforcement ( Table 2 ) . Seventeen of the trafficked children (33%) were referred for mental health care by non-emergency health services and 15 (29%) were referred by social care. Nine children (18%) had adverse pathways into services. Ten children (20%) were admitted as psychiatric inpatients while in contact with SLaM services and four (8%) had one or more compulsory psychiatric admissions under the Mental Health Act. The median duration of contact with SLaM services was 581 days.

Comparison of trafficked and non-trafficked children's pathways into secondary mental health services and clinical outcomes

Fifty-one trafficked children were compared with a randomly selected matched sample of 191 non-trafficked children. The matching ratio 1:3.7 fell below the target ratio 1:4 because not all children could be matched to four non-trafficked controls. All trafficked children were matched with at least one control.

Results of the comparative analyses are reported in Tables ​ Tables3 3 and ​ and4. 4 . Trafficking was not found to influence adverse pathway into care (adjusted odds ratio [AOR] 1.15, 95% CI 0.48–2.79, p = 0.65) or compulsory psychiatric admission (AOR 0.27, 95% CI 0.06–1.25, p = .10).

a Participants were matched on gender, age (± 1 year), primary diagnosis, inpatient admission on first contact, and year of most recent contact.

b Analyses of adverse pathways into care, compulsory psychiatric admission, duration of SLaM psychiatric inpatient admissions and change in clinical outcomes were adjusted for previous contact with secondary mental health services, previous admission as a psychiatric inpatient, substance misuse, history of deliberate self-harm, and duration of contact with SLaM services. Analyses of duration of contact with SLaM services were adjusted for previous contact with secondary mental health services, previous admission as a psychiatric inpatient, substance misuse, and history of deliberate self-harm.

a Participants were matched on gender, age (± 1 year), primary diagnosis, inpatient admission on first contact, and year of most recent contact. Models controlled for previous contact with secondary mental health services, previous admission as a psychiatric inpatient, substance misuse, history of deliberate self-harm, and duration of contact with SLaM services.

b Models were fitted to log-transformed values of Duration of contact with SLaM services and Duration of inpatient treatment admissions. For ease of interpretation we present % change (95% CI).

Multiple random effects regression analyses were conducted to investigate if duration of contact with SLaM services was associated with trafficking status. The results of this analysis indicated that trafficked children had a longer total duration of contact with SLaM services (b = 1.66, 95% CI 1.09–2.55, p<0.02), and that this association remained significant after controlling for previous contact with secondary mental health services, history of admission as a psychiatric inpatient, substance misuse, and history of deliberate self-harm (b = 1.56, 95% CI 1.14–2.13, p<0.01; Table 4 ). This indicated that the duration of contact with SLaM will be 56% longer for trafficked children than non-trafficked children. However, there were no significant differences between trafficked and non-trafficked children with regards to the total duration of inpatient admission (b = 0.97, 95% CI 0.81–1.16, p = 0.74). Changes in CGAS scores were also not significantly associated with trafficking status (b = 2.35, 95% CI -3.33–8.04, p = 0.42; Table 4 ).

Research on the health needs of trafficked children is limited [ 18 , 19 ]. To our knowledge, this research forms the largest study with trafficked children in a high income country and, for the first time, provides comparative data on trafficked and non-trafficked children with mental health problems.

Trafficked children in contact with secondary mental health services come from a range of countries and had been trafficked for several different types of exploitation, including sexual exploitation, labour exploitation and domestic servitude. The main countries of origin of trafficked children and the types of exploitation they experienced are consistent with national statistics of identified cases of child trafficking [ 7 ]. Clinical records indicated that trafficking was associated with high levels of physical and sexual violence. Exposure to violence is an established predictor of psychological morbidity in children more generally and has also been found to be a risk factor for depression, anxiety and suicidal ideation in trafficked children in contact with post-trafficking services in a large study by Kiss et al. in the Mekong region [ 8 ].

The most common clinical presentations in the trafficked group were posttraumatic responses (which included PTSD (22%) and reaction to severe stress and adjustment disorders (14%)) and affective disorders (22%). These are consistent with the most commonly endorsed symptoms reported by trafficked children in the Mekong study [ 8 ]. However, a significant proportion of children (19%) presented with non-specific emotional and behavioural difficulties, highlighting diagnostic complexity and the need for a multidisciplinary approach in their treatment. A large proportion of trafficked children (33%) presented with deliberate self-harm and 27% had a record of having attempted suicide. This is higher than the figure reported by Kiss et al. who found that 12% of their sample had tried to harm or kill themselves in the past month. The differences in prevalence may be partly explained by the fact that this was a treatment-seeking sample in contact with specialist mental health services, and that the coding of a history of suicide attempt was not only restricted to the last month before coming into contact with services but potentially over a child’s lifetime. The high prevalence of self-harm and suicide attempts, including during contact with secondary mental health services, indicates the need for rigorous risk assessment and care planning by clinicians in contact with trafficked children and young people. Notes for a very high proportion of children recorded the absence of one or both parents prior to exploitation. This points to the social contexts that may facilitate exploitation and contributes to the emerging literature about pre-trafficking characteristics and risk factors that may make people more vulnerable to exploitation and also to subsequent mental health difficulties Enquiring about a child’s pre-migration social situation as well as their experiences of exploitation may therefore help clinicians identify important risk factors for future and ongoing harm and contribute to the development of a more robust care plan.

Trafficked children’s clinical profiles and care pathways as compared to non-trafficked children

The key points of entry into mental health services were primary care, children’s social services, and emergency departments, highlighting the need for those working at the frontlines of these services to be trained to identify and respond appropriately to human trafficking. Contrary to hypothesis, no significant differences were observed with regards to trafficked children’s likelihood to have adverse pathways into mental health care when compared to matched controls. Similarly, trafficked children were no more likely to be compulsorily admitted for psychiatric inpatient care nor to have longer duration of inpatient stays. Trafficked children also did not show significant differences in CGAS as a result of contact with services. The only significant clinical difference that emerged was that trafficked children compared to non-trafficked children had a longer total duration of contact with SLaM services. Whereas longer duration of total contact could indicate greater chronicity of their mental health difficulties, it could also be an indication of their more complex social needs which might cause delays in services’ ability to discharge them. Indeed, a recent qualitative study of challenges faced by mental health providers in meeting the needs of trafficked individuals highlighted the impact of complex social needs and of difficulties with inter-agency working on care provision. However, as reasons for longer duration of contact were not directly investigated in this study, further research is needed to clarify the causes for this finding.

Strengths and limitations

The study used an innovative data source to gain access to data on a vulnerable population that is traditionally difficult to recruit for clinical research. Full electronic health records retrieved through the CRIS database enabled access to detailed information about trafficked children’s mental health needs and contacts with services. The study built on previous research with trafficked children by including a clinical control group, which allowed for an empirical test of differences in clinical profiles, pathways into care, and service use characteristics. It did, however, suffer from important limitations. Although several variables were routinely recorded in structured fields others were not, requiring searches to be conducted of free-text clinical notes. In particular, clinical records varied in the level of detail provided on children’s experiences of trafficking, sometimes simply noting that a child was suspected to be trafficked or currently applying for asylum on the grounds of being trafficked. This meant that establishing the type of exploitation and characteristics of the trafficking situation was not possible for a quarter of the cases. In these instances, records were closely checked against the UN Protocol definition of child trafficking, and consideration was given to third party information (e.g. communication from children’s services indicating a child was a suspected victim of trafficking) to ensure a child met the exposure criterion. Cases where trafficking status remained unclear were resolved with reference to a second reviewer. Experiences of violence and abuse are also not routinely assessed or recorded by clinicians; the prevalence of violence is therefore likely to be a conservative estimate.

In spite of using a comprehensive list of trafficking search terms to search for the records of trafficked children, it is likely that this method did not identify all trafficked children in contact with SLaM services during the study period. This is both due to staff not always becoming aware of a child’s trafficking status, and also, in instances where they were aware, not necessarily using ‘trafficking’ or other key words in their clinical records. It is possible that some of the children in the control group could have been trafficked, and that they had not been identified as such by staff. However, the likelihood of this being the case would have been very low.

Finally, the sample size of 51 trafficked and 191 non-trafficked children is not very large, and the lack of power may have affected the ability to detect significant between-group differences. This would have particularly affected the tests of binary outcomes, and negative findings need to be treated with care.

Generalisability of findings

In spite of the sample's diversity in terms of age, types of exploitation, and countries of origin, they represent a highly select group of trafficked children: those who have been able to access secondary mental healthcare. Information about their socio-demographic details and trafficking history is unlikely, therefore, to be representative of the wider population of trafficked children. In addition, the findings reflect the mental health needs of trafficked children in contact with secondary mental health services in London and will need replicating in other country settings.

Implications

Trafficked children are in contact with secondary mental health services in the UK and present with significant histories of sexual and physical violence, considerable social needs, and a range of clinical presentations. Mental health professionals need to be aware of indicators of possible exploitation and be supported to develop skills to enquire safely about suspected trafficking and respond appropriately, including through referrals to social and legal support.

Trafficked children in this study presented with a range of mental health symptoms and diagnoses, including high risk and severe mental illness warranting inpatient admission. Post-trafficking support organisations, children’s services, and other agencies in contact with trafficked children should incorporate mental health screening as part of their standard service provision in order to facilitate timely referrals to psychiatric care. Staff at these services would also benefit from being aware of signs of mental distress and being trained in how to respond, including how to access mental health support for clients through primary and secondary care.

Interventions with trafficked children should follow evidence-based, disorder-specific protocols that take into account children’s substantial history of abuse, separation from caregivers, and displacement. Clinicians may benefit from drawing on established models of working with young refugees, survivors of childhood sexual abuse, and looked-after children when drawing up individualised care plans [ 20 ]. Narrative exposure therapy [ 21 ] and the child version KidNET [ 22 ] are trauma-focused therapies with a strong evidence base with survivors of multiple trauma and human rights violations, and trauma-focused cognitive behavioural therapy (tf-CBT) has been shown to successfully treat PTSD in child survivors of sexual abuse [ 23 , 24 ]. Further research is needed to test the effectiveness of psychological interventions in meeting the mental health needs of trafficked children.

Mental health professionals need to be aware of potential indicators of trafficking and be able to respond safely and appropriately to suspicions and disclosures of abuse in order to effectively safeguard this vulnerable group. Further intervention research is needed to meet the significant mental health needs of trafficked children.

Supporting information

Acknowledgments.

We thank Matthew Broadbent, Megan Pritchard and Debbie Cummings of the BRC Nucleus for their invaluable support with use of the CRIS database.

Funding Statement

The authors received no specific funding for this work.

Data Availability

Child trafficking trends outlined in new report

August 3, 2023 – Globally, over 50% of child trafficking victims are recruited by family and friends, according to a new report by the FXB Center for Health & Human Rights at Harvard University and the International Organization for Migration (IOM).

The report also identified other major trends in child trafficking as well as a complex range of factors that make children more susceptible.

The report analyzed 20 years of data from over 69,000 victims across 186 countries, from the IOM Victims of Trafficking database. Among its many findings, the report showed that major methods of controlling victims included false promises, psychological and physical abuse, and threats. Furthermore, 43% of victims, mainly boys, were trafficked for forced labor in industries such as domestic work, begging, and agriculture; 21% of victims, mainly girls, faced sexual exploitation such as forced prostitution, pornography, and sexual servitude. Among factors increasing victims’ vulnerability to being trafficked were having little or no education or living in low-income countries.

The report recommended that countries develop policies to fight child trafficking based on reliable, up-to-date data so that they can combat trafficking effectively. “A comprehensive, coordinated, equity-based response is urgently needed to ensure that humanity honors its responsibility and commitment to protect children,” said report co-author Vasileia Digidiki , director of FXB’s Intensive Summer Course on Migration and Refugee Studies in Greece and an FXB health and human rights fellow.

Jacqueline Bhabha , professor of the practice of health and human rights at Harvard T.H. Chan School of Public Health and FXB director of research, was also a co-author of the report.

Read the report: From Evidence to Action: Twenty Years of IOM Child Trafficking Data to Inform Policy and Programming

Read a July 5 Telegraph article about the report: Thousands of child trafficking victims recruited by ‘own family and friends’

Read a July 6 Business Standard article about the report: Most child trafficking victims trafficked domestically: Report

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Child Trafficking Essay for Students and Children | PDF Download

What is Child Trafficking?. Children Trafficking is an illegal activity where children are forcefully migrating to other places in need of harmful activities. Child Trafficking is one of the major facing problems all over the world. In child trafficking , the girls are the most affected ones rather than the boy. Girl  child trafficking is done in other countries for sexual and other harmful activities. Similarly, the below e ssay on Child Trafficking covers all the major points and how they affect the lives of children. The below essay on Child Trafficking in India will explain the condition in India and many more unique points that you had ever heard. Further below in the article, the quotes on Child Trafficking are listed.

Small essay on Child Trafficking

Child Trafficking is a part of human Trafficking which means the illegal migration of people in need to fulfill something. In the world, the UK is the hub of Child Trafficking and many parts of Asia, Latin, and many more. In child Trafficking the girls are the most affected ones, the girl is migrated and is forcing them to involve in sex activities. Child Trafficking is the most profitable full task for the people who are involved in making the activity. Child Trafficking victims are made to educate about criminal activities. It is linked to many irregular activities like sexual assault, organ trade, child labor, terrorism, and many other illegal activities.

Child Trafficking is done for the need for cheap labor, lack of awareness in people, economical conditions . All the poor families sell their children for the money in need to fulfill their daily needs. Selling a child is a criminal activity that results in huge punishments. Most of the child trafficking was with poor families, roadside kids, orphan children , etc. As the children are migrated at a small age they were not aware of good and bad things. By using this as a weak point, the children are involved in manufacturing harmful products, forced into terrorism, theft activities. In India every year approximately 3 to 4 lakh children are victims of Child Trafficking . Child Trafficking is still happening in the country due to the improper implementation of laws in society. All the countries should come together to frame the laws for any trafficking happening all over the world.

Long Essay on Child Trafficking

Child Trafficking means the selling of children for money to other areas where there is a need for people to work or do other activities. Child Trafficking is one of the top issues for countries all over the world. Child Trafficking is a hugely profitable business for the people involved in the activities. But Child Trafficking is an illegal activity all over the world. Roadside children, poor kids, orphan children, and many other children are involved in child trafficking. Some families sell their children for the need or are greedy for money. Children are wonderful gifts by God to everyone on earth. But these activities make the children into trouble and some troubles lead to an end their lives.

Child Trafficking will happen for the cause of cheap labor, street begging, organ donation, terror attacks, drug manufacturing, and many others. Some of the works will not harm the health of the children, but some activities like organ donation and drugs will affect a child’s health physically and mentally. These children will be sent to many terrorist groups, they train the children for a long period where they can use as a weapon to their country. Some of the children will forcibly migrate to rich countries for domestic slavery activities . Children from 8 to 15 years of age are the affected children in child trafficking.

Most of the Girls are major affected by child trafficking. This trafficking is part of human trafficking all over the world. There are various trafficking to fulfill the needs of people who are majorly in the negative direction. The girls involved in Children Trafficking are majorly involved in sexual activities in other countries or demand countries. In the way of the process, they make the young girl child to adult child by injecting the drug to fast up the process in a girl’s body. This results in huge damage to girls’ health and major chances of death of the girls.

According to UNICEF 2011 Data, there are about 150 million children are suffered from Child Trafficking . The children who came over the Children trafficking will never get the proper needs. These children are not nutritious enough for their age and face many more problems with mental health and physical health. As the suffered children are from a small age they don’t know the good and bad about the work and society. Some children were forced to work physically like heavyweights. some children are involved in working in harmful areas like drug making, weapons-making.

Child trafficking is more in Latin countries, some parts of Asia, the UK, Europe , and many parts of the world. This majorly happened in poverty countries where the children cannot get enough nutrition. The governments of the countries should involve in the steps to secure the child and provide basic nutrition. A large number of teams, special forces, Child trafficking laws, and all the needs to keep an end to this process by the governments. All the people must be educated not to sell or other activities of child trafficking should not encourage and people should know the advantages of children to their future. There are some NGOs who work to get awareness in the people about child trafficking.

Quotes on Children Trafficking

• Life is a gift of our creator… And it should NEVER be for sale.
• Child slavery is a crime against humanity. Humanity itself is at stake here.
• Trafficking is a serious abuse of child rights and is seen as less risky than trafficking drugs
• The swelling epidemic of human trafficking makes a mockery of the law and its protections.
• When we look at human trafficking, we always think that it’s far away from us.
• To protect our kids, we’ve given law enforcement new tools to fight human trafficking.
• Human trafficking is a human tragedy. It’s an outrage against any decent people.
• If we truly want to have world peace, we have to end human trafficking
• Human trafficking is an open wound on the body of contemporary society, a scourge upon the body of Christ. It is a crime against humanity.
• Human trafficking is a globally assisted pandemic that generates billions of dollars of income a year.

Child Trafficking: Images

Conclusion: We believe that the above essays on Child Trafficking had helped you to know the unique stuff about the topic. All problems faced by the children are clearly described in the essay on Child Trafficking in India. These essays are helpful for UPSC & SSC aspirants, Students for exams, competitions, group discussions.

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Child Trafficking and Sexual Exploitation Essay

Shocking stories of trafficked children forced into slavery is often cited in newspapers. Children are trafficked for sexual exploitation, slavery, etc. Children from poor families from Africa, Southeast Asia, etc. are lured with dreams of migrating to Europe or America and gaining a better life. But instead, they are caught in the web of servitude.

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 than $10 million and 50 percent of this is child trafficking (UNICEF 2005).

Children are sold as commodities in this web of international trade. They are sold in foreign countries or internally usually from rural to urban areas. The enslavement of children results in millions of victims who are abused, smuggled and traded. These victims face cruel assault on their security and solemnity.

Child trafficking violates many core human rights, as it is a severe attack on human dignity. These children become victims of different forms of exploitation like sexual exploitation, forced labour, removal of organs etc. (Larsen 2011). Sexual exploitation of children being trafficked is a major problem is regions like Southeast Asia (Rafferty 2007), EU (Staiger 2005), Canada (Grover 2006), etc.

One of the main issues related to trafficking of children is how rampant is the problem and the identification of the victim. Further, trafficking of children poses concern for policymakers from both the countries where trafficking occurs and those where these children are trafficked.

Issues related to the prevention and subsequent rehabilitation of the trafficked children is observed in many developed countries. This paper discusses the various facets of child trafficking and its related issue of sexual exploitation of the trafficked children. Further, the paper sheds light on the trafficking of children in Canada.

In order to understand the problem related to child trafficking it is necessary to define the term trafficking. Trafficking is defined under Article 3 of the United Nations Protocol as the process of “recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion … for the purpose of exploitation.” (UNICEF 2005:11)

The definition clearly identifies the process of trafficking as a serious impingement to human rights and as an illegal activity. Further, the protocol clearly identifies the case of child trafficking as different from that of women or male adult trafficking, as it concerns a minor.

The nature of the trafficking crime becomes more intense as a minor gets into the trap of the trafficker due to deceit. The nature of exploitation of the children trafficked are varied in nature. According to the protocol exploitation is defined as “at a minimum, the exploitation of the prostitution of other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs” (UNICEF 2005:11).

The exploitative nature of child trafficking makes it more severely inhuman as an activity. Trafficking is a criminal act even though the definition many times does not explicitly mention it to be illegal. There is a definite lack of proper identification and data maintained for the number of trafficked children, but the number is huge and it is increasing consistently every year.

The exploitative nature of trafficking is abundantly clear. Children are trafficked for various exploitative purposes that include forced labour, sexual exploitation, marriage, domestic labour, military recruitment, and most heinously, for their organs. However, most of these children are trafficked for sex trade.

An estimated number of 1.8 million children in 2000, according to International Labour Organization (ILO), are traded into prostitution or pornographic industry. (UNICEF 2005; Staiger 2005) These children become victims of extreme form of physical, sexual, and psychological abuse.

Children are widely being recruited in conflict zones in armies or militia (Beyrer 2004; UNICEF 2005). The role of the children varies in such outfits where they work as soldiers, cooks, messengers, porters or sexual partners. Girls in conflict zones are extremely vulnerable to sexual abuse. Children join such outfits due to extreme poverty or are abducted.

In EU, children are trafficked for sexual exploitation from Central and Eastern European countries (Staiger 2005). Children above the age of 14 years are forced by poverty or gender related factors to succumb to traffickers. For instance, trafficking of Nepalese girls for sexual exploitation is largely related to domestic gender differences (Rafferty 2007).

In such countries, children are recruited mainly through the Internet, and transported to the EU countries. Germany is one of the destinations for children trafficked for sexual exploitation from Czech, Russia and Ukraine (Staiger 2005). Italy, Greece, and Belgium are destination for Albanian kids to be trafficked (Staiger 2005).

Why there is a rise in global trafficking of children? The reason lies in the widening gap between the poor and the rich, as the latter has access to greater chunk of the already scarce resources. The structural reasons that are driving child trafficking is demand for cheap child labour, especially those who can be controlled and continuously monitored.

An ILO estimate reveals that in 2003 there were 8 million children living under debt bondage mostly due to trafficking (Beyrer 2004) and more than 2 million children trafficked globally are exploited for sexual labour (Rafferty 2007). Omnivorous sex trade is also in demand, but girls are mostly in demand among traffickers as heterosexual sex trade has a greater demand. Sexual abusers may be paedophile abuser, prostitution, pornographic industry, and sex tourism (Rafferty 2007).

Canada, like many other developed countries, is destination for child traffickers. Children are brought in the country in crowded cargoes in ships in inhuman condition without food or water or ventilation (Grover 2006). These children are forced into prostitution or in the pornographic industry. However, there is an increasing problem of identification of these children. Further, the Canadian government is yet to provide a refugee status to the child victims of trafficking that add to their woes, even after they are rehabilitated, in a foreign land (Grover 2006).

A video report on child trafficking and child sex industry in Cambodia shows how young girls are lured into the sex industry (Journeyman Pictures 2007). The video demonstrates how the children are driven into prostitution at an early age of 10 years.

The video shows mostly the mothers sell their young daughters into the sex industry and it is due to poverty. the report shows that though it is believed that the Cambodian child sex industry developed due to demand from foreign tourists of virgins. But actually, Cambodian men demand for virgin girls, for which this industry developed.

Child trafficking is a growing problem globally. The way to counter is not only identification of the victims but also through prevention of the incidence of trafficking. In many cases the children are so brutally abused and traumatized, rehabilitation is of hardly any use to them.

The aim should be preventing and absolutely doing away with child trafficking rather than identification and protection of victims. However, it is difficult for the government to prevent or stop trafficking for sex trade for a few reasons. First as it is difficult to ascertain the age of the trafficked person and the reason for which she is trafficked.

Beyrer, Chris. 2004. “Global Child Trafficking.” Lancet 364(1):16-17.

Grover, Sonja. 2006. “Denying Right of Trafficked Minors to be Classed as Convention Refugees: The Canadian Case Example.” The International Jornal of Chindren’s Rights 14:235-249.

Journeyman Pictures. 2007. “Stolen Innocence – Cambodia.” YouTube. Web.

Larsen, Jacqueline J. 2011. “The trafficking of children in the Asia-Pacific.” Trends and Issues in crime and criminal justice, Australian Institute of Criminology, Australian Governement.

Rafferty, Yvonne. 2007. “Children for Sale: Child Trafficking in Southeast Asia.” Child Abuse Review 16:401-422.

Staiger, Ines. 2005. “Trafficking in Children for the purpose of Sexual Exploitation in the EU.” European Journal of Crime, Criminal Law and Criminal Justice 13(4):603-624.

UNICEF. 2005. “Combating Child Trafficking.” UNICEF. Web.

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IvyPanda . 2018. "Child Trafficking and Sexual Exploitation." October 17, 2018. https://ivypanda.com/essays/child-trafficking-and-sexual-exploitation/.

1. IvyPanda . "Child Trafficking and Sexual Exploitation." October 17, 2018. https://ivypanda.com/essays/child-trafficking-and-sexual-exploitation/.

Bibliography

IvyPanda . "Child Trafficking and Sexual Exploitation." October 17, 2018. https://ivypanda.com/essays/child-trafficking-and-sexual-exploitation/.

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Peer-reviewed

Research Article

Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation King’s College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Roles Conceptualization, Supervision, Writing – review & editing

Roles Investigation, Software

Affiliation South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom

Roles Formal analysis, Methodology

Affiliation King’s College London, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Roles Validation

Affiliation King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

Roles Conceptualization, Methodology, Supervision, Writing – review & editing

Affiliation King’s College London, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom

• Livia Ottisova, 
• Patrick Smith, 
• Hitesh Shetty, 
• Daniel Stahl, 
• Johnny Downs, 

• Published: March 8, 2018
• https://doi.org/10.1371/journal.pone.0192321
• Reader Comments

Child trafficking is the recruitment and movement of people aged younger than 18 for the purposes of exploitation. Research on the mental health of trafficked children is limited, and little is known about the use of mental health services by this group. This study aimed to investigate the mental health and service use characteristics of trafficked children in contact with mental health services in England.

Methods & findings

The study employed an historical cohort design. Electronic health records of over 250,000 patients were searched to identify trafficked children, and a matched cohort of non-trafficked children was randomly selected. Data were extracted on the socio-demographic and clinical characteristics, abuse history, and trafficking experiences of the trafficked children. Logistic and linear random effects regression models were fitted to compare trafficked and non-trafficked children on their clinical profiles and service use characteristics. Fifty-one trafficked children were identified, 78% were female. The most commonly recorded diagnoses for trafficked children were post-traumatic stress disorder (PTSD) (22%) and affective disorders (22%). Records documented a high prevalence of physical violence (53%) and sexual violence (49%) among trafficked children. Trafficked children had significantly longer duration of contact with mental health services compared to non-trafficked controls (b = 1.66, 95% CI 1.09–2.55, p<0.02). No significant differences were found, however, with regards to pathways into care, prevalence of compulsory psychiatric admission, length of inpatient stays, or changes in global functioning.

Conclusions

Child trafficking is associated with high levels of physical and sexual abuse and longer duration of contact with mental health services. Research is needed on most effective interventions to promote recovery for this vulnerable group.

Citation: 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. https://doi.org/10.1371/journal.pone.0192321

Editor: Michael L. Goodman, University of Texas Medical Branch at Galveston, UNITED STATES

Received: January 5, 2017; Accepted: January 9, 2018; Published: March 8, 2018

Copyright: © 2018 Ottisova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: BRC Case Register (CRIS) provides a means of analysing anonymised data from the South London & Maudsley Foundation NHS Trust (SLAM) electronic case records. Access to clinical information is clearly a sensitive issue and a security model was developed which has been considered and approved by the SLAM Caldicott Guardian and the Trust Executive, as well as forming part of the ethics application. We are unable to report individual-level data in the public domain because these comprise patient information, but these have been aggregated and proportions reported in full in the present paper. Researchers may apply for approval to access these or other CRIS data. Individuals wishing to apply for access to CRIS data can contact the NIHR Maudsley Biomedical Research Centre (BRC) Manager, Dr. Saliha Afzal, on [email protected] or Tel: +44 (0)20 7848 5485. More information is available at http://brc.slam.nhs.uk/about/core-facilities/cris .

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Child trafficking is a significant public health problem and human rights violation affecting millions of children worldwide. Child trafficking is defined as the recruitment, transportation, transfer, harbouring or receipt of young people for the purpose of their exploitation [ 1 ]. Globally, it is estimated that 20.9 million people are in situations of forced labour as a result of human trafficking, and that 5.5 million of these are children [ 2 , 3 ]. Children make up an increasingly large share of the total number of victims of human trafficking and comprise one third of all identified trafficked people [ 4 ].

Human trafficking is believed to affect all countries throughout the world, and these can serve as places of origin, transit and destination of trafficked individuals. Key socioeconomic drivers of human trafficking include poverty and socioeconomic inequality [ 5 ]. Children can become further vulnerable to exploitation due to illness or death of a family member or separation from the family in the context of forced migration, natural disasters, and civil unrest [ 4 , 5 ].

Given the illegal and clandestine nature of human trafficking, the exact numbers of trafficked children are unknown. Whilst official statistics on detected victims provide some information about general trends in trafficking, estimating the number of undetected victims remains a challenge [ 4 ]. Emerging research from the United Kingdom as well as national statistics indicate that children are trafficked into a range of industries, including sex work, forced marriage, domestic servitude, agricultural labour, car washing, factory labour and criminal exploitation, such as cannabis cultivation [ 6 , 7 ].

Children can experience extreme forms of exploitation and abuse in the context of human trafficking. Emerging research suggests that 24–56% of trafficked children experience physical violence and 21–51% experience sexual abuse [ 8 – 10 ]. A large body of evidence from other child populations attests to the adverse effects of physical and sexual violence on children’s physical health and wellbeing. Child physical and sexual abuse are also causally associated with a range of mental disorders, substance abuse, and suicide attempts [ 11 , 12 ]. Previous research with adults has found trafficking to be associated with high rates of posttraumatic stress disorder (PTSD), depression, and anxiety disorders [ 9 , 13 – 15 ]. However, research on the health needs and experiences of trafficked children is scarce. Three studies conducted with victims of child trafficking provided preliminary evidence of high rates of depression, PTSD, and anxiety disorders, as well as self-harm and suicide risk [ 8 – 10 ]. However, relatively little is known about the mental health needs of trafficked children, and even less is known about those with serious mental illnesses.

The only study to date conducted with a clinical population of trafficked people in contact with mental health services found that trafficked adults were significantly more likely to be compulsorily admitted as inpatients and had longer admissions than matched non-trafficked controls. However, whether or how the mental health needs of trafficked children in contact with services differ from those of non-trafficked children is currently not known.

This study aimed to investigate the sociodemographic and clinical characteristics of trafficked children in contact with secondary mental health services, and compare their pathways into services and current care with those of matched non-trafficked children. It was hypothesised that trafficked children, as compared to non-trafficked controls, would be (1) significantly more likely to have adverse pathways into care, defined as having first contact with secondary mental health services via the emergency department or police; (2) significantly more likely to be compulsorily admitted for psychiatric treatment (i.e. admitted for care under the Mental Health Act (MHA)); (3) have longer total length of contact with secondary mental health services and (4) longer inpatient admissions; and (5) would have significantly worse clinical outcomes as evidenced by less improvement in measures of global functioning.

An historical matched cohort design of trafficked and non-trafficked children in contact with secondary mental health services in South East London (UK) between 1 January 2006 and 21 November 2014. Data were obtained from the NIHR Biomedical Research Centre Clinical Record Interactive Search (CRIS) system, which provides access to electronic mental health records from South London and Maudsley (SLaM) NHS Foundation Trust, the largest provider of secondary mental health care in Europe. The CRIS database converts electronic mental health records into research-accessible datasets, preserving anonymity through technical and procedural safeguards [ 16 , 17 ]. CRIS allows for the search of over 250,000 anonymised full patient records of individuals referred to SLaM services, including over 46,000 children and adolescents (hereafter collectively referred to as children ). CRIS electronic records include all clinical and socio-demographic information recorded during patients’ contacts with SLaM services. Relevant records can be retrieved using search terms for structured fields (e.g. diagnosis) or free text (e.g. clinical event notes).

Participants

The sample consisted of trafficked and matched non-trafficked children in contact with SLaM services. Children were included in the trafficked group if they were less than 18 years old at first contact with SLaM services and their mental health records indicated that they were victims of human trafficking. Trafficking was defined in accordance with the United Nations protocol [ 1 ] as the recruitment or movement of people aged younger than 18 for the purposes of exploitation, and included international and domestic trafficking. Trafficking terms such as “trafficked” “domestic servitude” and “sexual exploitation” were used to search clinical notes and correspondence of children who had accessed care within SLaM since 1 January 2006–21 November 2014 (search upper date limit; see full list of search terms in S1 File ). Records that included one or more trafficking terms were screened for eligibility. Inclusion criteria for the trafficking group were met if clinical records suggested a child’s care team believed they had been trafficked, either based on information consistent with the definition of human trafficking given directly by the child, or because of access to third party information (e.g. ongoing police or social services investigation of allegations the child had been trafficked). Cases where trafficking was suspected but not confirmed during the course of contact with services were included in order to arrive at as comprehensive a sample as possible. Cases where trafficking exposure was unclear were resolved by consensus with reference to a second reviewer. Due to the limitations of clinical data we were unable to reliably assess whether all children were free from their traffickers while in contact with SLaM services (i.e. having escaped or been rescued from or having been abandoned by their traffickers) or whether some children were in contact with or returned to their traffickers during or after accessing mental healthcare.

The control group consisted of SLaM service users matched to cases for primary diagnosis, gender, age (+/- 1 year), type of initial care (inpatient or outpatient), and year of most recent service contact. The matched cohort was selected using a computer-generated random sample from all potential controls that met the matching criteria for each case, aiming for a case—control ratio of 1:4.

All data were collected as part of routine assessment and treatment of individuals in contact with SLaM services. Data were extracted from structured fields (e.g. dates, outcome scores) and by targeted searches of free-text clinical notes and correspondence using keywords and wildcards, which allowed searching for terms anywhere within a phrase.

Socio-demographic characteristics.

Gender, country of origin, and living arrangements at first contact were extracted from structured fields and supplemented by hand searching free-text notes. Age at first contact was calculated by subtracting the date of birth from the date of first contact with services, both of which are routinely recorded.

Pre-trafficking and trafficking characteristics.

Information about the absence or death of one or both parents and whether exploitation took place prior to arrival in the UK and/or in the UK was extracted from free-text clinical notes. Details about the type of exploitation were extracted from free-text clinical notes and coded as Sexual exploitation, Domestic servitude, Factory labour, Restaurant labour, Road construction, Laundry labour, Unspecified labour, Child soldier, Fraud, or Unknown. Due to small cell counts these were later re-categorised into Sexual exploitation, Domestic servitude, Other, or Unknown. As some children experienced multiple forms of exploitation, all types of exploitation were coded. Reports of sexual violence and physical violence whilst trafficked, pregnancy at the time of escaping the trafficking situation, and a history of terminations of pregnancy were extracted from free text clinical notes.

Clinical characteristics.

Primary ICD-10 diagnosis is routinely recorded in a structured field. Data extraction was supplemented with free-text searches of notes when this was missing (n = 5). For children whose diagnosis changed over time, the diagnosis at most recent contact was used. As primary diagnosis was one of the matching criteria, where this field was missing for trafficked children (n = 10), clinical records were independently reviewed by a consultant child psychiatrist (JD) and a consultant clinical psychologist (PS) and a diagnosis assigned. Initial inter-rater agreement was found for 7/10 cases; consensus diagnosis was reached for the remaining 3/10 cases.

Clinical outcomes were investigated using the Children’s Global Assessment Scale (CGAS) scores. The CGAS is a clinician-rated measure of children’s adaptive functioning in the domains of home, school and with peers during the previous month. It is rated on a 100-point scale with 1 being most impaired and 100 being least impaired, with descriptors given for each 10-point interval. CGAS ratings are routinely recorded in clinical notes at first contact and discharge. The difference between the initial and final CGAS score was used to assess clinical change during contact with services.

Participants were coded as having had prior contact with secondary mental health services and prior psychiatric admissions where this was indicated in their free text clinical notes. Data about history of deliberate self-harm, prior suicide attempt, and current or historical substance misuse were extracted from structured risk assessments and supplemented with information from free text clinical notes.

Service use characteristics.

Route of entry into care is a structured field and was routinely recorded in clinical notes. An adverse pathway into care was defined as first referral to SLaM services via the emergency department or police. Admission and discharge dates were used to identify episodes of inpatient care and the total duration of inpatient admissions with SLaM. To establish whether a child was an inpatient at first contact with the Trust, the date of acceptance of the first referral to SLaM was compared to the date of the first inpatient episode. Details of the use of Section 136 of the Mental Health Act, used in the UK by police to take individuals to a place of safety if they are in crisis, were found using structured fields on the use of the Mental Health Act and searches of free text notes. Compulsory psychiatric admissions were measured using structured fields recording the use of Section 2 or 3 of the Mental Health Act 1983, which in the UK are used to detain patients in hospital for assessment and/or treatment. Total duration of SLaM care was calculated by comparing the date of first referral and the date of last contact or discharge, excluding any periods in between different episodes of care (upper date limit 17 December 2015).

Abuse experiences.

Information about experiences of physical and sexual childhood abuse was extracted from free text notes. When history of abuse was not explicitly mentioned in clinical notes it was coded as ‘not present’, yielding a conservative estimate of the likely true prevalence.

Data analysis

All statistical analyses were conducted in Stata 12. Socio-demographic and clinical characteristics were described using descriptive statistics (proportions for categorical variables and means and SDs for continuous variables). Tests of normality showed that duration of contact with SLaM services and duration of SLaM inpatient admissions were not normally distributed. These were subsequently transformed by taking the natural logarithm to ensure a more normal distribution; the transformed variables were used in all subsequent analyses.

Random intercept logistic and linear regression models were fitted using trafficking status as a categorical independent variable (1 = trafficked, 0 = not trafficked) to compare characteristics of trafficked and matched non-trafficked children. A matching identifier representing clusters of matched individuals was included as a random factor in all regression models to account for possible non-independence of matched individuals. Prior contact with secondary mental health services, history of psychiatric admission, history of childhood abuse, substance misuse problems, and total duration of contact with SLaM were investigated as potential confounders and entered simultaneously into regression models. Because the regression coefficients for log-transformed outcome variables are difficult to interpret, we present the estimates of the fixed effects as the percentage of change between trafficked and non-trafficked children by using the formula 100 x (exp(b)- 1).

Ethics approval

Ethics approval for the research use of CRIS-derived anonymised databases was granted by an independent Research Ethics Committee (Oxfordshire C, reference 08/H0606/71). Approval for this study was granted by the Oversight Committee that reviews all applications to use CRIS (11/025). The terms of the oversight committee approval require some restrictions on reporting to maintain anonymity, for instance on reporting a cell count of less than 10 people. The committee reviewed the results reported below and gave permission to present low cell counts where shown.

The CRIS database searches identified 158 children whose records included one or more trafficking search terms; 103 of these were excluded, for instance because the term was used in relation to drug trafficking, or because the child was referred to but never formally assessed by services. Four cases in which trafficking exposure was unclear were discussed with a second reviewer; two of these were included and two were excluded after discussion. The final sample included 51 trafficked children.

Socio-demographic and clinical characteristics of trafficked children in contact with secondary mental health services

The socio-demographic characteristics of the trafficked children and information about their experiences of exploitation are described in Table 1 . Seventy-eight percent of the sample was female, and 53% fell in the 16–17 age range (mean 14.0 years, SD = 3.1, range 5–17). Children came from 21 countries, with the most commonly recorded countries of origin being Nigeria (13 children [25%]), Albania (4 [7.8%]) and the Democratic Republic of Congo (4 [7.8%]).

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https://doi.org/10.1371/journal.pone.0192321.t001

Children were most commonly trafficked for sexual exploitation (21 children [41%]) and domestic servitude (13 [25%]), as well as other forms of labour including restaurant work and laundry (4 children [8%]). Information regarding the type of exploitation was not recorded for 13 trafficked children (25%). Physical violence during trafficking was reported by 27 children (53%), sexual violence by 25 (49%), and 38 children (74%) reported physical or sexual violence.

Clinical characteristics of the trafficked children are reported in Table 2 . The most frequently recorded clinical diagnoses were PTSD (11 children [22%]), mood disorders (e.g. depression) (11 [22%]) and reaction to severe stress and adjustment disorders (7 [14%]). Ten children (20%) had non-specific diagnoses including ‘mental disorder, not otherwise specified’ and ‘childhood emotional disorder, unspecified’, and these were grouped under the category ‘Other childhood emotional disorder’. Seventeen children (33%) had deliberately self-harmed prior or during contact with SLaM services and 14 (27%) had attempted suicide. Six individuals (12%) had been in contact with secondary mental health services prior to SLaM and 3 (6%) had previously been admitted as psychiatric inpatients (not shown). Substance misuse problems were recorded for 9 individuals (18%).

https://doi.org/10.1371/journal.pone.0192321.t002

Children were referred to SLaM services by a variety of sources including child protection services, primary care physicians, paediatricians, and law enforcement ( Table 2 ) . Seventeen of the trafficked children (33%) were referred for mental health care by non-emergency health services and 15 (29%) were referred by social care. Nine children (18%) had adverse pathways into services. Ten children (20%) were admitted as psychiatric inpatients while in contact with SLaM services and four (8%) had one or more compulsory psychiatric admissions under the Mental Health Act. The median duration of contact with SLaM services was 581 days.

Comparison of trafficked and non-trafficked children's pathways into secondary mental health services and clinical outcomes

Fifty-one trafficked children were compared with a randomly selected matched sample of 191 non-trafficked children. The matching ratio 1:3.7 fell below the target ratio 1:4 because not all children could be matched to four non-trafficked controls. All trafficked children were matched with at least one control.

Results of the comparative analyses are reported in Tables 3 and 4 . Trafficking was not found to influence adverse pathway into care (adjusted odds ratio [AOR] 1.15, 95% CI 0.48–2.79, p = 0.65) or compulsory psychiatric admission (AOR 0.27, 95% CI 0.06–1.25, p = .10).

https://doi.org/10.1371/journal.pone.0192321.t003

https://doi.org/10.1371/journal.pone.0192321.t004

Multiple random effects regression analyses were conducted to investigate if duration of contact with SLaM services was associated with trafficking status. The results of this analysis indicated that trafficked children had a longer total duration of contact with SLaM services (b = 1.66, 95% CI 1.09–2.55, p<0.02), and that this association remained significant after controlling for previous contact with secondary mental health services, history of admission as a psychiatric inpatient, substance misuse, and history of deliberate self-harm (b = 1.56, 95% CI 1.14–2.13, p<0.01; Table 4 ). This indicated that the duration of contact with SLaM will be 56% longer for trafficked children than non-trafficked children. However, there were no significant differences between trafficked and non-trafficked children with regards to the total duration of inpatient admission (b = 0.97, 95% CI 0.81–1.16, p = 0.74). Changes in CGAS scores were also not significantly associated with trafficking status (b = 2.35, 95% CI -3.33–8.04, p = 0.42; Table 4 ).

Research on the health needs of trafficked children is limited [ 18 , 19 ]. To our knowledge, this research forms the largest study with trafficked children in a high income country and, for the first time, provides comparative data on trafficked and non-trafficked children with mental health problems.

Trafficked children in contact with secondary mental health services come from a range of countries and had been trafficked for several different types of exploitation, including sexual exploitation, labour exploitation and domestic servitude. The main countries of origin of trafficked children and the types of exploitation they experienced are consistent with national statistics of identified cases of child trafficking [ 7 ]. Clinical records indicated that trafficking was associated with high levels of physical and sexual violence. Exposure to violence is an established predictor of psychological morbidity in children more generally and has also been found to be a risk factor for depression, anxiety and suicidal ideation in trafficked children in contact with post-trafficking services in a large study by Kiss et al. in the Mekong region [ 8 ].

The most common clinical presentations in the trafficked group were posttraumatic responses (which included PTSD (22%) and reaction to severe stress and adjustment disorders (14%)) and affective disorders (22%). These are consistent with the most commonly endorsed symptoms reported by trafficked children in the Mekong study [ 8 ]. However, a significant proportion of children (19%) presented with non-specific emotional and behavioural difficulties, highlighting diagnostic complexity and the need for a multidisciplinary approach in their treatment. A large proportion of trafficked children (33%) presented with deliberate self-harm and 27% had a record of having attempted suicide. This is higher than the figure reported by Kiss et al. who found that 12% of their sample had tried to harm or kill themselves in the past month. The differences in prevalence may be partly explained by the fact that this was a treatment-seeking sample in contact with specialist mental health services, and that the coding of a history of suicide attempt was not only restricted to the last month before coming into contact with services but potentially over a child’s lifetime. The high prevalence of self-harm and suicide attempts, including during contact with secondary mental health services, indicates the need for rigorous risk assessment and care planning by clinicians in contact with trafficked children and young people. Notes for a very high proportion of children recorded the absence of one or both parents prior to exploitation. This points to the social contexts that may facilitate exploitation and contributes to the emerging literature about pre-trafficking characteristics and risk factors that may make people more vulnerable to exploitation and also to subsequent mental health difficulties Enquiring about a child’s pre-migration social situation as well as their experiences of exploitation may therefore help clinicians identify important risk factors for future and ongoing harm and contribute to the development of a more robust care plan.

Trafficked children’s clinical profiles and care pathways as compared to non-trafficked children

The key points of entry into mental health services were primary care, children’s social services, and emergency departments, highlighting the need for those working at the frontlines of these services to be trained to identify and respond appropriately to human trafficking. Contrary to hypothesis, no significant differences were observed with regards to trafficked children’s likelihood to have adverse pathways into mental health care when compared to matched controls. Similarly, trafficked children were no more likely to be compulsorily admitted for psychiatric inpatient care nor to have longer duration of inpatient stays. Trafficked children also did not show significant differences in CGAS as a result of contact with services. The only significant clinical difference that emerged was that trafficked children compared to non-trafficked children had a longer total duration of contact with SLaM services. Whereas longer duration of total contact could indicate greater chronicity of their mental health difficulties, it could also be an indication of their more complex social needs which might cause delays in services’ ability to discharge them. Indeed, a recent qualitative study of challenges faced by mental health providers in meeting the needs of trafficked individuals highlighted the impact of complex social needs and of difficulties with inter-agency working on care provision. However, as reasons for longer duration of contact were not directly investigated in this study, further research is needed to clarify the causes for this finding.

Strengths and limitations

The study used an innovative data source to gain access to data on a vulnerable population that is traditionally difficult to recruit for clinical research. Full electronic health records retrieved through the CRIS database enabled access to detailed information about trafficked children’s mental health needs and contacts with services. The study built on previous research with trafficked children by including a clinical control group, which allowed for an empirical test of differences in clinical profiles, pathways into care, and service use characteristics. It did, however, suffer from important limitations. Although several variables were routinely recorded in structured fields others were not, requiring searches to be conducted of free-text clinical notes. In particular, clinical records varied in the level of detail provided on children’s experiences of trafficking, sometimes simply noting that a child was suspected to be trafficked or currently applying for asylum on the grounds of being trafficked. This meant that establishing the type of exploitation and characteristics of the trafficking situation was not possible for a quarter of the cases. In these instances, records were closely checked against the UN Protocol definition of child trafficking, and consideration was given to third party information (e.g. communication from children’s services indicating a child was a suspected victim of trafficking) to ensure a child met the exposure criterion. Cases where trafficking status remained unclear were resolved with reference to a second reviewer. Experiences of violence and abuse are also not routinely assessed or recorded by clinicians; the prevalence of violence is therefore likely to be a conservative estimate.

In spite of using a comprehensive list of trafficking search terms to search for the records of trafficked children, it is likely that this method did not identify all trafficked children in contact with SLaM services during the study period. This is both due to staff not always becoming aware of a child’s trafficking status, and also, in instances where they were aware, not necessarily using ‘trafficking’ or other key words in their clinical records. It is possible that some of the children in the control group could have been trafficked, and that they had not been identified as such by staff. However, the likelihood of this being the case would have been very low.

Finally, the sample size of 51 trafficked and 191 non-trafficked children is not very large, and the lack of power may have affected the ability to detect significant between-group differences. This would have particularly affected the tests of binary outcomes, and negative findings need to be treated with care.

Generalisability of findings

In spite of the sample's diversity in terms of age, types of exploitation, and countries of origin, they represent a highly select group of trafficked children: those who have been able to access secondary mental healthcare. Information about their socio-demographic details and trafficking history is unlikely, therefore, to be representative of the wider population of trafficked children. In addition, the findings reflect the mental health needs of trafficked children in contact with secondary mental health services in London and will need replicating in other country settings.

Implications

Trafficked children are in contact with secondary mental health services in the UK and present with significant histories of sexual and physical violence, considerable social needs, and a range of clinical presentations. Mental health professionals need to be aware of indicators of possible exploitation and be supported to develop skills to enquire safely about suspected trafficking and respond appropriately, including through referrals to social and legal support.

Trafficked children in this study presented with a range of mental health symptoms and diagnoses, including high risk and severe mental illness warranting inpatient admission. Post-trafficking support organisations, children’s services, and other agencies in contact with trafficked children should incorporate mental health screening as part of their standard service provision in order to facilitate timely referrals to psychiatric care. Staff at these services would also benefit from being aware of signs of mental distress and being trained in how to respond, including how to access mental health support for clients through primary and secondary care.

Interventions with trafficked children should follow evidence-based, disorder-specific protocols that take into account children’s substantial history of abuse, separation from caregivers, and displacement. Clinicians may benefit from drawing on established models of working with young refugees, survivors of childhood sexual abuse, and looked-after children when drawing up individualised care plans [ 20 ]. Narrative exposure therapy [ 21 ] and the child version KidNET [ 22 ] are trauma-focused therapies with a strong evidence base with survivors of multiple trauma and human rights violations, and trauma-focused cognitive behavioural therapy (tf-CBT) has been shown to successfully treat PTSD in child survivors of sexual abuse [ 23 , 24 ]. Further research is needed to test the effectiveness of psychological interventions in meeting the mental health needs of trafficked children.

Mental health professionals need to be aware of potential indicators of trafficking and be able to respond safely and appropriately to suspicions and disclosures of abuse in order to effectively safeguard this vulnerable group. Further intervention research is needed to meet the significant mental health needs of trafficked children.

Supporting information

S1 file. list of trafficking search terms to generate trafficked sample..

https://doi.org/10.1371/journal.pone.0192321.s001

Acknowledgments

We thank Matthew Broadbent, Megan Pritchard and Debbie Cummings of the BRC Nucleus for their invaluable support with use of the CRIS database.

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• 2. International Labour Organisation. Global Estimate of Forced Labour: Results and Methodology. Geneva, Switzerland: 2012.
• 3. United Nations Office on Drugs and Crime. Global Report on Trafficking in Persons 2014. Vienna: United Nations, 2014.
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• 7. National Crime Agency. National Referral Mechanism Statistcs—End of Year Summary 2016. 2017.
• 21. Schauer M, Schauer M, Neuner F, Elbert T. Narrative exposure therapy: A short-term treatment for traumatic stress disorders: Hogrefe Publishing; 2011.
• 24. National Institute for Clinical Excellence. Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care. Clinical guideline. 2005;26.

Essay on Child Trafficking for Children and Students

Table of Contents

Child Trafficking refers to illegal transportation of children for forced labor, slavery or any other kind of exploitation. Child trafficking is a crime banned under law in every nation of the world; still the practice continues in poor and developing nations. Even trafficking children for the purpose of adoption is a crime. According to the data provided by the International Labour Organization (ILO), nearly 1.2 million children are trafficked every year. The crime of child trafficking has serious human rights implications and results in mental and physical trauma for the children.

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Long and Short Essay on Child Trafficking in English

We have provided below short and long essay on child trafficking in English for your information and knowledge.

These Child Trafficking essay written in simple yet effective English for you to make it easy to remember and present when needed.

After reading these essays on Child Trafficking you will know about the meaning of child trafficking, what impact does it has on the society and the children; how child trafficking impedes growth; what steps have been taken by the government to curtail child trafficking etc.

The essays will be helpful in school/college events wherein you are required to write essays, give speech or take part in debate competition.

Child Trafficking Essay 1 (200 words)

The action of illegally hiring or selling, delivering, receiving or sheltering children for the purpose of any kind of exploitation is child trafficking. Children are kidnapped, work as bonded labors or are forced for early marriages. The victims are also recruited to manufacture drugs and weapons.

There are a large number of children subjected to forced labor, begging and sexual exploitation. Innocent children, boys and girls are exposed to the vulnerable conditions, violence and sexual abuse. It is the violation of human rights and children are deprived freedom. It breaches the child’s mental and physical ability which is primary to every child’s growth. Children lose their childhood because of the ill-practice of child trafficking. The basic rights of children, irrespective of economic status, caste or gender, are robbed from them.

Traffickers are aware of the fact that children have less developed mental ability to understand wrong and right and are less capable to voice their trauma compared to the adults. Thus, they are an easy target. This practice deprives the child of proper growth with love and care of the family. He/ she is exposed to violence, abuse and traumatic conditions.

There is a need to create awareness and educate people about child trafficking. There should be appropriate laws in order to prevent child trafficking and these laws should be implemented effectively.

Child Trafficking Essay 2 (300 words)

Introduction.

Child trafficking is to seek a child for exploitation. Thousands of children trafficked every year from rural, tribal as well as urban areas in India. Victims bought and sold like commodities.

Different Stages of Child Trafficking

• Recruitment : Recruiting takes place in different ways. It may be voluntary if a child wants to support his/her family’s poor economic condition. Children may even kidnapped or sold to the recruiter directly.
• Movement : Movement might occur locally, regionally, nationally, or internationally through various modes of transportation.
• Exploitation : After the victim is transferred to the final destination, traffickers exploit them in various ways like child labor, sexual assault, begging, or making them domestic slaves etc.

Child Trafficking: Supply and Demand

• Supply : Those who are trafficked compose the supply. The various supply factors are poverty, natural disasters, unemployment, domestic violence etc.
• Demand : The traffickers and those who benefit from the child exploitation provide the demand. The most common demand factors are migrations, demand for cheap labor, organ trade, sex tourism, brothels, organized crime etc.

Child Trafficking in India

Child trafficking is the fastest growing and the third largest organized crime in India. According to UNICEF 12.6 million children engaged in unsafe occupations. NHRC of INDIA 40,000 children adducted each year out of which 11,000 are untraced. According to The Global Slavery Index, existing figure of slaves is 18.3 million in India. Every 8 minutes, a child is missing in India.

Child trafficking a fast growing network and has to be stopped. Government has to work with the help of NGO’s to develop, evaluate and implement laws and provisions to stop the crime. The exploiters have to punished rather than the exploited. Creating awareness and educating people is important. We need to stop supporting the act by refraining from giving donation to the beggars on the street as helping them encourages the crime even more.

Child trafficking Essay 3 (400 Words)

Child trafficking is the illegal activity of acquiring or moving people below the age of 18 for exploitation. Traffickers apply new methods every day to trick children and draw them away from home and sell them for certain amount or force them for labour, sex and other illegal activities. The various forms of child trafficking include child labour, early marriages, sexual assault, begging and organ trade etc. They isolated from happiness and constantly tortured.

Effects of Child Trafficking

Let us have a look at the effects of child trafficking in detail:

Children trafficked moved away from the family environment and departed from the shield of love, care and protection by parents. They have to work under hazardous conditions and exploited in several ways. Child trafficking is child abuse and has shattering and traumatic impact on a child. There is no one they can turn up to in such trauma.

Most of the children trafficked are from poor and uneducated families where children support their families for income, they hardly ever go to school. Such children tricked by traffickers for the lure of high wages and transported to other destinations to work in industries for cheap wages or sold for some amount. Young Girls forced in to prostitution and the work environment in the sex organizations is such that restricts child’s mental growth. Girls sexually assaulted and not encouraged for education.

Physical Health:

Child trafficking victims experience inhumane living conditions, Poor diet and hygiene, physical abuse and beating and deprived from the basic health care rights. Some of them used for organ trade, others get injured at workplace. Children sexually assaulted are at the risk of unwanted pregnancies, sexually transmitted diseases, infections and abortions. Acid poured into the eyes of some children to blind them for begging as they make more money. The life of the victims is always in danger in such working conditions.

Victims of child trafficking have adverse behaviour signs. Their voices shut and hearts wounded which affects their relationship with others. Some might isolate themselves and cause harm and pain to oneself physically. They might get panic and anxiety attacks. Some may also excuse the reality by taking drugs and alcohol. Victims may loss interest in life and might try to escape away or commit suicide.

Psychology could play vital role in recovery and healing the mental health of victims. The victims need to undergo proper healing process in the rehabilitation centres. Once rescued should nurtured with love and care by the communities. The victims should reunited with their families.

The consequences of child trafficking are dreadful. Improving and implementing prevention programs is critical. Creating awareness and educating people is vital. Forming different strategies and executing them to eliminate child trafficking groups and criminals should constant effort made by government with the help of society.

Child Trafficking Essay 4 (500 Words)

Child trafficking is the heart breaking truth chronic especially in India. The vital causes of child trafficking in India are lack of education, poor functioning of law, unemployment and poverty. Influenced by the society to have children despite poverty and scarcity of food, parents often find selling their children more profitable than nurturing them. Other children kidnapped or tricked for employment by the traffickers or have to work as bonded labours to pay family debts.

Causes of Child Trafficking

Let’s have a look at some vital causes in detail:

• Girls as the Object of Desire:

Girls seen as the objects of desire and demand from customers for young girls in prostitution is much higher, as a result female children bought and sold for the purpose of prostitution and sexual exploitation.

Unemployment:

Unemployment rate in India is high due to which there are less financial opportunities. In order to support family needs or under pressure of family members children bound to work. Often they tricked for work and subjected to slavery, begging and sexual exploitation. Children from rural areas in poor condition trafficked to cities for employment in industries such as spinning mills, hotels, restaurants, and construction for little or no pay at all. They often physically and mentally exploited by the employers and have to work under hazardous conditions.

• Bonded Labour:

Bonded labour also known as debt labour. Some parents sell their children as bonded labour for cash or bound by debt to force their children to work as a bonded labour. Children forced to work as bonded labors or do domestic work in order to pay family debts.

Lack of Education and Awareness:

Lack of education is the major reason for lack of awareness which makes families surrender to traffickers. Each year millions of children are born without any birth registration making it impossible to track in any system. These children become the easy target for child traffickers.

Poor Function of Laws:

Child trafficking in India has also increased due to poor functioning of the law. Child traffickers at lower risk as there no serious action taken against them.

Natural Disasters:

Natural disasters like earthquake or flood in a particular state or city is the time when traffickers attracted. Traffickers can act as a relief worker and trick children by offering food, work or shelter. They exploit the children under extremely vulnerable condition. Children who lose their families in natural disasters bound or forced by traffickers to take uncertain decisions.

Child Marriages:

Many girls forced by families or sold by traffickers for child marriage. In most cases the condition of girls in early marriages is like slaves. They exploited physically and mentally.

There are several constitutional and legislative provisions in India like, Prohibition of Child Marriage Act, 2006, Bonded Labour System Act 1986, Child Labour Act 1986, Transplantation of human organs Act 1994, The Immoral Traffic Act 1956. Proper implementation of the provisions required with the help of government and NGOs to end the root causes.

Child Trafficking Essay 5 (600 words)

The illicit act of forcefully acquiring or transferring children for the purpose of labour or sexual exploitation known as child trafficking.

Children deprived from the family environment and forced to work in the sectors where working conditions and the approach of employers towards them violate the human rights and freedom of the children. Children used for illegal activities like prostitution, begging, pickpocketing, drug couriering, early marriages, and organ transplants. The working environments are dangerous and harmful for child’s mental and physical health.

Types of Child Trafficking

Child Trafficking has been classified into different categories. Here is a look at some types of child trafficking in detail:

• Domestic slave

Child Labour

Bonded labour, sexual exploitation, illegal activities.

• Trafficking of Organs

Child Soldiers

Domestic slave.

Children and their families in the rural areas often tricked for the lure of higher wages in the cities. In reality the children sold for certain amount and forced to work as house help for no wages at all. In most of the child marriages young females exploited as domestic slave and sexually assaulted. Such crimes hardly ever exposed as they take place in private homes.

Children from rural areas often migrate or trafficked for employment in industries like hotels and restaurants, construction industries, spinning mills etc. Victims are also physically and mentally exploited. They forced to work for very low or no wages at all under threatening conditions.

Bonded labors the labours that forced to pay the family debt. Parents give away their children when they are unable to pay debts. Also children sold for some amount due to poverty and lack of basic resources.

Sexual Exploitation is the bitter truth in rural as well as urban areas in India. Young females trafficked and forced to work as prostitute. Children also exploited for commercial sex for the exchange of drugs, food, shelter etc. Unwanted pregnancy, HIV, STD’s and even deaths are the common after-effects faced by these victims.

Children also trafficked for illegal activities such as begging and organ trade as they more sympathized by people as weak. Therefore in some unfortunate conditions, their body parts damaged or cut off by the criminals as those injured make more money.

Trafficking for Organs

Demand for organs is higher than supply. This results in the illegal trade of organs and trafficking. Organs such as eyes and kidneys in particular are high in demand. There are criminal groups that exploit children for personal profits. Child organ trafficking is the dark reality in today’s world.

Many children under the age group of 18 are trafficked and are being exploited as child soldiers. Other children also forced to work as guards, cooks, servants etc. The children forced to work hard as a result they deprived from the childhood, love and care of their families.

The society and government needs to focus on Prevention, Prosecution and Protection. The government should adopt proper measures to prevent severe kind of child trafficking. Awareness in the society has to created by educating and informing people and the victims of child trafficking about the causes and effects of the different forms of child trafficking. The government needs to redefine laws and make sure the laws implemented efficiently. Government needs to make continuous efforts with the help of NGOs and society to abolish all forms of child trafficking. Serious action needs to taken against the trafficking chain and everyone involved in the crime must punished by law.

Related Information:

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Speech on Organ Trafficking

Paragraph on Child Labour

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Q&A: Researcher exposes child labor trafficking as a hidden crime after investigating 132 victims

by Cynthia McCormick Hibbert, Northeastern University

Children trafficked for their labor often work in public view in restaurants, laundromats, agricultural fields and water parks, but little has been known about their plight.

A new study co-authored by Northeastern University professor Amy Farrell provides insights about these children, those who traffic them and what makes children vulnerable to dangerous work—and conditions that too often rob them of a chance for an education, and leave them exhausted, hungry and sometimes injured.

Farrell, the director of Northeastern's School of Criminology and Criminal Justice, answered questions from Northeastern Global News about what researchers discovered in their investigation of 132 victims, as well as their recommendations for a better future for trafficked children.

The research says the average age of victims you studied was 14. Where do trafficked children work?

It's shocking how many different industries where we found children trafficked for their labor. They are all around us. They are on our roofs, they are in our gardens doing landscaping.

They work cleaning dentists' offices, for storage facilities and in restaurants, agriculture and poultry farms. They work in waterparks, hotels and in private homes providing child care and domestic labor.

There was another subset of labor in which children were trafficked called forced criminality. This is a situation where kids work in illicit economies—panhandling, organized theft and drug cultivation, packing and distribution.

When people think about child trafficking of children, they commonly think about sex trafficking . That's not because 90% of the human trafficking that is identified by the police is for sex trafficking, but because that's where most of the public awareness is.

Child labor trafficking remains very hidden.

We often think of child labor trafficking as a migrant issue. But 42% of the child victims in your study were American. What makes both U.S. and foreign-born children susceptible to trafficking?

Poverty and housing instability are really big factors.

We find minors in situations where they're working because they need to bring money into the family or because they've left their family and are unhoused and living with a group of other minors who are unhoused.

Housing is super expensive and hard to navigate for young people who often cannot independently secure housing. Young people need to survive.

In our data, we've also seen cases of familial trafficking where a parent or guardian traffics kids into family businesses or into doing childcare and domestic labor in the home.

We've had situations where sponsors of unaccompanied minors were coercing children into work—sometimes overtly. Other times economic pressure in the sponsor's household forced young people into jobs, in addition to trying to go to school.

There are some well-documented child labor trafficking cases where minors got sponsored out to nefarious actors who pretend they are going to take care of these kids and end up exploiting them.

Sponsors are needed to handle the influx of unaccompanied minors into the U.S., but much more accountability and oversight of sponsor programs are needed.

Family disruption is another huge piece of this. Lots and lots of young people, particularly those who are U.S. citizens, come from families with histories with the child welfare system.

Those kids, both girls and boys, are particularly vulnerable to both sex and labor trafficking. In some ways, it's about who gets to them first.

What motivates child labor traffickers?

It's just about extracting money from them. They're throwaway kids—no one cares about them. They are disposable.

They are going to labor until they run away, get hurt or maybe get arrested. And then there will be more kids right behind them to take their place.

There's not a lot of care to even be sure that they can continue to be exploited because they can so easily be replaced by someone else. So if they get hurt, they don't get medical care.

It's really heartbreaking.

If sounds as if it's very difficult to leave child labor trafficking situations

They leave with nothing on their back—no money but sometimes a lot of debt to smugglers or others who have loaned them money or provided housing. The reliance on traffickers to meet basic needs is one of the mechanisms that traffickers use to keep kids laboring.

One of the victims we studied came to the U.S. from Guatemala with a group of teenagers as young as 14 or 15, many of whom were exploited in an egg farm.

Although the teen we studied avoided the exploitative farming situation, he ended up being exploited by someone else who had portrayed themselves as a good Samaritan willing to take him in. He was eventually trafficked to a woodworking factory.

It's a really difficult situation, because even when young people get away from a trafficking situation, they are still vulnerable to being abused or re-trafficked by others.

When do labor abuse issues become child labor trafficking violations?

Labor abuses become trafficking crimes when a person is coerced, defrauded or forced into laboring.

Unlike sex trafficking, where proving force, fraud and coercion are not required for children under the age of 18, these elements are required to prove child labor trafficking.

A major finding of this study is that coercion was omnipresent in situations where adults are providing things for kids to meet their daily needs.

For example, adults trafficking child laborers often provided young people with a place to stay, clothes or food. In other cases, adults provide love or acceptance to young people who are seeking their approval and care.

Fraud was another issue, even for children. People pay money to come to the United States and stay in unsafe jobs to pay off their debts or the debts of their family.

Is child labor trafficking getting worse?

We don't know because we lack comprehensive data. We really have no way of knowing what child trafficking was like 10 years ago in comparison to what it's like today.

This study is one of the first to lay out the kinds of conditions under which a wide cross section of children experience victimization.

Here in Boston we are undergoing a migration crisis where we have lots of families coming into Massachusetts who are not able to work or find stable housing.

That is a situation that is ripe for exploitation of both adults and minors.

What can be done to stop child labor trafficking?

We're not saying kids shouldn't work. We're not saying foreign national kids shouldn't work. Work is often a very helpful and developmentally appropriate activity for young people. What we're saying is kids need to work in situations where they won't be harmed.

One of our recommendations is that if kids experience a violation of the Fair Labor Standards Act or any of the existing wage, hour and work protections, coercion should be assumed if there's an adult involved. More attention is needed to young people laboring in situations where there is clear labor abuse.

Police and child welfare agencies have a role to prevent trafficking, but the people who may be in the best position to identify child labor violations are inspectors and regulators who ensure workplaces across a variety of industries are safe.

.It is critically important that legal advocates and worker rights organizations are provided with resources to help serve young people who are in precarious situations of workplace abuse.

We also recommend that vocational programs be expanded to provide teenagers with valuable skills in safe, lawful employment and alternative housing be funded for minors to reduce their vulnerability to dangerous forms of illegal employment.

Do you think efforts by states seeking to roll back child labor protections are ill-informed?

It's important for young people to have developmentally appropriate opportunities to work.

But we don't want young people working 12 hours overnight at a factory making potato chips or dog food and falling asleep in school—then dropping out of school and continuing to work at the dog food factory, where what they do is dangerous.

When communities face economic need and housing insecurity that drive young people into dangerous jobs, it is time to step back and ensure we have shored up the safety nets that help children and families meet basic needs without children laboring in exploitative situations.

Provided by Northeastern University

This story is republished courtesy of Northeastern Global News news.northeastern.edu .

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Watch CBS News

17-year-old girl trafficked into U.S. from Mexico rescued after texting 911 and describing landmarks

By Kerry Breen

Updated on: May 17, 2024 / 11:11 AM EDT / CBS News

A 17-year-old girl has been rescued and a man arrested after the girl was allegedly trafficked into the United States from Mexico, authorities in Southern California said Thursday. The girl was able to text authorities asking for help and describe enough landmarks for police to find her. 

The Ventura County Sheriff's Communication Center in California received a text message at around 3 a.m. on Thursday, April 9 that included pleas for help, the sheriff's department said in a news release . A dispatcher at the center began communicating with the texter, who was sending messages in Spanish. The texter had no idea where she was but described multiple landmarks and "other identifiable information," and the dispatcher passed this information along to deputies at the Ojai Sheriff's Sub-Station.

Those deputies launched a search in the Casita Springs area, and after just 20 minutes, the texter was found. 

The texter was identified as a 17-year-old girl, but her name and hometown have not been released publicly. 

Officials said the investigation found that the girl was trafficked into California about two months ago. She was evaluated and transferred to Ventura County Child Family Services until she can be reunited with her family. Authorities did not say if the girl had family in the U.S. or when the reunion was expected to happen. 

The girl identified Gerardo Cruz of Veracruz, Mexico as a suspect in the case. Cruz, 31, was "quickly located and arrested by deputies," officials said. 

Cruz has been charged with human trafficking, forcible rape, lewd acts upon a child, luring, and sexual penetration with force. He pleaded not guilty to the charges, according to online records reviewed by CBS News. 

Cruz remains in the Todd Road Jail on a $500,000 bail, according to online records. His next court date is set for May 22. 

• Child Trafficking

Kerry Breen is a reporter and news editor at CBSNews.com. A graduate of New York University's Arthur L. Carter School of Journalism, she previously worked at NBC News' TODAY Digital. She covers current events, breaking news and issues including substance use.

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