AWHONN Position Statement: Human Trafficking

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Human trafficking is a form of modern-day slavery that involves the use of force, abduction, fraud, or coercion for purposes of forced labor or sexual exploitation (National Institute of Justice, 2019). In 2016, 800,000 individuals were trafficked worldwide, and 7,500 of those cases occurred in the United States (Office on Women's Health, 2018). Globally, it was also estimated that 40.3 million people have suffered due to human trafficking, and, of this group, 75% of victims are women and girls (Polaris, 2018). These statistics make the issue of human trafficking particularly important for nurses working in women’s health and pediatric care.

As a nursing student striving to understand the significance of human trafficking in nursing care, the topic was viewed in terms of how it pertains to current issues and problems within my community. Once an understanding of the matter was determined, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) position statement on human trafficking and additional nursing research were reviewed to gain insight in how proper care techniques could aid in safety and identification of these vulnerable populations.

 Human trafficking recently came to the forefront of social concern with the indictment of U.S. v. Jeffrey Epstein. In this case, it was discovered that sexual exploitation and abuse of minors occurred over three decades (United States Department of Justice, 2019). In addition to this highly publicized case, the president’s fiscal year 2020 budget proposed $68 million worth of cuts from the International Labor Affairs Bureau, which is the agency that provides funding and oversight to the Office of Child Labor, Forced Labor, and Human Trafficking (House Committee on Appropriations, 2019).

 In addition to the issue coming to the forefront of national and social concern, human trafficking has dramatically impacted the state of North Dakota in the last several years with the influx of outside entities entering the state due to the Bakken Oil boom. Since 2007, the National Human Trafficking Hotline has reported 122 cases of trafficking in North Dakota, which may only be a small fraction since statistics are based on contacts made to the hotline (National Human Trafficking Hotline, 2018). This data, along with examples shared by nurses in the clinical setting, prompted an interest in the care of individuals victimized by human trafficking.

In the United States, sex trafficking is the most common form of human trafficking (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016). Specific to sex trafficking of women, there are additional physical and mental health issues related to forced sexual activities. Women who have faced the anguish of these sexual encounters are more likely to experience fear, isolation, increased trauma, alcohol and drug abuse, and ineffective coping (Office on Women's Health, 2018). Victims of sex trafficking also have a higher risk of contracting sexually transmitted infections, especially HIV (Office on Women's Health, 2018).  Furthermore, since victims do not receive basic, routine health services, they often have untreated medical problems such as physical abuse, malnutrition, dehydration, depression, and posttraumatic stress disorder (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016).

 Based on the adversities faced by victims, nurses must understand that those affected by human trafficking need to be cared for with an added sense of fragility and attentiveness. For this reason, AWHONN “supports improved education and awareness for nurses regarding human trafficking” (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016, p. 458). Since victims are fearful and traumatized from their experiences, screening should occur in safe, private environments away from potential abusers. Furthermore, AWHONN “opposes laws and other policies that require nurses to report the results of screening to law enforcement or other regulatory agencies without the consent of the woman who experiences the human trafficking,” unless it is a mandatorily reportable event (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016, p. 458). Due to the under-identification and sensitivity of care needed for these patients, my views on improved nursing education and patient safety greatly mirrors that of AWHONN.

 Since nurses may be some of the few professionals that interact with trafficking victims, especially those still in captivity, their roles are critical in identifying warning signs, implementing safe interview techniques, and providing follow-up resources (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016). If the nurse does not recognize warning signs such as branding and controlled behaviors, an opportunity to help a vulnerable person may be lost. Additionally, if appropriate and discrete interview techniques are not used, the nurse could increase the risk of additional harm being caused by the trafficker.

 With nurses being essential care providers with trafficked individuals, there is an increased responsibility in completing thorough assessments. In care areas such as emergency departments and women’s health clinics, knowledge of human trafficking and training on care techniques may significantly increase nurses’ responsiveness and advocacy of care (Hachey & Phillippi, 2017). In one study completed in a maternity ward, nurses felt an obligation to assist suspected victims of human trafficking; however, the lack of training acted as a barrier in ensuring patients received the care needed (Hachey & Phillippi, 2017). When a training barrier is present, nurses are less likely to intervene and be the advocates that these patients desperately need.

 As one of the most trusted professions, nurses have the most significant opportunity to instill change and awareness for those in greatest need. As a future nurse, advocacy and care of vulnerable populations will be essential in each area of specialty. With specific issues, such as suspicion of human trafficking, additional attentiveness and sensitivity will need to be implemented to promote safety and openness in care. Moreover, improved educational resources will empower all nurses in identifying warning signs and meeting AWHONN advocacy goals. No matter the situation of the patient, nurses may be some of the few individuals that can catch safety concerns before it is too late. To promote quality of life, we as nurses must ensure that we have the appropriate resources to advocate for our patients and community vigorously.

References

  • Association of Women’s Health, Obstetric and Neonatal Nurses. (2016). Human trafficking. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(3), 458-460. doi:10.1016/j.jogn.2016.04.001
  • Hachey, L., & Phillippi, J. (2017). Identification and management of human trafficking victims in the emergency department. Advanced Emergency Nursing Journal, 39(1), 31-51. doi:10.1097/TME.0000000000000138
  • House Committee on Appropriations. (2019). Chairwoman DeLauro statement at hearing on fy               2020 labor department budget request. Retrieved from https://appropriations.house. gov/news/statements/ chairwoman-delauro-statement-at-hearing-on-fy-2020-labor-department-budget-request
  • National Human Trafficking Hotline. (2018). North Dakota. Retrieved from https://humantraffickinghotline.org/state/north-dakota
  • National Institute of Justice. (2019). Human trafficking. Retrieved from https://www.nij.gov/topics/crime/human-trafficking/pages/welcome.aspx
  • Office on Women's Health. (2018). Human trafficking. Retrieved from https://www.womenshealth.gov/relationships-and-safety/other-types/human-trafficking
  • Polaris. (2018). The facts. Retrieved from https://polarisproject.org/human-trafficking/facts
  • United States Department of Justice. (2019). United States v. Jeffrey Epstein, 19 Cr. 490 (RMB). Retrieved from https://www.justice.gov/usao-sdny/programs/victim-witness-services/united-states-v-jeffrey-epstein-19-cr-490-rmb

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