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Zimmerman C, Hargreaves S, Lau K, Kiss L, Lin RCY, Pocock N. Addressing labour exploitation in the global workforce. Lancet 2024; 403:1748. [PMID: 38704165 DOI: 10.1016/s0140-6736(24)00459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Affiliation(s)
- C Zimmerman
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Hargreaves
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK.
| | - K Lau
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK
| | - L Kiss
- London School of Hygiene and Tropical Medicine, London, UK
| | - R Chia-Yin Lin
- The Migrant Health Research Group, St George's University of London, London SW17 0RE, UK
| | - N Pocock
- London School of Hygiene and Tropical Medicine, London, UK
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2
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Pirkle L, Zimmerman C, Sadhu S, Kysia K, Ranganathan M. Child labour in cocoa growing regions of Ghana and Côte d'Ivoire: an analysis of academic attainment in children engaged in hazardous labour. Glob Public Health 2024; 19:2320860. [PMID: 38390670 DOI: 10.1080/17441692.2024.2320860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d'Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour.
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Affiliation(s)
- Lucy Pirkle
- Department of Brain Sciences, Imperial College London, London, UK
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Santadarshan Sadhu
- Vulnerable Populations Research Area, NORC at the University of Chicago, Chicago, IL, USA
| | - Kareem Kysia
- Department of Brain Sciences, Imperial College London, London, UK
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Busza J, Shewamene Z, Zimmerman C, Erulkar A, Hailu E, Negeri L, Anderson E, Lo Y. Accidental traffickers: qualitative findings on labour recruitment in Ethiopia. Global Health 2023; 19:102. [PMID: 38098068 PMCID: PMC10722833 DOI: 10.1186/s12992-023-01005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The growth of labour migration and associated risks of human trafficking and exploitation remain significant global human rights and health challenges. There is increasing policy interest in addressing structural determinants of adverse migration outcomes such as migrants' use of informal employment recruiters. In Ethiopia, "safe migration" policies have introduced regulations for registered private employment agencies and penalties for anyone else placing migrants into work overseas. Yet migrants continue to use informal facilitators who are often demonised as traffickers without evidence of their motivations, experiences or perceptions. We conducted qualitative interviews with 28 informal facilitators as part of a study into how recruitment practices shape risks for female migrants seeking domestic work in the Middle East and Gulf States. We present the realities of irregular recruitment on the ground, and how these practices are affected by policies that dichotomise recruiters into legal/safe and illegal/unsafe categories. RESULTS We identified four main themes. First, arranging migration from rural areas differs from in the capital, Addis Ababa, where laws and regulations originate. Outside Addis Ababa, registration was difficult for facilitators to arrange, with little incentive to do so due to its lack of importance to prospective migrants. Second, the ability to circumvent legal requirements was considered an advantage of informal facilitators because it reduced costs and expedited migrants' departure. Third, facilitators did not work alone but operated in long "chains" of diverse actors. This meant migrants' safety was not determined by any given individual, but spread across numerous people involved in sending a migrant abroad, some of whom might be registered and others not. And finally, facilitators did not believe they could realistically safeguard migrants once they were outside of Ethiopia and working under different laws and employers. CONCLUSIONS Findings from this study add to a growing body of work demonstrating the diversity of people involved in the migration process, and consequent oversimplification of popular policy solutions. A more effective approach might be to constructively engage informal facilitators and identify ways they could assist with referring migrant workers to registered agencies and safe employment, rather than criminalising their participation.
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Affiliation(s)
- Joanna Busza
- Department of Public Health, Environment & Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Zewdneh Shewamene
- Department of Public Health, Environment & Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Annabel Erulkar
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa, 18609, Ethiopia
| | - Eyasu Hailu
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa, 18609, Ethiopia
| | - Lemi Negeri
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa, 18609, Ethiopia
| | - Elizabeth Anderson
- The Freedom Fund, Lighterman House, 30 Wharfdale Road, London, N1 9RY, UK
| | - Yuki Lo
- The Freedom Fund, Lighterman House, 30 Wharfdale Road, London, N1 9RY, UK
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Pearson I, Page S, Zimmerman C, Meinck F, Gennari F, Guedes A, Stöckl H. The Co-Occurrence of Intimate Partner Violence and Violence Against Children: A Systematic Review on Associated Factors in Low- and Middle-Income Countries. Trauma Violence Abuse 2023; 24:2097-2114. [PMID: 35481390 PMCID: PMC10486154 DOI: 10.1177/15248380221082943] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Violence against women (VAW) and violence against children (VAC) are public health issues of global concern. Intimate partner violence (IPV) is a commonly occurring form of VAW and there is evidence to suggest that IPV and VAC frequently co-occur within the same families. This systematic literature review searched for studies published in any language between 1st January 2000 to 16th February 2021 and identified 33 studies that provided findings for co-occurring IPV and VAC in 24 low- and middle-income countries (PROSPERO: CRD42020180179). These studies were split into subgroups based on the types of co-occurring violence they present and meta-analyses were conducted to calculate pooled odds ratios (ORs) within these subgroups. Our results indicate a significant association between IPV and VAC, with all pooled ORs showing a significant positive association between the two. Almost half of the studies focused exclusively on co-occurrence between male-to-female IPV and female caregiver-to-child VAC; few authors reported on male caregiver-to-child violence. Only three studies identified risk factors for co-occurring IPV and VAC, and those that did suggested conflicting findings on the risks associated with maternal age, alcohol and drug use, and parental education level. We also found incongruity in the violence definitions and measurements used across studies. Future research should aim to develop more consistent definitions and measurements for co-occurrence and move beyond solely examining dyadic and unidirectional violence occurrence in families; this will allow us to better understand the interrelationships between these different forms of abuse.
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Affiliation(s)
- Isabelle Pearson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sabrina Page
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Franziska Meinck
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | | | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Germany
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Mak J, Bentley A, Paphtis S, Huq M, Zimmerman C, Osrin D, Devakumar D, Abas M, Kiss L. Psychosocial interventions to improve the mental health of survivors of human trafficking: a realist review. Lancet Psychiatry 2023; 10:557-574. [PMID: 37353265 DOI: 10.1016/s2215-0366(23)00105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 06/25/2023]
Abstract
More than 50 million people globally are subjected to modern slavery and human trafficking. Adverse mental health consequences of extreme exploitation are prevalent and often severe. We conducted a systematic and realist review on evaluations of psychosocial interventions for survivors of human trafficking. The review aimed to identify the influence of these interventions on the mental health and wellbeing of trafficked people and examine how they worked for which survivors in which contexts. We searched eight databases (MEDLINE, MEDLINE In-Process, Embase, PsycINFO, Global Health, CINAHL Plus, Web of Science, and Cochrane) for published evaluations of psychosocial interventions for survivors of human-trafficking. We followed a realist approach to analyse the data and report on the limitations of the studies identified. We identified four mechanisms of change as being triggered by the various intervention activities: (1) awareness and understanding; (2) trust, safety, and security; (3) agency, autonomy, empowerment, and social connections; and (4) self-reflection, self-expression, and self-care. Improving mental health after traumatic events is an ongoing, nonlinear process. Intervention effectiveness and transferability would benefit from more transparent programme theories and well articulated assumptions that identify the pathways to change.
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Affiliation(s)
- Joelle Mak
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Abigail Bentley
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sharli Paphtis
- Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Mita Huq
- Institute for Global Health, University College London, London, UK
| | - Cathy Zimmerman
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | | | - Melanie Abas
- Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK.
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Thi AM, Zimmerman C, Ranganathan M. Hazardous Child Labour, Psychosocial Functioning, and School Dropouts among Children in Bangladesh: A Cross-Sectional Analysis of UNICEF's Multiple Indicator Cluster Surveys (MICS). Children (Basel) 2023; 10:1021. [PMID: 37371253 DOI: 10.3390/children10061021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Child labour is a common financial coping strategy in poor households, especially in low-and middle-income countries with many children working under hazardous conditions. Little is known about the linkages between hazardous work conditions and psycho-social and educational outcomes. We analysed the Bangladesh Multiple Indicator Cluster Survey (BMICS) round 6 to assess the association between the exposure variables, including child labour, hazardous child labour (HZCL) and hazardous work, and outcome variables, including psychosocial functioning difficulty and school dropout, in children aged 5 to 17 years. We conducted bivariable and multivariable analyses to examine the association. In the adjusted analyses, children engaged in HZCL had increased odds of psychosocial functioning difficulty (aOR: 1.41; 95% CI: 1.16-1.72) and school dropout (aOR: 5.65; 95% CI: 4.83-6.61) among 5-14-year-olds compared to children who did not engage in child labour and hazardous work. Other independent factors associated with psychosocial functioning difficulty and school dropout included being male, living in a deprived neighbourhood, being exposed to violent punishment, the caregiver's attitude towards physical punishment, the mother's functional difficulty and lower maternal education. The linkages between hazardous work and psychosocial functioning difficulty appear more prominent among children not in school. Further, the evidence on the relationship between hazardous work and school dropout is stronger among children with psychosocial functioning difficulty. Policies and programmes that target the most hazardous forms of work are likely to have the greatest benefits for children's mental health, social well-being and educational attainment.
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Affiliation(s)
- Aye Myat Thi
- Innovations for Poverty Action, Yangon 11111, Myanmar
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Meghna Ranganathan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Zimmerman C, Mak J, Pocock NS, Kiss L. Corrigendum: Human trafficking: Results of a 5-year theory-based evaluation of interventions to prevent trafficking of women from South Asia. Front Public Health 2023; 11:901443. [PMID: 36844859 PMCID: PMC9949481 DOI: 10.3389/fpubh.2023.901443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2021.645059.].
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Affiliation(s)
- Cathy Zimmerman
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,*Correspondence: Cathy Zimmerman ✉
| | - Joelle Mak
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicola S. Pocock
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,Lumos Foundation, London, United Kingdom,Nicola S. Pocock ✉
| | - Ligia Kiss
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,Faculty of Population Health Science, Institute for Global Health, University College London, London, United Kingdom
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Howard-Merrill L, Zimmerman C, Sono R, Riber J, Wamoyi J, Pawlak P, Rolleri Insignares L, Yaker R, Buller AM. Shifting social norms to prevent age-disparate transactional sex in Tanzania: what we can learn from intervention development research. Front Psychol 2023; 14:926531. [PMID: 37205068 PMCID: PMC10187065 DOI: 10.3389/fpsyg.2023.926531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory-social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design.
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Affiliation(s)
- Lottie Howard-Merrill
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
| | - Cathy Zimmerman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - John Riber
- Media for Development International, Arusha, Tanzania
| | - Joyce Wamoyi
- Department for Sexual and Reproductive Health, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Piotr Pawlak
- Independent Consultant, Washington, DC, United States
| | | | | | - Ana Maria Buller
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Ana Maria Buller,
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Shewamene Z, Zimmerman C, Hailu E, Negeri L, Erulkar A, Anderson E, Lo Y, Jackson O, Busza J. Migrant Women's Health and Safety: Why Do Ethiopian Women Choose Irregular Migration to the Middle East for Domestic Work? Int J Environ Res Public Health 2022; 19:13085. [PMID: 36293665 PMCID: PMC9603558 DOI: 10.3390/ijerph192013085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Low-wage labour migration is an increasing determinant of global health, associated with risks of exploitation, abuse, and unsafe conditions. Despite efforts to prevent irregular migration and initiatives to warn individuals of the risks of trafficking, many migrants still opt for irregular channels, particularly women seeking jobs as domestic workers. Ethiopia is one of the largest source countries for female migrants entering the domestic labour market in the Middle East. This qualitative study explored migration decision making by Ethiopian women traveling to the Middle East for domestic labour, focusing on the use of irregular channels. METHODS We conducted semistructured interviews with policy stakeholders, migration recruiters, and returnee domestic workers. RESULTS We identified three main themes that help explain decision making by female migrants and their communities. First, women were not always clear whether they were using legally approved processes, particularly because of the range of individuals involved in arranging migration plans. Second, irregular migration was seen to be quicker and easier than regular migration procedures. Third, study participants believed the risks between irregular and regular migration were similar. CONCLUSION Our study highlights challenges associated with antitrafficking initiatives that discourage irregular migration and suggests new perspectives to address the health risks linked to labour migration.
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Affiliation(s)
- Zewdneh Shewamene
- Department of Public Health, Environment & Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London WC1H 9SH, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Eyasu Hailu
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa 18609, Ethiopia
| | - Lemi Negeri
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa 18609, Ethiopia
| | - Annabel Erulkar
- Population Council, Heritage Plaza, Bole Medhaneialem Road, Addis Ababa 18609, Ethiopia
| | - Elizabeth Anderson
- The Freedom Fund, Lighterman House, 30 Wharfdale Road, London N1 9RY, UK
| | - Yuki Lo
- The Freedom Fund, Lighterman House, 30 Wharfdale Road, London N1 9RY, UK
| | - Orla Jackson
- The Freedom Fund, Lighterman House, 30 Wharfdale Road, London N1 9RY, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London WC1H 9SH, UK
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Lowe H, Brown L, Ahmad A, Daruwalla N, Gram L, Osrin D, Panchal K, Watson D, Zimmerman C, Mannell J. Mechanisms for community prevention of violence against women in low- and middle-income countries: A realist approach to a comparative analysis of qualitative data. Soc Sci Med 2022; 305:115064. [PMID: 35653892 PMCID: PMC7614855 DOI: 10.1016/j.socscimed.2022.115064] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/03/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Growing evidence suggests that community-based interventions in low- and middle-income countries (LMICs) can effectively address harmful social norms that promote or sustain gender inequality and drive violence against women (VAW). However, understanding what actions communities are already taking to address harmful social norms and prevent VAW is an essential first step for intervention development. Towards this goal, drawing on collective action theory, we conducted a realist analysis of secondary qualitative data collected with communities in India, Afghanistan, Peru and Rwanda. We coded interview and focus-group data from 232 participants to identify the contexts, mechanisms and outcomes (CMO) relevant for community action. We synthesized CMO configurations from each dataset into a conceptual framework composed of three middle-range theories of mechanisms driving community action to prevent VAW in LMICs. Our results highlight the importance of dedicated spaces for discussing VAW, VAW leaders as positive role models, and community perceptions of VAW as a problem worthy of intervention. In Rwanda and Peru, there was strong evidence to support the operation of these mechanisms. Contextual factors, including national and local policy and programmes targeting VAW, activated mechanisms that led to community action. In India and Afghanistan, evidence for the presence of these mechanisms was weaker, with social norms about women's position and violence being a private family matter preventing communities from addressing violence. Despite contextual differences, our data demonstrated communities in all four settings were somewhere along a pathway of change towards VAW prevention. This supports the need to build future prevention interventions on pre-existing mechanisms that trigger community action, rather than implementing existing interventions without local adaptation. Our conceptual framework serves as a tool for assessing these mechanisms of community action as part of intervention development research, centring community knowledge and fostering local ownership for more relevant and sustainable VAW prevention interventions.
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, UK.
| | - Laura Brown
- Institute for Global Health, University College London, UK
| | | | - Nayreen Daruwalla
- SNEHA (Society for Nutrition, Education and Health Action), Mumbai, India
| | - Lu Gram
- Institute for Global Health, University College London, UK
| | - David Osrin
- Institute for Global Health, University College London, UK
| | - Krishna Panchal
- SNEHA (Society for Nutrition, Education and Health Action), Mumbai, India
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Thi AM, Zimmerman C, Pocock NS, Chan CW, Ranganathan M. Child Domestic Work, Violence, and Health Outcomes: A Rapid Systematic Review. Int J Environ Res Public Health 2021; 19:427. [PMID: 35010705 PMCID: PMC8744913 DOI: 10.3390/ijerph19010427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
This rapid systematic review describes violence and health outcomes among child domestic workers (CDWs) taken from 17 studies conducted in low- and middle-income countries. Our analysis estimated the median reported rates of violence in CDWs aged 5-17-year-olds to be 56.2% (emotional; range: 13-92%), 18.9% (physical; range: 1.7-71.4%), and 2.2% (sexual; range: 0-62%). Both boys and girls reported emotional abuse and sexual violence with emotional abuse being the most common. In Ethiopia and India, violence was associated with severe physical injuries and sexual insecurity among a third to half of CDWs. CDWs in India and Togo reported lower levels of psycho-social well-being than controls. In India, physical punishment was correlated with poor psycho-social well-being of CDWs [OR: 3.6; 95% CI: 3.2-4; p < 0.0001]. Across the studies, between 7% and 68% of CDWs reported work-related illness and injuries, and one third to half had received no medical treatment. On average, children worked between 9 and 15 h per day with no rest days. Findings highlight that many CDWs are exposed to abuse and other health hazards but that conditions vary substantially by context. Because of the often-hidden nature of child domestic work, future initiatives will need to be specifically designed to reach children in private households. Young workers will also benefit from strategies to change social norms around the value and vulnerability of children in domestic work and the long-term implications of harm during childhood.
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Affiliation(s)
- Aye Myat Thi
- Innovations for Poverty Action, Yangon 11111, Myanmar
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (C.Z.); (N.S.P.); (M.R.)
| | - Nicola S. Pocock
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (C.Z.); (N.S.P.); (M.R.)
- Lumos Foundation, London EC3R 8NB, UK
| | | | - Meghna Ranganathan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (C.Z.); (N.S.P.); (M.R.)
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Pocock NS, Stöckl H, Tadee R, Rongrongmuang W, Tharawan K, B Adamson F, Zimmerman C. Victims or suspects? Identifying and assisting potentially trafficked fishermen: A qualitative study with stakeholders and first responders in Thailand. J Migr Health 2021; 4:100074. [PMID: 34888538 PMCID: PMC8634033 DOI: 10.1016/j.jmh.2021.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Prompted by reports of 'sea slavery' in the fishing industry and threats of sanctions, Thailand has faced pressure to eradicate human trafficking the fishing sector. Although the Thai government has responded with anti-trafficking policies, there remains little understanding about their implementation. Specifically, little is known about how government agencies, NGOs or industry perceive "trafficking", and no research examines how trafficked fishermen are identified and assisted. This study aimed to: 1) explore how stakeholders described trafficking in the fishing sector and their perceptions of trafficking indicators; and 2) identify challenges encountered by frontline responders to identify and assist trafficked fishermen. We conducted interviews with 33 key informants, which were analysed thematically. Findings indicate that authorities and industry representatives believed migrant brokers caused employers to "inadvertently" traffic men. Trafficking was perceived to take place primarily outside of Thai waters, beyond the government's jurisdiction. Most stakeholders considered violence and being confined as key indicators of trafficking. Officials expressed confusion about whether debt bondage and document confiscation "counted" as indicators. Ambiguity and confusion about trafficking indicators in screening forms, combined with perceived "deservingness" of official victim status, underpinned frontline responders' decisions about who was a victim of trafficking (VoT). Practical and structural constraints included interpreter shortages, and expanded civil servant remits without commensurate staff increases, which hindered officials' responses to trafficking. This study addresses a critical knowledge gap on the implementation of anti-trafficking policies and offers findings to assist policymakers to address the challenges faced by frontline responders to improve victim identification and assistance.
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Affiliation(s)
- Nicola S Pocock
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, Northern Ireland WC1H 9SH, United Kingdom
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, Epidemiology, Ludwig-Maximilians-University, Germany
| | - Reena Tadee
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | | | - Kanokwan Tharawan
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Fiona B Adamson
- Department of Politics and International Studies, SOAS, University of London, London, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, Northern Ireland WC1H 9SH, United Kingdom
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Stöckl H, Fabbri C, Cook H, Galez-Davis C, Grant N, Lo Y, Kiss L, Zimmerman C. Human trafficking and violence: Findings from the largest global dataset of trafficking survivors. J Migr Health 2021; 4:100073. [PMID: 34888537 PMCID: PMC8637135 DOI: 10.1016/j.jmh.2021.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human trafficking is a recognized human rights violation, and a public health and global development issue. Violence is often a hallmark of human trafficking. This study aims to describe documented cases of violence amongst persons identified as victims of trafficking, examine associated factors throughout the trafficking cycle and explore prevalence of abuse in different labour sectors. METHODS AND FINDINGS The IOM Victim of Trafficking Database (VoTD) is the largest database on human trafficking worldwide. This database is actively used across all IOM regional and country missions as a standardized anti-trafficking case-management tool. This analysis utilized the cases of 10,369 trafficked victims in the VoTD who had information on violence. RESULTS The prevalence of reported violence during human trafficking included: 54% physical and/or sexual violence; 50% physical violence; and 15% sexual violence, with 25% of women reporting sexual violence. Experiences of physical and sexual violence amongst trafficked victims were significantly higher amongst women and girls (AOR 2.48 (CI: 2.01,3.06)), individuals in sexual exploitation (AOR 2.08 (CI: 1.22,3.54)) and those experiencing other forms of abuse and deprivation, such as threats (AOR 2.89 (CI: 2.10,3.98)) and forced use of alcohol and drugs (AOR 2.37 (CI: 1.08,5.21)). Abuse was significantly lower amongst individuals trafficked internationally (AOR 0.36 (CI: 0.19,0.68)) and those using forged documents (AOR 0.64 (CI: 0.44,0.93)). Violence was frequently associated with trafficking into manufacturing, agriculture and begging (> 55%). CONCLUSIONS An analysis of the world's largest data set on trafficking victims indicates that violence is indeed prevalent and gendered. While these results show that trafficking-related violence is common, findings suggest there are patterns of violence, which highlights that post-trafficking services must address the specific support needs of different survivors.
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Affiliation(s)
- Heidi Stöckl
- The Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, Munich, Germany
| | - Camilla Fabbri
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Northern Ireland, United Kingdom
| | - Harry Cook
- Migrant Protection and Assistance Division International Organization for Migration, Geneva, Switzerland
| | - Claire Galez-Davis
- Migrant Protection and Assistance Division International Organization for Migration, Geneva, Switzerland
| | - Naomi Grant
- Migrant Protection and Assistance Division International Organization for Migration, Geneva, Switzerland
| | - Yuki Lo
- The Freedom Fund, Northern Ireland, United Kingdom
| | - Ligia Kiss
- Institute for Global Health, University College London, Northern Ireland, United Kingdom
| | - Cathy Zimmerman
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Northern Ireland, United Kingdom
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Mak J, Zimmerman C, Roberts B. "I had tears in my eyes but I just left without looking back". A qualitative study of migration-related stressors amongst Nepali male labour migrants. J Migr Health 2021; 4:100042. [PMID: 34405192 PMCID: PMC8352159 DOI: 10.1016/j.jmh.2021.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
Labour migration has become a crucial livelihood strategy in settings where employment options are limited. Such opportunities come with potential benefits but also introduce stressors. This study explores migration-related stressors amongst returnee male Nepali international labour migrants. We conducted a qualitative study in Kathmandu amongst 42 returnee male international labour migrants. We explored migration decisions, processes, experiences in destination and on return. The participants worked in low- and semi-skilled jobs in Malaysia, Qatar, and Saudi Arabia. Men reported stressors representing five broad areas: workplace/employer, family, recruitment, environment and legal. Most belonged to the workplace/employer category such as exploitative practices of document confiscation, contract discrepancies and poor working conditions. Family stressors were often due to disagreements about whether to migrate, and once in destination, being absent during illness and death in the family. Recruitment stressors were linked to the migration process and costs. Environmental stressors included over-crowdedness and poor hygiene, and poor security at the accommodation and in the wider town. Legal stressors were related to the lack of documentation, and negative encounters with the local police. Multiple stressors were often experienced simultaneously or in succession. Male labour migrants from Nepal who had worked in various countries and job-sectors reported multiple types of stress. The majority of stressors belong to the workplace category, where migrants may have limited power to challenge problems with their employers. The cumulative effect of such experiences may negatively impact on migrants' wellbeing. Future research should explore migrants' ability to cope with the many stressors encountered.
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Mak J, Zimmerman C, Roberts B. Coping with migration-related stressors - a qualitative study of Nepali male labour migrants. BMC Public Health 2021; 21:1131. [PMID: 34118898 PMCID: PMC8199809 DOI: 10.1186/s12889-021-11192-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background International labour migration has become a crucial livelihood strategy, especially in countries where decently paid employment opportunities are limited. Such opportunities come with many potential benefits but also many stressors that challenge migrants’ coping skills, especially when they are in a foreign environment away from their normal support network. This paper explores how labour migrants coped with migration-related stressors using a sample of male Nepali migrants. Methods Qualitative life histories were conducted in Kathmandu among returnee male migrants. Coping responses were categorised based Skinner and Zimmer-Gembeck’s coping typologies. The interview scripts were transcribed in Nepali and translated into English for analysis. Each interview script was open coded and then categorised according to the 12 core coping families. Data were analysed thematically to explore relationships across and within coping and stressors. Results Forty-two men were interviewed who mainly worked in low- and semi-skilled jobs in Malaysia, and the Gulf States. The coping strategies most commonly used belonged to the families of problem-solving, support-seeking, negotiation and helplessness. Men used these either individually or collectively with other migrants. Those who sought assistance from authorities or civil society organisations did not always receive the help needed and there were mixed messages as to when and what types of assistance were available. Some stressors involved multiple coping strategies simultaneously, others described changing strategies following unsuccessful earlier attempts. The coping families of helplessness and social isolation reflected migrants’ limited power in challenging certain stressors. The choice of coping strategies was also moderated by factors such as outstanding loans, language difficulties, or not wanting to cause their family distress. Some coping strategies used led to new stressors. Conclusions Migrants need greater clarifications on their rights with respect to contract discrepancies, the types of support available, how and from whom to access them once in destination. Improvements to the support mechanisms migrants can access as well as strengthening migrant-led initiatives in destination countries to support labour migrants' in managing stressors are needed. These may contribute to reducing the experiences and impact of such stressors, which may ultimately lead to more successful migration outcomes. As labour migration from Nepal is likely to continue, government and CSOs need to ensure migrants have the support they need to cope with the challenges they may encountered along the way. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11192-y.
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Affiliation(s)
- Joelle Mak
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15 - 17 Tavistock Place, London, WC1H 9SH, UK.
| | - Cathy Zimmerman
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15 - 17 Tavistock Place, London, WC1H 9SH, UK
| | - Bayard Roberts
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15 - 17 Tavistock Place, London, WC1H 9SH, UK
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Zimmerman C, Mak J, Pocock NS, Kiss L. Human Trafficking: Results of a 5-Year Theory-Based Evaluation of Interventions to Prevent Trafficking of Women From South Asia. Front Public Health 2021; 9:645059. [PMID: 34079782 PMCID: PMC8166201 DOI: 10.3389/fpubh.2021.645059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings.
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Affiliation(s)
- Cathy Zimmerman
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,*Correspondence: Cathy Zimmerman
| | - Joelle Mak
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicola S. Pocock
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,Lumos Foundation, London, United Kingdom,Nicola S. Pocock
| | - Ligia Kiss
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom,Faculty of Population Health Science, Institute for Global Health, University College London, London, United Kingdom
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Pocock NS, Chan CW, Zimmerman C. Suitability of Measurement Tools for Assessing the Prevalence of Child Domestic Work: A Rapid Systematic Review. Int J Environ Res Public Health 2021; 18:2357. [PMID: 33670949 PMCID: PMC7957663 DOI: 10.3390/ijerph18052357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
Child domestic work (CDW) is a hidden form of child labour. Globally, there were an estimated 17.2 million CDWs aged 5-17 in 2012, but there has been little critical analysis of methods and survey instruments used to capture prevalence of CDW. This rapid systematic review identified and critically reviewed the measurement tools used to estimate CDWs in Low- and Middle-Income Countries, following PRISMA guidelines (PROSPERO registration: CRD42019148702). Fourteen studies were included. In nationally representative surveys, CDW prevalence ranged from 17% among 13-24-year-old females in Haiti to 2% of children aged 10-17 in Brazil. Two good quality studies and one good quality measurement tool were identified. CDW prevalence was assessed using occupation-based methods (n = 9/14), household roster (n = 7) and industry methods (n = 4). Six studies combined approaches. Four studies included task-based questions; one study used this method to formally calculate prevalence. The task-based study estimated 30,000 more CDWs compared to other methods. CDWs are probably being undercounted, based on current standard measurement approaches. We recommend use of more sensitive, task-based methods for inclusion in household surveys. The cognitive and pilot testing of newly developed task-based questions is essential to ensure comprehension. In analyses, researchers should consider CDWs who may be disguised as distant or non-relatives.
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Affiliation(s)
- Nicola S. Pocock
- Lumos Foundation, Peninsular House, 30-36 Monument Street, London EC3R 8NB, UK
- Gender Violence & Health Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | | | - Cathy Zimmerman
- Gender Violence & Health Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Cornell A, Melo M, Zimmerman C, Therrien JF. Nestling Physiology Is Independent of Somatic Development in a Common Raptor, the American Kestrel ( Falco sparverius). Physiol Biochem Zool 2021; 94:99-109. [PMID: 33464188 DOI: 10.1086/712816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractAlthough many studies have documented the developmental trajectory of somatic traits in birds, few measure physiological traits, and even fewer document individual variation in developmental trajectory across ecological context. Hematological traits underlying aerobic capacity can be predictive of nestling survival, fledgling flight ability, and ultimately recruitment. This study aimed to assess individual variation in the developmental trajectory of two physiological traits that underlie aerobic capacity, hematocrit and hemoglobin concentration, in relation to somatic development and ecological context. Our study species, the American kestrel (Falco sparverius), is sexually dimorphic and therefore likely to show sexual variation in developmental trajectory and nestling maturity. We used lay date, year, brood size, nestling sex ratio, and parental nest visit rate to assess ecological context. Although somatic traits showed similar trajectories across nestlings, developmental trajectory for hematocrit and hemoglobin concentration showed individual variation not previously documented. This individual variation in developmental change, or trajectory, for physiological traits could not be explained by somatic development, sex, parental nest visit rate, lay date, year, brood size, or nestling sex ratio. However, we did find higher final hemoglobin concentration in 2018 and in nests with earlier lay dates. These findings demonstrate the importance of assessing physiological traits that capture aspects of individual quality distinct from somatic traits. Future studies are needed to understand the causes of individual variation in developmental trajectory, which cannot be explained by the ecological variables presented here, and the potential fitness consequences of this variation.
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Zimmerman C, Drahy F, Shourick J, Montlahuc C, Hua C, Bouaziz JD, Chosidow O, Wolkenstein P, Bagot M, Duong T. Urgences dermatologiques : quelles consultations dans 2 centres hospitalo-universitaires ? Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pocock NS, Kiss L, Dash M, Mak J, Zimmerman C. Challenges to pre-migration interventions to prevent human trafficking: Results from a before-and-after learning assessment of training for prospective female migrants in Odisha, India. PLoS One 2020; 15:e0238778. [PMID: 32941448 PMCID: PMC7498043 DOI: 10.1371/journal.pone.0238778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Awareness-raising and pre-migration training are popular strategies to prevent human trafficking. Programmatic theories assume that when prospective migrants are equipped with information about risks, they will make more-informed choices, ultimately resulting in safe migration. In 2016, India was estimated to have 8 million people in modern slavery, including those who migrate internally for work. Work in Freedom (WiF) was a community-based trafficking prevention intervention. This study evaluated WiF’s pre-migration knowledge-building activities for female migrants in Odisha to prevent future labour-related exploitation. Methods Pre- and post- training questionnaires were administered to women (N = 347) who participated in a two-day pre-migration training session. Descriptive analysis and unadjusted analyses (paired t-tests, McNemar’s tests, Wilcoxon signed ranks tests) examined differences in women’s knowledge scores before and after training. Adjusted analyses used mixed effects models to explore whether receiving information on workers’ rights or working away from home prior to the training was associated with changes in scores. Additionally, we used data from a household survey (N = 4,671) and survey of female migrants (N = 112) from a population sample in the same district to evaluate the intervention’s rationale and implementation strategy. Results Female participants were on average 37.3 years-old (SD 11) and most (67.9%) had no formal education. Only 11 participants (3.2%) had previous migration experience. Most participants (90.5%) had previously received information or advice on workers’ rights or working away from home. Compared to female migrants in the population, training participants were different in age, caste and religion. Awareness about migration risks, rights and collective bargaining was very low initially and remained low post-training, e.g. of 13 possible migration risks, before the training, participants named an average of 1.2 risks, which increased only slightly to 2.1 risks after the training (T(346) = -11.64, p<0.001). Changes were modest for attitudes about safe and risky migration practices, earnings and savings. Before the training, only 34 women (10.4%) considered migrating, which reduced to 25 women (7.7%) post-training (X2 = 1.88, p = 0.169)—consistent with the low prevalence (7% of households) of female migration locally. Women’s attitudes remained relatively fixed about the shame associated with paid domestic work. Survey data indicated focusing on domestic work did not correspond to regional migration trends, where women migrate primarily for construction or agriculture work. Conclusion The apparent low effectiveness of the WiF short-duration migration training may be linked to the assumption that individual changes in knowledge will lead to shifts in social norms. The narrow focus on such individual-level interventions may overestimate an individual’s agency. Findings indicate the importance of intervention development research to ensure activities are conducted in the right locations, target the right populations, and have relevant content. Absent intervention development research, this intervention suffered from operating in a site that had very few migrant women and a very small proportion migrating for domestic work—the focus of the training. To promote better development investments, interventions should be informed by local evidence and subjected to rigorous theory-based evaluation to ensure interventions achieve the most robust design to foster safe labour migration for women.
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Affiliation(s)
- Nicola Suyin Pocock
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: ,
| | - Ligia Kiss
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute for Global Health, Faculty of Population Health Science, University College London, Bloomsbury, London, United Kingdom
| | - Mamata Dash
- ASTITWA Gender Resource Centre, Bhubaneswar, India
| | - Joelle Mak
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cathy Zimmerman
- Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kiss L, Quinlan-Davidson M, Pasquero L, Tejero PO, Hogg C, Theis J, Park A, Zimmerman C, Hossain M. Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries. Confl Health 2020; 14:11. [PMID: 32127913 PMCID: PMC7045597 DOI: 10.1186/s13031-020-0254-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.
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Affiliation(s)
- Ligia Kiss
- 1Institute for Global Health, University College London, London, UK
| | | | | | - Patricia Ollé Tejero
- All Survivors Project, Vaduz, Liechtenstein.,3London School of Economics, London, UK
| | - Charu Hogg
- All Survivors Project, Vaduz, Liechtenstein
| | | | | | - Cathy Zimmerman
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,7Centre for Women, Peace and Security, London School of Economics, London, UK
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Nodzenski M, Kiss L, Pocock NS, Stoeckl H, Zimmerman C, Buller AM. Post-trafficking stressors: The influence of hopes, fears and expectations on the mental health of young trafficking survivors in the Greater Mekong Sub-region. Child Abuse Negl 2020; 100:104067. [PMID: 31272744 DOI: 10.1016/j.chiabu.2019.104067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Human trafficking and labor exploitation are prevalent in Southeast Asia and have substantial health consequences for children and adolescents. Research on pre-departure circumstances and trafficking experiences show that gender plays a key role in shaping the experience of exploited children and adolescents. OBJECTIVE This study estimates how youth's concerns and hopes for the future influence the mental health outcomes of male and female children and adolescents. PARTICIPANTS AND SETTING Data were collected in face-to-face interviews with 517 children and adolescents (10-19 years old) who attended post-trafficking services between year 2010 and year 2013 in Cambodia, Thailand or Vietnam. METHODS Multivariable logistic regression models were fitted to estimate the association of children and adolescents' post-trafficking concerns and hopes for the future with mental health outcomes, namely symptoms of depression, anxiety and Post Traumatic Stress Disorder (PTSD). The analysis was stratified by sex. RESULTS In adjusted analysis, children and adolescents' concerns about social ostracization and maltreatment by others in their community of origin were associated with all three outcomes in males and with depression in females. Being concerned about their own mental health was associated with all outcomes, with a potentially stronger effect observed in males for depression (AOR 9.14, CI:1.21-68.68), anxiety (AOR 13.47, CI:1.70-106.48) and PTSD (AOR 8.36, CI:1.22-56.9) than in females where the odds for depression (AOR 3.24, CI:1.92-5.48), anxiety (AOR 3.05, CI:1.82-5.11) and PTSD (AOR 1.85, CI:1.08-3.14) were much lower. CONCLUSIONS Young people's post-trafficking care needs and reintegration planning should be designed based on their current mental health, personal security, family and financial resources and age-related capacity.
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Affiliation(s)
- Marie Nodzenski
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Ligia Kiss
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Nicola S Pocock
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Heidi Stoeckl
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Cathy Zimmerman
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Ana Maria Buller
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London WC1H 9SH, United Kingdom.
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Williamson V, Borschmann R, Zimmerman C, Howard LM, Stanley N, Oram S. Responding to the health needs of trafficked people: A qualitative study of professionals in England and Scotland. Health Soc Care Community 2020; 28:173-181. [PMID: 31483083 DOI: 10.1111/hsc.12851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/04/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referrals for trafficked people in the United Kingdom (UK). Semi-structured, face-to-face interviews were conducted with healthcare (n = 23) and non-health (n = 27) professionals with relevant policy or practical experience related to human trafficking in the UK. Topic guides covered identifying, referring and providing care to trafficked people. Transcripts were analysed using thematic analysis. Four interconnected themes emerged: trafficked persons' entitlements to healthcare, availability of healthcare resources, providers' knowledge about trafficking, and the particular needs of trafficked individuals. Providers explained that policies limiting entitlements to healthcare created significant obstacles to care, as did the inadequate resourcing of interpreter services, trafficking support services, and specialist mental health services. Few healthcare professionals reported having received training on responses to trafficked people and most were unaware of support options and referral routes. Healthcare professionals will be better equipped to serve trafficked individuals if they are provided training to identify and respond to human trafficking, guidance on referral and support options and entitlements to care. Simultaneously, improving trafficked people's healthcare access and use will also require government interventions to ensure they are not unjustifiably denied healthcare.
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Affiliation(s)
- Victoria Williamson
- King's College London, King's Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise M Howard
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Sian Oram
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Iglesias-Rios L, Harlow SD, Burgard SA, Kiss L, Zimmerman C. Gender differences in the association of living and working conditions and the mental health of trafficking survivors. Int J Public Health 2019; 64:1015-1024. [PMID: 31243470 PMCID: PMC10506657 DOI: 10.1007/s00038-019-01269-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess the association of living and working conditions experienced during trafficking with mental health of female and male survivors. METHODS We analyzed a cross-sectional study of 1015 survivors who received post-trafficking services in Cambodia, Thailand, and Vietnam. Modified Poisson regression models were conducted by gender to estimate prevalence ratios. RESULTS For females, the elevated prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms was associated with adverse living conditions, while for males the prevalence of anxiety (PR = 2.21; 95% CI 1.24-3.96) and depression (PR = 2.63; 95% CI 1.62-4.26) more than doubled and almost tripled for PTSD (PR = 2.93; 95% CI 1.65-5.19) after adjustment. For males in particular, excessive and extreme working hours per day were associated with more than a four- and threefold greater prevalence of PTSD. Being in a detention center or jail was associated with all three mental health outcomes in males. CONCLUSIONS Providers and stakeholders need to consider the complex mental health trauma of the differential effects of living and working conditions for female and male survivors during trafficking to support treatment and recovery.
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Affiliation(s)
- Lisbeth Iglesias-Rios
- Department of Epidemiology, Center for Midlife Science, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Siobán D Harlow
- Department of Epidemiology, Center for Midlife Science, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Sarah A Burgard
- Department of Sociology, College of Literature Science, and the Arts, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Ligia Kiss
- Department of Global Health and Development, Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
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Hargreaves S, Rustage K, Nellums LB, McAlpine A, Pocock N, Devakumar D, Aldridge RW, Abubakar I, Kristensen KL, Himmels JW, Friedland JS, Zimmerman C. Occupational health outcomes among international migrant workers: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e872-e882. [PMID: 31122905 PMCID: PMC6565984 DOI: 10.1016/s2214-109x(19)30204-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/25/2019] [Accepted: 03/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Globally, there are more than 150 million international migrant workers-individuals who are employed outside of their country of origin-comprising the largest international migrant group. A substantial number of migrants work in hazardous and exploitative environments, where they might be at considerable risk of injury and ill health. However, little data on occupational health outcomes of migrant workers exist, with which to inform global policy making and delivery of health services. METHODS For this systematic review and meta-analysis, we searched Embase, MEDLINE, Ovid Global Health, and PsychINFO databases for primary research published between Jan 1, 2008, and Jan 24, 2018, reporting occupational health outcomes among international migrant workers (defined as individuals who are or have been employed outside their country of origin), without language or geographical restrictions. We excluded studies containing mixed cohorts of migrants and native workers in which migrant data could not be disaggregated, and studies that did not explicitly report migrant status. The main outcome was prevalence of occupational health outcomes (defined as any injury, mortality, or physical or psychiatric morbidity due to an individual's work or workplace environment) among international migrant workers. Summary estimates were calculated using random-effects models. The study protocol has been registered with PROSPERO, number CRD42018099465. FINDINGS Of the 1218 studies identified by our search, 36 studies were included in our systematic review, and 18 studies were included in the meta-analysis. The systematic review included occupational health outcomes for 12 168 international migrant workers employed in 13 countries and territories, mostly employed in unskilled manual labour. Migrant workers originated from 25 low-income and middle-income countries, and worked in the following sectors: agriculture; domestic, retail, and service sectors; construction and trade; and manufacturing and processing. Migrant workers had various psychiatric and physical morbidities, and workplace accidents and injuries were relatively common. In the meta-analysis, among 7260 international migrant workers, the pooled prevalence of having at least one occupational morbidity was 47% (95% CI 29-64; I2=99·70%). Among 3890 migrant workers, the prevalence of having at least one injury or accident, including falls from heights, fractures and dislocations, ocular injuries, and cuts was 22% (7-37; I2=99·35%). INTERPRETATION International migrant workers are at considerable risk of work-related ill health and injury, and their health needs are critically overlooked in research and policy. Governments, policy makers, and businesses must enforce and improve occupational health and safety measures, which should be accompanied by accessible, affordable, and appropriate health care and insurance coverage to meet the care needs of this important working population. FUNDING Wellcome Trust.
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Affiliation(s)
- Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK; Section of Infectious Diseases and Immunity, Imperial College London, London, UK.
| | - Kieran Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK; Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Laura B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, UK; Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Alys McAlpine
- Gender, Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nicola Pocock
- Gender, Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London
| | | | | | - Kristina L Kristensen
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Jan W Himmels
- Institute for Infection and Immunity, St George's, University of London, London, UK; Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Jon S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK; Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
In an Editorial, Ligia Kiss and Cathy Zimmerman discuss the need for research on the prevention of human trafficking and mitigation of its effects.
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Affiliation(s)
- Ligia Kiss
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (LK); (CZ)
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (LK); (CZ)
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Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, Dhavan P, Fouad FM, Groce N, Guo Y, Hargreaves S, Knipper M, Miranda JJ, Madise N, Kumar B, Mosca D, McGovern T, Rubenstein L, Sammonds P, Sawyer SM, Sheikh K, Tollman S, Spiegel P, Zimmerman C. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet 2018; 392:2606-2654. [PMID: 30528486 PMCID: PMC7612863 DOI: 10.1016/s0140-6736(18)32114-7] [Citation(s) in RCA: 369] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Robert W Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Rachel Burns
- Institute for Global Health, University College London, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, Salvador-Bahia, Brazil
| | - Poonam Dhavan
- International Organization for Migration, Geneva, Switzerland
| | - Fouad M Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nora Groce
- Leonard Cheshire Centre, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Yan Guo
- School of Public Health, Peking University, Beijing, China
| | - Sally Hargreaves
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nyovani Madise
- African Institute for Development Policy, Lilongwe, Malawi; Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Terry McGovern
- Program on Global Health Justice and Governance, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leonard Rubenstein
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Sammonds
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Kabir Sheikh
- Public Health Foundation of India, Institutional Area Gurgaon, India; Nossal Institute of Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, UK
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Iglesias-Rios L, Harlow SD, Burgard SA, Kiss L, Zimmerman C. Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study. BMC Psychol 2018; 6:56. [PMID: 30541612 PMCID: PMC6292017 DOI: 10.1186/s40359-018-0269-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established. METHODS We conducted a cross-sectional study with 1015 female and male survivors of trafficking (adults, adolescents and children) who received post-trafficking assistance services in Cambodia, Thailand or Vietnam and had been exploited in various labor sectors. We assessed anxiety and depression with the Hopkins Symptoms Checklist (HSCL-25) and post-traumatic stress disorder (PTSD) symptoms with the Harvard Trauma Questionnaire (HTQ), and used validated questions from the World Health Organization International Study on Women's Health and Domestic Violence to measure physical and sexual violence. Sex-specific modified Poisson regression models were estimated to obtain prevalence ratios (PRs) and their 95% confidence intervals (CI) for the association between violence (sexual, physical or both), coercion, and mental health conditions (anxiety, depression and PTSD). RESULTS Adjusted models indicated that for females, experiencing both physical and sexual violence, compared to not being exposed to violence, was a strong predictor of symptoms of anxiety (PR = 2.08; 95% CI: 1.64-2.64), PTSD (PR = 1.55; 95% CI: 1.37-1.74), and depression (PR = 1.57; 95% CI: 1.33-1.85). Among males, experiencing physical violence with additional threats made with weapons, compared to not being exposed to violence, was associated with PTSD (PR = 1.59; 95% CI: 1.05-2.42) after adjustment. Coercion during the trafficking experience was strongly associated with anxiety, depression, and PTSD in both females and males. For females in particular, exposure to both personal and family threats was associated with a 96% elevated prevalence of PTSD (PR = 1.96; 95% CI: 1.32-2.91) and more than doubling of the prevalence of anxiety (PR = 2.11; 95% CI: 1.57-2.83). CONCLUSIONS The experiences of violence and coercion in female and male trafficking survivors differed and were associated with an elevated prevalence of anxiety, depression, and PTSD in both females and males. Mental health services must be an integral part of service provision, recovery and re-integration for trafficked females and males.
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Affiliation(s)
- Lisbeth Iglesias-Rios
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Sarah A Burgard
- Department of Sociology, College of Literature Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Ligia Kiss
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Pocock NS, Nguyen LH, Lucero-Prisno Iii DE, Zimmerman C, Oram S. Occupational, physical, sexual and mental health and violence among migrant and trafficked commercial fishers and seafarers from the Greater Mekong Subregion (GMS): systematic review. Glob Health Res Policy 2018; 3:28. [PMID: 30288452 PMCID: PMC6166293 DOI: 10.1186/s41256-018-0083-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/11/2018] [Indexed: 02/08/2023] Open
Abstract
Background Little is known about the health of GMS commercial fishers and seafarers, many of whom are migrants and some trafficked. This systematic review summarizes evidence on occupational, physical, sexual and mental health and violence among GMS commercial fishers/seafarers. Methods We searched 5 electronic databases and purposively searched grey literature. Quantitative or qualitative studies reporting prevalence or risk of relevant outcomes were included. Two reviewers independently screened articles. Data were extracted on nationality and long/short-haul fishing where available. Results We identified 33 eligible papers from 27 studies. Trafficked fishers/seafarers were included in n=12/13 grey literature and n=1/20 peer-reviewed papers. Among peer-reviewed papers: 11 focused on HIV/AIDS/sexual health; nine on occupational/physical health; one study included mental health of trafficked fishers. Violence was quantitatively measured in eight papers with prevalence of: 11-26% in port convenience samples; 68-100% in post-trafficking service samples. Commercial fishers/seafarers whether trafficked or not worked extremely long hours; trafficked long-haul fishers had very limited access to care following injuries or illness. Lesser-known risks reported among fishers included penile oil injections and beriberi. We found just one work safety intervention study and inconclusive evidence for differences in the outcomes by nationality. Findings are limited by methodological weaknesses of primary studies. Conclusion Results show an absence of high-quality epidemiological studies beyond sexual health. Formative and pilot intervention research on occupational, physical and mental health among GMS commercial fishers and seafarers is needed. Future studies should include questions about violence and exploitation. Ethical and reporting standards of grey literature should be improved. Trial Registration Review registration number: PROSPERO 2014: CRD42014009656.
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Affiliation(s)
- Nicola S Pocock
- 1Department of Global Health and Development, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH UK.,2United Nations University International Institute of Global Health, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur Malaysia
| | - Long Hoang Nguyen
- 3School of Medicine and Pharmacy, Vietnam National University, No. 144 Xuan Thuy Street, Cau Giay district, Hanoi, Vietnam
| | - Don Eliseo Lucero-Prisno Iii
- 4Department of Public Health, Emerging and Interdisciplinary Sciences Building (ES) South Campus, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Road, Suzhou Dushu Lake Science and Education Innovation District, Suzhou Industrial Park, Suzhou, 215123 People's Republic of China
| | - Cathy Zimmerman
- 1Department of Global Health and Development, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Siân Oram
- 5Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Kings College London, London, SE5 8AF UK
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Xu A, Cullen B, Penner C, Zimmerman C, Kerr C, Schmalzl L. Comparing embodiment experiences in expert meditators and non-meditators using the rubber hand illusion. Conscious Cogn 2018; 65:325-333. [DOI: 10.1016/j.concog.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Crispens M, Slocum P, Heft J, Mokshagundam S, Zimmerman C, Harvey L. Surgical outcomes of superobese women treated for endometrial intraepithelial neoplasia and endometrial cancer. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pocock NS, Tadee R, Tharawan K, Rongrongmuang W, Dickson B, Suos S, Kiss L, Zimmerman C. "Because if we talk about health issues first, it is easier to talk about human trafficking"; findings from a mixed methods study on health needs and service provision among migrant and trafficked fishermen in the Mekong. Global Health 2018; 14:45. [PMID: 29739433 PMCID: PMC5941587 DOI: 10.1186/s12992-018-0361-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/19/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Human trafficking in the fishing industry or "sea slavery" in the Greater Mekong Subregion is reported to involve some of the most extreme forms of exploitation and abuse. A largely unregulated sector, commercial fishing boats operate in international waters far from shore and outside of national jurisdiction, where workers are commonly subjected to life-threatening risks. Yet, research on the health needs of trafficked fishermen is sparse. This paper describes abuses, occupational hazards, physical and mental health and post-trafficking well-being among a systematic consecutive sample of 275 trafficked fishermen using post-trafficking services in Thailand and Cambodia. These findings are complemented by qualitative interview data collected with 20 key informants working with fishermen or on issues related to their welfare in Thailand. RESULTS Men and boys trafficked for fishing (aged 12-55) were mainly from Cambodia (n = 217) and Myanmar (n = 55). Common physical health problems included dizzy spells (30.2%), exhaustion (29.5%), headaches (28.4%) and memory problems (24.0%). Nearly one-third (29.1%) reported pain in three or more areas of their body and one-quarter (26.9%) reported being in "poor" health. Physical health symptoms were strongly associated with: severe violence; injuries; engagement in long-haul fishing; immigration detention or symptoms of mental health disorders. Survivors were exposed to multiple work hazards and were perceived as disposable when disabled by illness or injuries. Employers struggled to apply internationally recommended Personal Protective Equipment (PPE) practices in Thailand. Non-governmental organizations (NGOs) encountered challenges when trying to obtain healthcare for uninsured fishermen. Challenges included fee payment, service provision in native languages and officials siding with employers in disputes over treatment costs and accident compensation. Survivors' post-trafficking concerns included: money problems (75.9%); guilt and shame (33.5%); physical health (33.5%) and mental health (15.3%). CONCLUSION Fishermen in this region are exposed to very serious risks to their health and safety, and their illnesses and injuries often go untreated. Men who enter the fishing industry in Thailand, especially migrant workers, require safe working conditions and targeted protections from human trafficking. Survivors of the crime of sea slavery must be provided with the compensation they deserve and the care they need, especially psychological support.
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Affiliation(s)
- Nicola S. Pocock
- United Nations University International Institute of Global Health, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Reena Tadee
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon District, Nakhon Pathom, 73170 Thailand
| | - Kanokwan Tharawan
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon District, Nakhon Pathom, 73170 Thailand
| | | | - Brett Dickson
- International Organization for Migration, Norodom Blvd, No. 281, 4th Floor, Sangkat Tonle Basac, Khan Chamkamorn, Phnom Penh, Cambodia
| | | | - Ligia Kiss
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH UK
| | - Cathy Zimmerman
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH UK
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Pocock N, Tadee R, Tharawan K, Rongrongmuang W, Dickson B, Suos S, Kiss L, Zimmerman C. 6.3-O5Findings from a mixed methods study on health needs and service provision among migrant and trafficked fishermen in the Mekong. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Pocock
- United Nations University International Institute of Global Health, Kuala Lumpur, Malaysia
| | - R Tadee
- Institute for Population and Social Research, Mahidol University, Thailand
| | - K Tharawan
- Institute for Population and Social Research, Mahidol University, Thailand
| | | | - B Dickson
- International Organization for Migration, Cambodia
| | - S Suos
- Independent consultant, Cambodia
| | - L Kiss
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
| | - C Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
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Abramsky T, Mak J, Zimmerman C, Kiss L, Sijapati B. Migration Planning Among Female Prospective Labour Migrants from Nepal: A Comparison of First-Time and Repeat-Migrants. Int Migr 2018. [DOI: 10.1111/imig.12449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Joelle Mak
- London School of Hygiene and Tropical Medicine
| | | | - Ligia Kiss
- London School of Hygiene and Tropical Medicine
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Abstract
Mental health professionals have opportunities to intervene and provide care for trafficked people. Research shows that mental health problems – including depression, anxiety and post-traumatic stress disorder – are prevalent among trafficked people, and that at least some trafficked people come into contact with secondary mental health services in England.
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Bick D, Howard LM, Oram S, Zimmerman C. Maternity care for trafficked women: Survivor experiences and clinicians' perspectives in the United Kingdom's National Health Service. PLoS One 2017; 12:e0187856. [PMID: 29166394 PMCID: PMC5699814 DOI: 10.1371/journal.pone.0187856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians' perspectives of maternity care for trafficked persons. METHODS Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women. FINDINGS Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women's movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low. CONCLUSIONS More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care. Given the prevalence of sexual exploitation and abuse among trafficking survivors, clinicians should ensure antenatal care and screening for sexually transmitted infections can be readily accessed by women. Clinicians require specialised training alongside designated pathways and protocols with clear referral options to ensure confidential maternity care tailored to each woman's needs.
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Affiliation(s)
- Debra Bick
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital London, United Kingdom
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry and Neuroscience, David Goldberg Centre, King's College London, De Crespigny Park, London, United Kingdom
| | - Sian Oram
- Section of Women’s Mental Health, Institute of Psychiatry and Neuroscience, David Goldberg Centre, King's College London, De Crespigny Park, London, United Kingdom
| | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Affiliation(s)
- Nicola S Pocock
- United Nations University International Institute of Global Health, Kuala Lumpur, Malaysia
| | - Syed S Mahmood
- New York Presbyterian Hospital-Weill Cornell Medical Centre, New York, US
| | | | - Miriam Orcutt
- UCL-Lancet commission on migration and health, University College London, UK
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Abstract
In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.
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Affiliation(s)
- Cathy Zimmerman
- London School of Hygiene and Tropical Medicine, London, United Kingdon
- * E-mail:
| | - Ligia Kiss
- London School of Hygiene and Tropical Medicine, London, United Kingdon
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Stöckl H, Kiss L, Koehler J, Dong DT, Zimmerman C. Trafficking of Vietnamese women and girls for marriage in China. Glob Health Res Policy 2017; 2:28. [PMID: 29202096 PMCID: PMC5683360 DOI: 10.1186/s41256-017-0049-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background Bride-trafficking has been a growing phenomenon in Southeast Asia, particularly in China, where one-child policies have resulted in demographic imbalances favoring males. Yet, empirical evidence about women and girls sold into marriage in China remains sparse. Methods This study describes the experiences of 51 Vietnamese women and girls as young as 14 in post-trafficking services who were sold into marriage in China. A consecutive sample of individuals from five services in Vietnam were invited to be interviewed within the first 2 weeks of admission. It is part of a wider dataset for research on the health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam, the largest study to date on human trafficking and health. We calculated proportions for all variables and conducted bivariate analyses using Fisher Exact Tests for their associations with mental health disorders symptoms. Results Before leaving home, 31% (n = 15) participants were married. Participants reported high levels of sexual violence (n = 43; 86%) while trafficked and59% (n = 30) spent time in detention before returning to Vietnam. Once in post-trafficking care 52.9% (n = 27) reported probable depression, anxiety or post-traumatic stress disorders (PTSD), two women (4%) attempted suicide in the past month and 38 (75%) remained afraid of their trafficker. Ten (22%) became pregnant while trafficked, and seven (16%) were pregnant at the interview. Conclusions The cross-border bride trade between Vietnam and China raises complex policy issues, including questions about detention and immigration rights and strategies for supported return processes, including maternal and child health services. As the repercussions of China’s absent female population will persist, Vietnam and China must grapple with the political and social conditions to implement prevention strategies, and resources for women who fall prey to this cross-border bride trade.
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Affiliation(s)
- Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SE UK
| | - Ligia Kiss
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SE UK
| | | | | | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SE UK
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Busza J, Teferra S, Omer S, Zimmerman C. Learning from returnee Ethiopian migrant domestic workers: a qualitative assessment to reduce the risk of human trafficking. Global Health 2017; 13:71. [PMID: 28893298 PMCID: PMC5594517 DOI: 10.1186/s12992-017-0293-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International migration has become a global political priority, with growing concern about the scale of human trafficking, hazardous work conditions, and resulting psychological and physical morbidity among migrants. Ethiopia remains a significant "source" country for female domestic workers to the Middle East and Gulf States, despite widespread reports of exploitation and abuse. Prior to introduction of a "safe migration" intervention, we conducted formative research to elicit lessons learned by women who had worked as domestic workers abroad. The aim of the study was to identify realistic measures future migrants could take to protect themselves, based on the collective insights and experience of returnees. METHODS We conducted a qualitative assessment among returnee domestic labour migrants in Amhara Region, Ethiopia, an area considered a "hotspot" for outmigration. We conducted in-depth interviews and focus group discussions with a total of 35 female returnees, exploring risk and protective factors experienced by Ethiopian women during domestic work abroad. We used thematic content analysis to identify practical messages that could improve prospective migrants' preparedness. RESULTS Returnees described the knowledge and skills they acquired prior to departure and during migration, and shared advice they would give to prospective migrants in their community. Facilitators of positive migration included conforming to cultural and behavioural expectations, learning basic Arabic, using household appliances, and ensuring safety in employers' homes. Respondents also associated confidence and assertiveness with better treatment and respect, and emphasized the importance of access to external communication (e.g. a mobile phone, local sim card, and contact details) for help in an emergency. Following their own challenging or even traumatic experiences, returnees were keen to support resilience among the next wave of migrants. CONCLUSIONS There is little evidence on practices that foster safer migration, yet attention to human trafficking has led to an increase in pre-migration interventions. These require robust evidence about local risk and protective factors. Our findings identify knowledge, skills, attributes and resources found useful by returnee domestic workers in Amhara region, and have been used to inform a community-based programme aiming to foster better decision-making and preparation, with potential to offer insights for safer migration elsewhere.
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Affiliation(s)
- Joanna Busza
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sehin Teferra
- Independent Research Consultant, Addis Ababa, Ethiopia
| | - Serawit Omer
- Independent Research Consultant, Addis Ababa, Ethiopia
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Mak J, Abramsky T, Sijapati B, Kiss L, Zimmerman C. What is the prevalence of and associations with forced labour experiences among male migrants from Dolakha, Nepal? Findings from a cross-sectional study of returnee migrants. BMJ Open 2017; 7:e015835. [PMID: 28801409 PMCID: PMC5629688 DOI: 10.1136/bmjopen-2017-015835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Growing numbers of people are migrating outside their country for work, and many experience precarious conditions, which have been linked to poor physical and mental health. While international dialogue on human trafficking, forced labour and slavery increases, prevalence data of such experiences remain limited. METHODS Men from Dolakha, Nepal, who had ever migrated outside of Nepal for work were interviewed on their experiences, from predeparture to return (n=194). Forced labour was assessed among those who returned within the past 10 years (n=140) using the International Labour Organization's forced labour dimensions: (1) unfree recruitment; (2) work and life under duress; and (3) impossibility to leave employer. Forced labour is positive if any one of the dimensions is positive. RESULTS Participants had worked in India (34%), Malaysia (34%) and the Gulf Cooperation Council countries (29%), working in factories (29%), as labourers/porters (15%) or in skilled employment (12%). Among more recent returnees (n=140), 44% experienced unfree recruitment, 71% work and life under duress and 14% impossibility to leave employer. Overall, 73% experienced forced labour during their most recent labour migration.Forced labour was more prevalent among those who had taken loans for their migration (PR 1.23) and slightly less prevalent among those who had migrated more than once (PR 0.87); however the proportion of those who experienced forced labour was still high (67%). Age, destination and duration of stay were associated with only certain dimensions of forced labour. CONCLUSION Forced labour experiences were common during recruitment and at destination. Migrant workers need better advice on assessing agencies and brokers, and on accessing services at destinations. As labour migration from Nepal is not likely to reduce in the near future, interventions and policies at both source and destinations need to better address the challenges migrants face so they can achieve safer outcomes.
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Affiliation(s)
- Joelle Mak
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tanya Abramsky
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bandita Sijapati
- Centre for the Study of Labour and Mobility, Social Science Baha, Kathmandu, Nepal
| | - Ligia Kiss
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Affiliation(s)
- Claudia García-Moreno
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Watts
- Gender, Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, UK; Department for International Development, London, UK
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Borschmann R, Oram S, Kinner SA, Dutta R, Zimmerman C, Howard LM. Self-Harm Among Adult Victims of Human Trafficking Who Accessed Secondary Mental Health Services in England. Psychiatr Serv 2017; 68:207-210. [PMID: 27745538 DOI: 10.1176/appi.ps.201500509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study estimated the prevalence and correlates of self-harm among adult victims of human trafficking who accessed secondary mental health services, and it estimated the responses of mental health services to these individuals. METHODS A clinical records database was searched for self-harm, sociodemographic, clinical, and service use characteristics among trafficked adults who accessed secondary mental health services in South London (2006-2012). Logistic regression models compared trafficked patients (N=84) and a matched cohort of nontrafficked patients (N=287). RESULTS Among trafficked patients, 33% had engaged in self-harm prior to care and 25% in self-harm during care. After engaging in self-harm, trafficked patients were more likely than nontrafficked patients to be admitted as a psychiatric inpatient (adjusted odds ratio [AOR]=2.81) but less likely to visit an emergency department (AOR=.47). CONCLUSIONS Self-harm is prevalent among trafficked adults accessing secondary mental health services, and mental health professionals have a crucial role to play in supporting survivors.
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Affiliation(s)
- Rohan Borschmann
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
| | - Sian Oram
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
| | - Stuart A Kinner
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
| | - Rina Dutta
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
| | - Cathy Zimmerman
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
| | - Louise M Howard
- Dr. Borschmann is with the Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne (e-mail: ). Dr. Oram and Prof. Howard are with the Department of Health Service and Population Research and Dr. Dutta is with the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London. Prof. Kinner is with the Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Dr. Zimmerman is with the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London
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McAlpine A, Hossain M, Zimmerman C. Sex trafficking and sexual exploitation in settings affected by armed conflicts in Africa, Asia and the Middle East: systematic review. BMC Int Health Hum Rights 2016; 16:34. [PMID: 28031024 PMCID: PMC5192570 DOI: 10.1186/s12914-016-0107-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/25/2016] [Indexed: 11/29/2022]
Abstract
Background Sex trafficking and sexual exploitation has been widely reported, especially in conflict-affected settings, which appear to increase women’s and children’s vulnerabilities to these extreme abuses. Methods We conducted a systematic search of ten databases and extensive grey literature to gather evidence of sex trafficking and sexual exploitation in conflict-affected settings. International definitions of “sexual exploitation” and “sex trafficking” set the indicator parameters. We focused on sexual exploitation in forms of early or forced marriage, forced combatant sexual exploitation and sexual slavery. We extracted prevalence measures, health outcomes and sexual exploitation terminology definitions. The review adhered to PRISMA guidelines and includes quality appraisal. Results The search identified 29 eligible papers with evidence of sex trafficking and sexual exploitation in armed conflict settings in twelve countries in Africa, Asia, and the Middle East. The evidence was limited and not generalizable, due to few prevalence estimates and inconsistent definitions of “sexual exploitation”. The prevalence estimates available indicate that females were more likely than males to be victims of sexual exploitation in conflict settings. In some settings, as many as one in four forced marriages took place before the girls reached 18 years old. Findings suggest that the vast majority of former female combatants were sexually exploited during the conflict. These studies provided various indicators of sexual exploitation compatible to the United Nation’s definition of sex trafficking, but only 2 studies identified the exploitation as trafficking. None of the studies solely aimed to measure the prevalence of sex trafficking or sexual exploitation. Similar descriptions of types of sexual exploitation and trafficking were found, but the inconsistent terminology or measurements inhibited a meta-analysis. Conclusions Findings indicate there are various forms of human trafficking and sexual exploitation in conflict-affected settings, primarily occurring as early or forced marriage, forced combatant sexual exploitation, and sexual slavery. The studies highlight the extraordinary vulnerability of women and girls to these extreme abuses. Simultaneously, this review suggests the need to clarify terminology around sex trafficking in conflict to foster a more cohesive future evidence-base, and in particular, robust prevalence figures from conflict-affected and displaced populations.
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Affiliation(s)
- Alys McAlpine
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, UK.
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, UK
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, UK
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Pocock NS, Kiss L, Oram S, Zimmerman C. Labour Trafficking among Men and Boys in the Greater Mekong Subregion: Exploitation, Violence, Occupational Health Risks and Injuries. PLoS One 2016; 11:e0168500. [PMID: 27992583 PMCID: PMC5161368 DOI: 10.1371/journal.pone.0168500] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background Men comprise nearly two-thirds of trafficked and forced labourers in common low-skilled labour sectors including fishing, agriculture and factory work. Yet, most evidence on human trafficking has focused on women and girls trafficked for sex work, with scant research on trafficked men and boys. Methods We analyse survey data from the largest systematic consecutive sample of trafficked people collected to date to describe the prevalence of violence, occupational health risks and injuries and associated factors. Participants were labour-trafficked men and boys using post-trafficking support services in Thailand, Cambodia and Vietnam. Findings Data are presented on 446 males aged 10–58. Men and boys were mainly trafficked for fishing (61.7%), manufacturing (19.1%) and begging (5.2%). Fishermen worked extensive hours (mean 18.8 hours/day, SD 5.9) and factory workers worked on average 11.9 hours/day (SD 2.9). 35.5% of male survivors had been injured while trafficked; 29.4% received no personal protective equipment (e.g. gloves). The most commonly reported injuries among all males were deep cuts (61.8%) and skin injuries (36.7%), injuries for which fewer than one-quarter reported receiving medical care. Six fishermen lost body parts, none of whom received medical care. Most males (80.5%) had no or very few rest breaks. One-third (37.8%) experienced severe violence. Work-related injuries were associated with severe violence (AOR 3.44, CI:1.63–7.26), being in the fishing sector, (AOR 4.12, CI:2.39–7.09) and threats (AOR 2.77, CI:1.62–4.75). Experiencing any violence was associated with threats (AOR 26.86, CI:14.0–51.23), being in the fishing sector (AOR 18.53, CI:8.74–39.28) and fluency in language of destination country (AOR 0.39, CI:0.20–0.75). Conclusion This study highlights the abuse and extreme occupational hazards suffered by trafficked men and boys. Occupational health and safety interventions are urgently needed to protect male migrant labourers working in high-risk sectors, particularly fishing.
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Affiliation(s)
- Nicola S. Pocock
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Ligia Kiss
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Oram
- Section of Women’s Mental Health, Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
For the 2016 end-of-the-year editorial, the PLOS Medicine editors asked 7 global health leaders to discuss developments relevant to the equitable provision of medical care to all populations. The result is a collection of expert views on ethical trial design, research during outbreaks, high-burden infectious diseases, diversity in research and protection of migrants.
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Affiliation(s)
- The PLOS Medicine Editors
- Public Library of Science, San Francisco, California, United States of America
- Public Library of Science, Cambridge, United Kingdom
- * E-mail:
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, London, United Kingdom
| | - Michael A. Johansson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- Center for Communicable Disease Dynamics, T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gabriel Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hannah Valantine
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
- Laboratory of Genome Transplantation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Esteban G. Burchard
- Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sam S. Oh
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abubakar I, Devakumar D, Madise N, Sammonds P, Groce N, Zimmerman C, Aldridge RW, Clark J, Horton R. UCL-Lancet Commission on Migration and Health. Lancet 2016; 388:1141-2. [PMID: 27650082 DOI: 10.1016/s0140-6736(16)31581-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Delan Devakumar
- UCL Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Nyovani Madise
- Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Peter Sammonds
- UCL Institute of Risk and Disaster Reduction, University College London, London WC1N 1EH, UK
| | - Nora Groce
- UCL Leonard Cheshire Disability and Inclusive Development Centre, University College London, London WC1N 1EH, UK
| | | | - Robert W Aldridge
- UCL Institute for Health Informatics, University College London, London WC1N 1EH, UK
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Stanley N, Oram S, Jakobowitz S, Westwood J, Borschmann R, Zimmerman C, Howard LM. The health needs and healthcare experiences of young people trafficked into the UK. Child Abuse Negl 2016; 59:100-110. [PMID: 27552002 PMCID: PMC5023059 DOI: 10.1016/j.chiabu.2016.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 05/31/2023]
Abstract
Young people who have been trafficked may have experienced significant trauma and violence but little is known about their health and healthcare needs. This UK study aimed to address that gap. It included a health survey and qualitative interviews with 29 young people aged 16-21 trafficked into the UK from other countries who were recruited through voluntary organisations and children's social services. These data were supplemented by interviews with relevant professionals. Over half the young people had been trafficked for sex work but sexual violence had also been experienced by those trafficked for domestic servitude and labour exploitation. Physical violence, threats, restrictions of liberty and deprivation were also widespread, as were experiences of physical and sexual violence prior to being trafficked. Five young women had become pregnant whilst trafficked; three were parents when interviewed. Two-thirds screened positive for high levels of psychological distress, including PTSD. Twelve reported suicidal thinking. Whilst some were keen for opportunities to talk to health professionals confidentially and wanted practitioners to treat their accounts as credible, others wanted to forget abusive experiences. Complex gatekeeping systems, language barriers and practitioners who failed to take them seriously limited access to healthcare. Support and advocacy were helpful in assisting these young people to navigate healthcare systems. Health professionals need to recognise and respond appropriately to trafficked young people's often complex mental health needs and refer them to relevant services, as well as facilitating care at later times when they might need support or be more ready to receive help.
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Affiliation(s)
- Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, PR1 2 HE, UK.
| | - Siân Oram
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sharon Jakobowitz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Joanne Westwood
- School of Applied Social Science, University of Stirling, FK9 4LA, UK
| | - Rohan Borschmann
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne 3052, Australia and Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
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Hemmings S, Jakobowitz S, Abas M, Bick D, Howard LM, Stanley N, Zimmerman C, Oram S. Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Serv Res 2016; 16:320. [PMID: 27473258 PMCID: PMC4966814 DOI: 10.1186/s12913-016-1538-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 07/07/2016] [Indexed: 11/27/2022] Open
Abstract
Background Despite the multiple physical and psychological health consequences associated with human trafficking, there is little evidence-based guidance available for health providers on assessing and meeting the health needs of trafficked people. We aimed to review literature that provided guidance or research on care provision for people who had been trafficked. Methods We conducted a systematic review and qualitative analysis of peer-reviewed and grey literature. Data sources included electronic databases, reference list screening, citation tracking, and expert recommendations. Documents were included if they reported on: 1) male or females (adults or children) who were currently or had previously been trafficked; 2) health interventions or service provision; 3) primary, secondary, tertiary or specialist post-trafficking services; and 4) World Bank high income countries. Two reviewers independently screened and quality appraised documents. Framework analysis was used to analyse extracted data. Results Forty-four documents were included, 19 of which reported findings of primary studies and nine of which exclusively addressed children. Evidence to inform the identification, referral and care of trafficked people is extremely limited. Within current literature on survivor identification, key indicators included signs of physical and sexual abuse, absence of documentation, and being accompanied by a controlling companion. Findings highlighted the importance of interviewing possible victims in private, using professional interpreters, and building trust. For provision of care, key themes included the importance of comprehensive needs assessments, adhering to principles of trauma-informed care, and cultural sensitivity. Further prominent themes were the necessity of multi-agency working strategies and well-defined referral pathways. Conclusions Human trafficking survivors require healthcare that is trauma-informed and culturally sensitive to their particular needs. Coordination is needed between health providers and statutory and voluntary organisations. Future research should generate empirical evidence to develop trafficking indicators for use by health providers, alongside validated screening tools, and evaluate the effectiveness of psychological interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1538-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stacey Hemmings
- King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Sharon Jakobowitz
- King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Melanie Abas
- King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Debra Bick
- King's College London, James Clerk Maxwell Building, Waterloo, London, SE1 8WA, UK
| | - Louise M Howard
- King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Nicky Stanley
- University of Central Lancashire, School of Social Work, Harrington Building, Preston, PR1 2HE, UK
| | - Cathy Zimmerman
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sian Oram
- King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
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50
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Oram S, Abas M, Bick D, Boyle A, French R, Jakobowitz S, Khondoker M, Stanley N, Trevillion K, Howard L, Zimmerman C. Human Trafficking and Health: A Survey of Male and Female Survivors in England. Am J Public Health 2016; 106:1073-8. [PMID: 27077341 DOI: 10.2105/ajph.2016.303095] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate physical and mental health and experiences of violence among male and female trafficking survivors in a high-income country. METHODS Our data were derived from a cross-sectional survey of 150 men and women in England who were in contact with posttrafficking support services. Interviews took place over 18 months, from June 2013 to December 2014. RESULTS Participants had been trafficked for sexual exploitation (29%), domestic servitude (29.3%), and labor exploitation (40.4%). Sixty-six percent of women reported forced sex during trafficking, including 95% of those trafficked for sexual exploitation and 54% of those trafficked for domestic servitude. Twenty-one percent of men and 24% of women reported ongoing injuries, and 8% of men and 23% of women reported diagnosed sexually transmitted infections. Finally, 78% of women and 40% of men reported high levels of depression, anxiety, or posttraumatic stress disorder symptoms. CONCLUSIONS Psychological interventions to support the recovery of this highly vulnerable population are urgently needed.
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Affiliation(s)
- Siân Oram
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Melanie Abas
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Debra Bick
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Adrian Boyle
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Rebecca French
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Sharon Jakobowitz
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Mizanur Khondoker
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Nicky Stanley
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Kylee Trevillion
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Louise Howard
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
| | - Cathy Zimmerman
- Siân Oram, Melanie Abas, Sharon Jakobowitz, Kylee Trevillion, and Louise Howard are with Health Service and Population Research, King's College London, London, England. Debra Bick is with the Faculty of Nursing and Midwifery, King's College London. Adrian Boyle is with Addenbrookes Hospital, Cambridge, England. Rebecca French is with the Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London. Mizanur Khondoker is with the Department of Biostatistics, King's College London. Nicky Stanley is with the School of Social Work, University of Central Lancashire, Preston, England. Cathy Zimmerman is with the Department of Global Health and Development, London School of Hygiene & Tropical Medicine
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