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HEALTH-RELATED HARMS ASSOCIATED WITH HUMAN TRAFFICKING – STUDY – THE LANCET

 

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70082-3/fulltext

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Trafficking, Migration, & Health: Complexities & Future Directions

By Shira M Goldenberg

 

Documenting the health-related harms associated with human trafficking is crucial for the development of strategies to protect and promote the health of individuals who experience this serious human rights violation. In The Lancet Global Health, Ligia Kiss and colleagues report the results of a study of 1102 men, women, and children receiving post-trafficking services in Cambodia, Thailand, and Vietnam—the largest quantitative study of its kind. They document the health-related harms experienced by men, women, and children trafficked for sex work (32%), fishing (27%), and factory work (13%). Countering dominant portrayals of trafficked people as mainly women and girls trafficked for sexual labour, this study shows the diversity of trafficked people (eg, both sexes, and adults and children) and that trafficking occurs across many sectors. Kiss and colleagues’ findings begin to address a gap in research pertaining to health outcomes associated with sex trafficking (ie, trafficking for sexual labour), as well as trafficking into other sectors (eg, fishing, manufacturing). Both contributions are important for informing interventions to protect and promote the health and wellbeing of trafficked people.

Most research on the health of trafficked people has focused on trafficking for sexual labour,2 which has often been conflated with sex work (ie, the consensual sale or exchange of sexual services between adults adult), and the idea of migrant labour. The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children,3 defines human trafficking as involving actions by a third party (eg, recruitment, transportation); use of force, deception, or other fraudulent means; and purposes of exploitation (eg, forced labour). The conflation of sex trafficking and sex work on an ideological and political basis has historically fuelled repressive policies that have undermined efforts to advance the health and human rights of sex workers.

For example, the clause requiring recipients of funding from the 2003 US President's Emergency Plan for AIDS Relief to explicitly oppose sex work, its legalisation, and sex trafficking (the so-called anti-prostitution pledge) was instrumental in shaping international and bilateral policies that conflated sex work and trafficking over the past decade. As a result of such conflation, many countries—including Thailand, Cambodia, and Vietnam—implemented punitive measures targeting the sex industry, including laws criminalising aspects of sex work, and accompanying police crackdowns, raids, and rescue operations. Such enforcement-based measures contribute to unintended harms that exacerbate health inequities and human rights violations—for example, by displacing sex workers to isolated, unsafe work environments; undermining their access to health care; and increasing their vulnerability to police abuses. Although the clause was revoked in 2013, its legacy continues to warrant scrutiny to ensure that anti-trafficking efforts target those who commit trafficking, rather than consenting adults in the sex industry. About 40% of the women, men, and children participating in Kiss and colleagues’ study were trafficked for forced labour in fishing or factories. Conflation of trafficking with sex work risks overlooking opportunities to address the health and social needs of this diverse population.

Furthermore, most participants in the study by Kiss and colleagues were migrants trafficked outside their country of origin. Migrants come from different places and have diverse experiences of immigration, occupations, ages, and reasons for migration. These factors greatly affect the extent to which migrants might be vulnerable or protected from human rights abuses, including trafficking, and their health implications. Migrants are often forced to live at society's margins, with many reasons contributing to their precariousness, including insecure immigration status, stigma, and discrimination. The findings of Kiss and colleagues reinforce the need to recognise the complex links between trafficking and migration in future research.

Kiss and colleagues’ study surpasses earlier research on trafficking and health (which primarily emphasised violence and individual risk factors) to show the importance of working and living conditions as determinants of health. Future research examining the mental, physical, and sexual health of both trafficked persons as well as migrant workers through labour and human rights frameworks should be a priority. Migrant workers are more likely than other occupational groups to work under hazardous conditions, for reasons including their precarious legal status and lack of political capital, which make it unlikely that workplace abuses will be reported. They are also often denied access to health care as a result of discriminatory practices, legal barriers, and fear of criminalisation or deportation.11 The need for comprehensive policy and programmatic responses to address migrants’ unequal access to occupational standards and health care is shown by the positions of international policy bodies, including the UN Special Rapporteur on the human rights of migrants, who noted that it is precisely these types of inequities that should be the focus of the post-2015 development agenda, if equity in health and development is to be realized.