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Identifying and Assisting Sexually Exploited and Trafficked Patients Seeking Women's Health Care Services

Tracy, Erin E. MD, MPH; Macias-Konstantopoulos, Wendy MD, MPH

doi: 10.1097/AOG.0000000000002144
Contents: Clinical Expert Series
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Expert Discussion
Spanish Translation

It is estimated that 21 million people are trafficked worldwide, including 11.4 million women and girls. Approximately 4.5 million are forced to do sexual labor. The exact prevalence of human trafficking is difficult to ascertain, however, given the limitations of data collection in an illegal industry. Obstetrician–gynecologists should not only be aware of the widespread nature of human trafficking, but also have the tools to assess patients for trafficking and respond to victim identifications. Patients may present with signs of physical abuse, depression, anxiety, posttraumatic stress disorder, substance use, sexually transmitted infections, pregnancy, and nonspecific somatic complaints. As with intimate partner violence, clinicians should be suspicious if the patient is accompanied by an individual who refuses to leave her side. Other potential red flags include patients with wounds in various stages of healing, patients appearing fearful or unable to answer specific questions, and patients who do not have any personal identification. Health care providers should speak with the patient privately, using professional interpreters when indicated. Although there are no validated screening questions for the health care setting, in this article, we provide sample questions such as, “Is anyone forcing you to do anything physically or sexually that you do not want to do?” The physical examination should be thorough with appropriate workup, sexually transmitted infection prophylaxis, and emergency contraception. Physicians and patients should be aware of their state's mandatory reporting requirements and careful documentation is essential. Finally, to ensure a comprehensive, interdisciplinary response to trafficked patients, practitioners should engage hospital-based and community-based services when appropriate.

Health care providers are uniquely positioned to identify and assist victims and survivors of human trafficking, a widespread human rights violation with profound health consequences.

Department of Obstetrics and Gynecology, Vincent Obstetrics and Gynecology Global Health Program, Massachusetts General Hospital, Boston, Massachusetts and Emergency Medicine Department, Massachusetts General Hospital, Boston, Massachusetts.

Corresponding author: Erin E. Tracy, MD, MPH, Massachusetts General Hospital, Vincent Obstetrics and Gynecology, 55 Fruit Street, 406 Founders House, Boston, MA 02114; email:

Financial Disclosure The author did not report any potential conflicts of interest.

Continuing medical education for this article is available at

Each author has indicated that she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.