The Trauma of Child Trafficking, Hidden in Plain Sight
WASHINGTON—Human trafficking—whether sex or labor, adult or child—has devastating consequences on the victims.
“We see an extraordinary amount of physical and mental health effects from child and adult trafficking,” said Dr. Jordan Greenbaum, medical director of the Child Protection Center at Children’s Healthcare of Atlanta, at a human trafficking event at the Department of Justice in Washington on Feb. 2.
Greenbaum said that in Atlanta, about one-third of the girls under 18 who have been sex trafficked have a history of pregnancy. Almost half have an active sexually transmitted infection, such as gonorrhea or chlamydia, and a third have had a prior history of infection.
“Drug use is very, very common—almost 90 percent of our kids use drugs,” she said. “In another study of child survivors, almost 50 percent of them had a drug abuse problem, and 75 percent of them had post traumatic stress disorder.”
Almost 50 percent reported a prior suicide attempt within the last year, said Greenbaum.
“These are adolescents. Fifty percent trying to take their own lives,” she said.
Child sex trafficking is so hidden in society that a reliable estimate of its prevalence in the United States doesn’t exist. Estimates vary wildly from tens of thousands to hundreds of thousands of cases per year.
Of the nearly 25,000 runaways reported to the National Center of Missing and Exploited Children in 2017, one in seven were likely victims of child sex trafficking. Of those, 88 percent were in the care of social services when they went missing.
Health Care Providers
Greenbaum said health care providers need to be more aware of the signs of trafficking in their patients.
She said in one study of adults and adolescent girls who were sex trafficking survivors, 88 percent said they had seen a health care provider while they were being exploited, yet none of them had been identified in the health care setting.
“What does that say to us? It says that victims are coming to get health care, but we’re not recognizing them,” she said. “We have yet to see a victim come in and say, ‘My chief complaint, my concern, is human trafficking.’ They don’t self-disclose spontaneously.”
Greenbaum said she would like to see protocols around identifying and responding appropriately to sex trafficking victims at health clinics, emergency departments, and hospitals around the country.
The issue is complicated, though. Very few victims actually realize they’re being exploited, she said.
“They don’t see themselves as needing or wanting outreach and help. So it becomes very difficult,” Greenbaum said.
“It’s often a case of being re-trafficked and re-trafficked and re-trafficked. And we will see the same child every three or four months as they are picked up again by police. Then they are back out again.
“We can’t force anything, but we can certainly make it very clear that we want to help if we can.”
Once they’re out of the trade, however, there is a long road ahead.
Many girls are mandated into residential facilities because they are minors.
“We assume temporary custody while they’re with us; they’re with us about a year,” said Mary Frances Bowley, founder and executive director of Atlanta-based Wellspring Living, which has a residential program for girls aged 12 to 17. Most of the girls are referred through the Department of Family and Children Services.
“As they come in, one of the things we have to know is they’re probably not ready … because they’re being mandated to us,” Bowley said.
One of the most difficult things to do is break the trauma bond, or the loyalty, that the victim has to their trafficker. Also known as the Stockholm Syndrome, it’s the psychological phenomenon where strong emotional ties develop between two people where one person intermittently harasses, beats, threatens, abuses, or intimidates the other, according to the Marin County Coalition to End Human Trafficking.
“The victim expresses empathy and sympathy and positive feelings toward their captors, sometimes to the point of defending and identifying with them,” the coalition website states.
Most commonly, the pimp or trafficker makes the girl feel as if they’re in love and manipulates her into being too afraid to leave.
Bowley said at Wellspring they avoid telling the girl that the trafficker was wrong. “They have to see it for themselves.”
“So exposing them to who they are and maybe helping them to understand that they have been exploited … they don’t see that they’ve been exploited, at first,” Bowley said.
“But generally about 60 to 90 days in, with consistent care, consistent therapy, they begin to see that and move away from that trauma bond.
“But it is very, very hard to break. There is no doubt about that—it is very hard to break.”
Bowley said building a trust relationship in a healthier way than the trafficker did is critical. But it’s often school that makes the girls want to stay, especially the younger ones.
They realize they will now be able to get their high school diploma, which they had given up on.
“I think another aspect of the way that our girls and women feel like they can stay in the program is because we also work with a lot of volunteers. We celebrate a lot. And as you celebrate them, it helps them to believe ‘Maybe this is hard, but it’s better than where I’ve been,’” Bowley said.
The average age of girls forced into the commercial sex trade is between 12 and 14; and for boys, it’s 11 to 13, according to the Department of Homeland Security.
The top five states for sex trafficking in the United States are California, Texas, Florida, Ohio, and New York.