The international policy and research framework to address the sexual and reproductive health needs of trafficked persons is built, unsurprisingly, on a restricted narrative focused on conditions arising as a result of sex trafficking, even though these needs are not limited to sex trafficked individuals. This bias has resulted in a number of neglected areas. First, the current narrative fails to differentiate between issues of sexual health caused by human trafficking and those compounded by it; the difference between, say, acquiring HIV through exploitation and the effect of trafficking on one’s ability to access to anti-retroviral treatment. This parallels a focus on sexual and reproductive health outcomes of trafficking – rather than looking to health needs throughout the trafficking process. Second, it prioritizes sexual exploitation within the sex trade; glossing over sexual abuse that may occur in the context of labor exploitation, for instance. Third, arguably, by perpetuating a policy bias towards sex trafficking, the framework is disengaged from the health impacts of policies that subject exploited migrant women outside sex work to deportation. Fourth, this narrative reinforces a normative framework of family, excluding, importantly, single mothers and simultaneously gendering sexual health by focusing almost exclusively on women.
In developing anti-trafficking initiatives, including the Palermo Protocol, the international community has focused disproportionally on the sexual exploitation of women and children. Subsequent health policy and research has mirrored this interest, while broadly focusing on health outcomes of trafficking, including sexual violence and abuse, HIV, other sexually transmitted infections (STIs), and unsafe or forced abortions as a result of non-consensual or exploitative sex. Robust research in this specific area is needed to ensure the development of effective and targeted interventions. Future research could be enhanced through a more holistic perspective on health, complimented via range of under-researched outcomes, such as the effects of trafficking on mental health (including the link between, for instance, sexual abuse and trauma). There has been progress on women’s health issues, including the UN’s recent announcement that access to contraception is a universal human right. Despite these changes, a wave of current anti-trafficking initiatives, such as those that emphasize ending demand for prostitution, remain alarmingly ill-informed about the negative effects of such policies on the health needs or rights of sex workers. Such evidence includes the recently published research by the UN Development Program (UNDP), the UN Population Fund (UNFPA) and the Joint UN Program on HIV/AIDS (UNAIDS) examining sex work policies and HIV in Asia and the Pacific. Importantly, the report found that “where sex work has been decriminalized, there is a greater chance for safer sex practices through occupational health and safety standards across the industry. Furthermore, there is no evidence that decriminalization has increased sex work.”
However, there is a necessity to shift localized responses to trafficking so that policy is not unfairly partial to the outcomes of sex exploitation given the reproductive health needs of all trafficked persons. Moreover, a noticeable gap exists in the current trafficking literature on sexual and reproductive health issues that may coincide with, but not be a product of, exploitation. This may include instances such as the example above – how might a preexisting condition (like HIV) of a trafficked individual be affected by other health issues they may experience as a result of trafficking, such as malnutrition, poor living or working conditions, limited or lack of access to healthcare, or the effects of trauma and violence? There may also be value in exploring areas of preventative care, such as contraceptive use among female domestic workers whose reproductive health decisions may impact not only their employment, but migration status. Though these areas of research extend beyond trafficking specifically, information collected from the experiences of workers in specific industries (e.g. construction, domestic work) would be able to inform trafficking-related service provision and health-related interventions.
There is also lack of information on sexual (or reproductive) health vulnerabilities that may contribute to exploitation. For example, as noted above, there is a focus in existing research on HIV transmission as a result of sexual exploitation. There is an opportunity for this impact to be reconceptualized: to what extent might discrimination or financial constraints influence the decision of an individual to take risks in migration or employment to pay for the treatment of their disease – or even to pay for medical treatment of family members? In addition, how might individuals be affected by circumstances warranting a need for short-term care (the treatment of a minor infection) versus long-term health care (ongoing treatment of HIV/AIDS)?
International human rights protections enshrined within the Convention on the Elimination of Discrimination against Women (CEDAW) and labor standards established by the International Labor Organization (ILO) aim to ensure employment equality between all men and women (including migrant workers). Despite these provisions, which include not being unfairly dismissed from employment due to pregnancy, states openly subject pregnant migrant workers to discriminatory policies, often resulting in deportation. As Human Rights Watch summarizes, in General Recommendation No. 26 the Committee on the Elimination of Discrimination against Women, which oversees CEDAW, highlights the necessity of “governments to ensure that women migrant workers have the same rights and protections extended to all workers in the country and should lift bans prohibiting migrant workers from getting pregnant.” However, protections for migrants fall short when equality provisions are not legislated or enforced for local women in the first instance.
In addition to labor protections, international law (e.g. CEDAW (Article 12)) also requires states to ensure equality in access to health care including family planning, pregnancy and post-natal care. Many low-skilled migrant workers are vulnerable to exploitation due to costs incurred as a result of their migration which may place them in debt (making healthcare unaffordable). They may also be vulnerable as a result of the type of work undertaken, which may be dangerous (necessitating health care) and include long hours (restricting access to provider services). Abusive employers may also restrict movement and/or refuse to pay to address health needs – particularly in preventative care, inhibiting access to certain forms of contraception, for example.
In Singapore discriminatory policies impact the reproductive health of migrant women. For instance, as a public health measure, all work pass holders are required to undertake regular pregnancy (and STI) tests. Counter to CEDAW obligations, pregnancy results in the termination of employment and subsequent deportation. This issue has been especially problematic for domestic workers in Singapore and, as Human Rights Watch highlighted, existing policy language in the Employment of Foreign Manpower Act is confusing to employers, often to the detriment of the worker:
Confusion reigns about the wording in the work permit conditions, which prohibits domestic workers from “becoming” pregnant. Many employers, domestic workers, and employment agents interpret this clause to mean that a domestic worker who becomes pregnant automatically loses her job and must leave Singapore. Others believe the employers additionally forfeit the S$5,000 [U.S.$2,950] bond. According to Human Rights Watch interviews with Ministry of Manpower officials, the bond is forfeited only if a domestic worker runs away from her place of employment. They also clarified that a domestic worker may seek a voluntary abortion if she becomes pregnant and then continue her employment. What is forbidden is to give birth in Singapore: officials told us that domestic workers will be deported if they carry the pregnancy to term.
However, according to HOME’s CEDAW Shadow Report, “although legal in Singapore, the cost of abortion and fear of authorities being notified cause some workers to access self-administered, dangerous abortion drugs”. Fear of deportation combined with a total dependence on one’s employer to cover all medical expenses may affect a worker’s decision to report any abuse, let alone access reproductive and sexual health services.
Lastly, there is a dearth of information available on the nature of the birth of children to irregular migrants, and subsequent vulnerabilities to exploitation for both mother and child. Pregnancy itself may not only be an outcome of exploitation, but may exacerbate an individual’s risk to health (via forced abortion, pregnancy complications) or their safety. Research in the UK by the Child Exploitation and Online Protection Centre recorded several cases in which girls were abandoned once they became pregnant. Cases concerning infants and small children could be compounded by the statelessness of children who may not be registered at birth; undoubtedly complicating sexual and reproductive health needs, and access to care. This issue is gaining some traction in transnational migration studies. For example, building on her previous research on the exploitation of migrant women in Korea’s nightlife entertainment industry, and the issue of migrant brides, Sallie Yea examines the experiences of infants and mothers in the process of migration (forthcoming). Dr. Yea points to a need to address concerns faced by single mothers and mothers with irregular migration status, as well as the lack of research regarding minors born during mother’s migration.
In June 2012, Thailand’s Minister of Labor’s proposal to deport pregnant migrant laborers was marketed as an anti-trafficking mechanism; a migration policy developed under the guise of reducing child labor. This type of discriminatory policy calls to mind questions regarding state complicity and responsibility in repatriating workers to countries of origin where appropriate (or even consistent) health care many not be available. These policies also create – and potentially add to existing – vulnerability, affecting an individual’s immediate health needs as well as migration, legal, and economic status. Rather than perpetuating a limited focus on existing health repercussions of trafficking, policymakers and researchers have an opportunity to enhance the reproductive and sexual health framework of by incorporating a holistic consideration of the health needs of individuals across the spectrum of exploitation.