Human trafficking: a call for heightened awareness and advocacy by obstetrician-gynecologists.

A a recent labor floor sign-out round, the resident presented a laboring patient with a complicated social history. The patient was a homeless teenager who had just arrived from Texas and was having an unplanned, undesired pregnancy. I somewhat sheepishly asked, “Any possibility of human trafficking here?” I realized that, despite having recently become educated about this topic, I still did not feel fully prepared to educate my peers about trafficking or identify and assist victims of trafficking. As obstetrician–gynecologists (ob-gyns), we need to educate ourselves and feel empowered to help these patients. Years ago, the physician’s role in identifying and assisting victims of intimate partner violence was not recognized. After decades of advocacy and education, intimate partner violence became a topic of formal instruction in medical schools and residency programs, and the same should be true regarding human trafficking. The extent of human trafficking is staggering. Barrows and Finger note that the “practice of slavery is alive and well around the globe.”1 According to the U.S. Department of State, there are many kinds of human trafficking, including forced labor, bonded labor, involuntary domestic servitude, sex trafficking, forced child labor, child soldiers, and child sex trafficking.2 The United Nations Office on Drugs and Crime reports that human trafficking is one of the top three most profitable crimes crossing national borders.3 By some estimates, nearly 1 million people in the world are trafficked across international borders each year, and approximately 14,500–17,500 people are trafficked into the United States each year.4 According to the most recent U.S. Department of State’s Trafficking in Persons report, trafficking is widespread across this nation and the year 2010 saw an increase in the number of female, foreign-born trafficking victims receiving services in the United States.5 This U.S. report identifies Thailand, India, Mexico, the Philippines, Haiti, Honduras, El Salvador, and the Dominican Republic as the most common countries of origin of persons trafficked into the United States. However, human trafficking does not require the crossing of international borders, and the aforementioned figures do not include the larger number of individuals estimated to be trafficked domestically within their own countries. According to one report, the United States is second only to Germany with regard to the rate at which women and children are trafficked into sex work.6 One author notes that there are currently at least 100,000 victims of domestic minor sex trafficking in the United States and that there are as many as 325,000 additional youth at risk of being trafficked.7 Although there are many challenges in determining accurate prevalence estimates, the United States enacted the Victims of Trafficking and Violence Prevention Act in 2000 in response to this seeming epidemic.8 The Act subsequently was amended and reauthorized in 2003, 2005, and 2008. Additionally, the United States ratified the United Nations’ “Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children” in November 2005.9 Encounters with health care providers can be windows of opportunity to intervene on behalf of these victims. Given the many medical problems associated with trafficking, health care providers are uniquely positioned to identify and assist these vicFrom Massachusetts General Hospital, Boston, Massachusetts.