Frequently Asked Questions About Child Trafficking and Exploitation

According to federal law, ‘severe forms of human trafficking’ involve 3 components: an action, means and purpose. That is, to demonstrate that someone is a victim of trafficking, one must show that at least one of the ‘actions’ listed in Figure 1 below have occurred, using one of the ‘means’, for one of the listed ‘purposes.’ There are two main forms of human trafficking, including sex and labor trafficking. State laws may differ slightly from federal law so it is prudent to be familiar with your state statutes.

Figure 1. What is Human Trafficking?

There are a few important points to make. The first is that when considering sex trafficking of a minor (<18 years of age), one does not need to demonstrate the presence of force, fraud or coercion (although these are often present). A minor is unable to legally consent to sexual exploitation. Therefore, federal law deems that any commercial sex act with a minor represents child sex trafficking. An adolescent who makes a decision to have sex with a person in exchange for food or shelter may consider that they have given their ‘consent’ and no force has occurred. But this situation would still qualify as child sex trafficking.

Secondly, the irrelevance of ‘means’ does NOT apply to child labor trafficking. One must demonstrate force, fraud and/or coercion as a means of labor exploitation when considering adults and children. Thirdly, ‘transporting’ is only one of several possible ‘actions’ included in the definition. Transporting someone across a border, or even across town, is not required to fulfill the criteria of human trafficking.

Finally, state statutes often vary in their definitions of commercial sexual exploitation of children and child trafficking so it is helpful for pediatricians to be familiar with their state laws.

According to the Office of Juvenile Justice and Delinquency Prevention, commercial sexual exploitation of children (CSEC) involves “a range of crimes and activities involving the sexual abuse or exploitation of a child for the financial benefit of any person or in exchange for anything of value (including monetary and non-monetary benefits) given or received by any person.” This includes transactional sex (exchange of sex acts for something of value) that does not involve a 3rd party (“pimp”). ‘CSEC’ and ‘child sex trafficking’ are often used interchangeably.

Yes. While research on child labor trafficking in the US is quite limited compared to that regarding commercial sexual exploitation, there is evidence that children and youth are involved in labor trafficking in a variety of occupational sectors. Some of these include agriculture, domestic work (e.g. live-in ‘maids’ and/or ‘nannies’), nail salons, restaurants/small businesses, gang-involved drug sales and gun carrying, traveling sales crews (e.g., magazine sales), and peddling/begging rings. Further basic information about forced child labor in the US may be found on the  the Office of Juvenile Justice and Delinquency Prevention page.

Reliable prevalence estimates for human trafficking are not available, due to a number of factors including a lack of recognition of exploitation (either by trafficked persons, themselves, or by others), lack of reporting to authorities, lack of a common database of suspected victims, and to the criminal nature of the activity. The prevalence of boys experiencing commercial sexual exploitation/trafficking is even less clear, but studies of homeless/runaway youth indicate that relatively high proportions of males in that population are involved in either labor or sex trafficking. In a 10-city American study of homeless youth receiving services at Covenant House sites, 16% of young men reported engaging in any type of trafficking (11% sex, 9% labor).

It is widely understood that male victims are markedly under-recognized and under-reported and a number of hypotheses have been proposed to explain this. Gender roles emphasizing males as strong, protective and assertive may cause exploited boys to keep their situation hidden, as they may feel that disclosure would lead others to view them as ‘weak’ or ‘ineffective.’ A strong cultural emphasis on gender roles also may lead professionals to overlook the possibility of trafficking or ignore signs of exploitation. Cis-gender boys may be concerned that questions about sexual orientation will be raised if they disclose their exploitation, especially if it involves having sex with other males. Finally, public awareness tends to focus on girls as victims of trafficking, ignoring the existence of cis-gender boys and LGBTQ+ youth who are exploited. For more information on sexual exploitation of boys, see bibliography below.

Yes. LGBTQ+ youth are disproportionately represented among the homeless/runaway population. Using a nationally representative phone-based survey of over 26,000 households, Morton et al demonstrated that LGBT young persons had greater than twice the risk for homelessness relative to those not reporting a sexual minority status. Within a sample of Massachusetts public high school students (grades 9-12), Corliss found that sexual-minority males and females had 4-13 times the odds of reporting current homelessness relative to their exclusively heterosexual peers.

Once LGBTQ+ youth leave home or become homeless, they are at increased risk of sex trafficking. Greeson compared sex trafficked with non-trafficked homeless young people in 3 American cities. The 17% of homeless participants (45/270) who reported sex trafficking were significantly more likely to be transgender, and/or bisexual relative to the comparison group.

Labor and sex trafficked children and youth may face several barriers to disclosing their exploitation. They may be accompanied to the health visit by someone involved in the trafficking, and be closely monitored by that person. They may fear retribution from the trafficker if they disclose (even if the trafficker is not present). They may also fear involvement of child protective services, law enforcement or immigration officials if they talk about their experiences. Children and youth may also feel intense shame or guilt associated with the exploitation (convinced by the trafficker that it is their fault they are in this predicament, or ashamed that they were ‘conned’ into the situation, incurred a large ‘debt’ and are unable to send money home, for example). Frequently, trafficked persons do not perceive themselves to be victims of exploitation. They do not realize they are being manipulated, or may be unaware that they have legal rights (e.g. protection by labor laws, anti-trafficking laws). They cannot disclose something of which they are unaware. Finally, distrust of authorities, fear of negative judgment and discrimination by health professionals, and a pervasive sense of hopelessness may prevent disclosure to professionals.

These barriers to disclosure make it all the more important for pediatricians to be aware of risk factors and potential indicators of child labor and sex trafficking, and feel comfortable talking with vulnerable children and youth about possible exploitation, using a trauma-informed approach.

Legally, minors under 18 years cannot consent to be sexually exploited via commercial sex. While some youth may decide to engage in commercial sex in order to obtain something they or someone else needs, it is assumed that their decision comes from a position of extremely limited options, and often, the presence of subtle (or not) coercion, manipulation and/or abuse of power. For example, a man may approach a homeless youth and offer them a place to stay. Once the child agrees and has settled in, the adult may demand sex in return for his ‘favor’.

No. According to U.S. federal law, engaging in any commercial sex act with a person less than 18 years of age is considered ‘sex trafficking’. The ‘exchange of something of value’ does not need to involve a 3rd person. However, state statutes may vary and law enforcement may not aggressively investigate cases in which there is no defined 3rd party exploiter.

Definition of Human Trafficking

1. United States Government. Justice for Victims of Trafficking Act of 2015.Available at https://www.congress.gov/114/plaws/publ22/PLAW-114publ22.pdf;  Accessed on May 18, 2020.2. United States Government. Trafficking Victims Protection Act Pub L No 106-386 Division A 103(8) [USC02] 22 USC Ch 78. 2000;Available at https://www.govinfo.gov/content/pkg/PLAW-106publ386/pdf/PLAW-106publ386.pdf .

CSEC vs Child sex trafficking

1. Office of Juvenile Justice and Delinquency Prevention. Commercial sexual exploitation of children. Available at https://ojjdp.ojp.gov/programs/sexual-exploitation-children; accessed on 5/19/20.

Labor Trafficking

1. Gibbs DA, Aboul-Hosn S, Kluckman MN. Child labor trafficing within the US: A first look at allegations investigated by Florida's c;hild welfare agency. J human trafficking. 2019;https://doi.org/10.1080/23322705.2019.1594551.
2. Gozdziak E, Bump MN. Victims no longer: Research on child survivors of trafficking for sexual and labor exploitation in the United States. US Department of Justice report (document No: 221891); available at https://www.ojp.gov/pdffiles1/nij/grants/221891.pdf Accessed on Nov 20, 2018. 2008.
3. Murphy LT. Labor and sex trafficking among homeless youth: A ten-city study executive summary. Available at https://oag.ca.gov/sites/all/files/agweb/pdfs/ht/murphy-labor-sex-trafficking-homeless-youth.pdf; accessed on 8/8/18. 2016.
4. National Human Trafficking Resource Center. Child labor trafficking in the United States. Available at https://humantraffickinghotline.org/resources/child-labor-trafficking-united-states.
5. U.S. Department of Labor. What are child labor and forced labor?  Child labor--definitions. Available at https://www.dol.gov/agencies/ilab/resources/what-is-child-labor-human-trafficking Accessed December 8, 2016.

Boys and Commercial Sexual Exploitation

1. Dennis J. Women are victims, men make choices: The invisiblity of men and boys in the global sex trade. Gend Issues. 2008;25(11-25).
2. ECPAT USA. And Boys Too: An ECPAT-USA discussion paper about the lack of recognition of the commercial sexual exploitation of boys in the United States.  2013 Available at https://static1.squarespace.com/static/594970e91b631b3571be12e2/t/5977b2dacd0f688b2b89e6f0/1501016795183/ECPAT-USA_AndBoysToo.pdf; Accessed on Oct 29, 2017.
3. Edinburgh L, Pape-Blabolil J, Harpin SB, Saewyc E. Assessing exploitation experiences of girls and boys seen at a child advocacy center. Child Abuse Neglect. 2015;46:47-59.
4. Edwards JM, Iritani BJ, Hallfors DD. Prevalence and correlates of exchanging sex for drugs or money among adolescents in the United States. Sex Transm Infect. 2006;82(5):354-8.
5. Lillywhite R, Skidmore P. Boys are not sexually exploited? A challenge to practitioners. Child Abuse Review. 2006;15:351-61.
6. Miles G, Blanch H. What about boys?  An initial exploration of sexually exploited boys in Cambodia. Love 146. 2011;Accessed at https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1019&context=humtraffconf3 on Jun 4, 2016.
7. Moynihan M, Mitchell K, Pitcher C, Havaek F, Ferguson M, Saewyc E. A systematic review of the state of the literature on sexually exploited boys internationally. Child Abuse & Neglect 2018;76:440-51.

LGBTQ+ youth and sex trafficking

1. Corliss HL, Goodenow CS, Nichols L, Austin SB. High burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample. Am J Public Health. 2011;101(9):1683-9.
2. Greeson JKP, Treglia D, Wolfe DS, Wasch S, . Prevalence and correlates of sex trafficking among homeless and runaway youths presenting for shelter services. Social Work Research. 2019;43(2):91-100.
3. Morton MH, Dworsky A, Matjasko JL, Curry SR, Schlueter D, Chávez R, et al. Prevalence and Correlates of Youth Homelessness in the United States. J Adolesc Health. 2018;62(1):14-21.
4. Murphy LT. Labor and sex trafficking among homeless youth: A ten-city study executive summary. Available at https://oag.ca.gov/sites/all/files/agweb/pdfs/ht/murphy-labor-sex-trafficking-homeless-youth.pdf ; accessed on 8/8/18. 2016.

Why don’t children and youth spontaneously disclose their exploitation to pediatricians?

1. Albright K, Greenbaum J, Edwards S, Tsai C. Systematic Review of Facilitators of, Barriers to, and Recommendations for Healthcare Services for Child Survivors of Human Trafficking Globally. Child abuse & neglect. 2020;100:104289, 1-27.
2.   Armstrong S, Greenbaum VJ. Using survivors' voices to guide the identification and care of trafficked persons by U.S. health care professionals: A systematic review. Adv Emergency Nursing J. 2019;41:244-60.
3. Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health and Human Rights: An International Journal. 2011;13(1):unpaginated.
4. Ijadi-Maghsoodi R, Bath E, Cook M, Textor L, Barnert E. Commercially sexually exploited youths’ health care experiences, barriers, and recommendations: A qualitative analysis. Child Abuse Neglect. 2018;76(334-341).

Do you need 3rd party involvement?

1. United States Government. Justice for Victims of Trafficking Act of 2015.Available at https://www.congress.gov/114/plaws/publ22/PLAW-114publ22.pdf;  Accessed on May 18, 2020.2. United States Government. Trafficking Victims Protection Act Pub L No 106-386 Division A 103(8) [USC02] 22 USC Ch 78. 2000;Available at https://uscode.house.gov/view.xhtml?path=/prelim@title22/chapter78&edition=prelim; accessed 12/30/19.