"It isn't that we're prostitutes": Child protection and sexual exploitation of adolescent girls within and beyond refugee camps in Rwanda.

BACKGROUND: While refugee camps can protect children from harm, they can also introduce new risks and vulnerabilities. Research suggests that adolescent girls are at particular risk for gender-based violence and sexual exploitation. OBJECTIVE: This study aimed to identify existing social and economic vulnerabilities of female adolescents in refugee camps in Rwanda. PARTICIPANTS AND SETTING: Research was carried out in two Congolese refugee camps in Rwanda. METHODS: Ten focus group discussions (FGDs) were held with 87 boys and 79 girls aged 12-17 years Six FGDs were held with a total of 36 parents and caregivers in the two camps. Key informant interviews were held with nine local and national level stakeholders. RESULTS: Study findings centered upon intersectionality. Camps designed for security and containment introduced new forms of vulnerability and threats. Economic stressors threatened the viability of families. Girls had material needs but few options to meet those needs within the camps. Their families expected them to do domestic work at home. Participants reported that the convergence of material deprivation, lack of economic opportunity, and vulnerability led to transactional sex and exploitation within and around the camps. The study concludes that vulnerabilities and threats associated with gender and generation must be examined concurrently with the conditions associated with being a refugee in a setting of protracted displacement.

An international comparative public health analysis of sex trafficking of women and girls in eight cities: achieving a more effective health sector response.

Sex trafficking, trafficking for the purpose of forced sexual exploitation, is a widespread form of human trafficking that occurs in all regions of the world, affects mostly women and girls, and has far-reaching health implications. Studies suggest that up to 50 % of sex trafficking victims in the USA seek medical attention while in their trafficking situation, yet it is unclear how the healthcare system responds to the needs of victims of sex trafficking. To understand the intersection of sex trafficking and public health, we performed in-depth qualitative interviews among 277 antitrafficking stakeholders across eight metropolitan areas in five countries to examine the local context of sex trafficking. We sought to gain a new perspective on this form of gender-based violence from those who have a unique vantage point and intimate knowledge of push-and-pull factors, victim health needs, current available resources and practices in the health system, and barriers to care. Through comparative analysis across these contexts, we found that multiple sociocultural and economic factors facilitate sex trafficking, including child sexual abuse, the objectification of women and girls, and lack of income. Although there are numerous physical and psychological health problems associated with sex trafficking, health services for victims are patchy and poorly coordinated, particularly in the realm of mental health. Various factors function as barriers to a greater health response, including low awareness of sex trafficking and attitudinal biases among health workers. A more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. There are numerous opportunities for local health systems to engage in antitrafficking efforts while partnering across sectors with relevant stakeholders.

A qualitative case study of child protection issues in the Indian construction industry: investigating the security, health, and interrelated rights of migrant families.

BACKGROUND: Many of India's estimated 40 million migrant workers in the construction industry migrate with their children. Though India is undergoing rapid economic growth, numerous child protection issues remain. Migrant workers and their children face serious threats to their health, safety, and well-being. We examined risk and protective factors influencing the basic rights and protections of children and families living and working at a construction site outside Delhi. METHODS: Using case study methods and a rights-based model of child protection, the SAFE model, we triangulated data from in-depth interviews with stakeholders on and near the site (including employees, middlemen, and managers); 14 participants, interviews with child protection and corporate policy experts in greater Delhi (8 participants), and focus group discussions (FGD) with workers (4 FGDs, 25 members) and their children (2 FGDs, 9 members). RESULTS: Analyses illuminated complex and interrelated stressors characterizing the health and well-being of migrant workers and their children in urban settings. These included limited access to healthcare, few educational opportunities, piecemeal wages, and unsafe or unsanitary living and working conditions. Analyses also identified both protective and potentially dangerous survival strategies, such as child labor, undertaken by migrant families in the face of these challenges. CONCLUSIONS: By exploring the risks faced by migrant workers and their children in the urban construction industry in India, we illustrate the alarming implications for their health, safety, livelihoods, and development. Our findings, illuminated through the SAFE model, call attention to the need for enhanced systems of corporate and government accountability as well as the implementation of holistic child-focused and child-friendly policies and programs in order to ensure the rights and protection of this hyper-mobile, and often invisible, population.

Psychosocial adjustment and mental health in former child soldiers--systematic review of the literature and recommendations for future research.

AIMS AND SCOPE: This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age <18 years) associated with armed forces and armed groups (CAAFAG)--commonly referred to as child soldiers. METHODS: PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Sociological Abstracts in February 2012 for all articles on former child soldiers and CAAFAG. Twenty-one quantitative studies from 10 countries were analyzed for author, year of publication, journal, objectives, design, selection population, setting, instruments, prevalence estimates, and associations with war experiences. Opinion pieces, editorials, and qualitative studies were deemed beyond the scope of this study. Quality of evidence was rated according to the systematic assessment of quality in observational research (SAQOR). FINDINGS: According to SAQOR criteria, among the available published studies, eight studies were of high quality, four were of moderate quality, and the remaining nine were of low quality. Common limitations were lack of validated mental health measures, unclear methodology including undefined sampling approaches, and failure to report missing data. Only five studies included a comparison group of youth not involved with armed forces/armed groups, and only five studies assessed mental health at more than one point in time. Across studies, a number of risk and protective factors were associated with postconflict psychosocial adjustment and social reintegration in CAAFAG. Abduction, age of conscription, exposure to violence, gender, and community stigma were associated with increased internalizing and externalizing mental health problems. Family acceptance, social support, and educational/economic opportunities were associated with improved psychosocial adjustment. CONCLUSIONS: Research on the social reintegration and psychosocial adjustment of former child soldiers is nascent. A number of gaps in the available literature warrant future study. Recommendations to bolster the evidence base on psychosocial adjustment in former child soldiers and other war-affected youth include more studies comprising longitudinal study designs, and validated cross-cultural instruments for assessing mental health, as well as more integrated community-based approaches to study design and research monitoring.

Transactional sex as a form of child sexual exploitation and abuse in Rwanda: implications for child security and protection.

OBJECTIVE: To illuminate the different manifestations of transactional sexual exploitation and abuse among Rwanda's children in order to inform effective responses by policies, programs, and communities. METHOD: Qualitative data was collected during April and May 2010. One-hundred and thirty-nine adults (56% female) and 52 children (60% female) participated in focus groups across three geographic locations in Rwanda. Eleven interviews were held with child protection stakeholders. RESULTS: Interview and focus group participants reported how children, primarily girls, engaged in transactional sex as a survival strategy in response to situations of adversity including economic deprivation, difficulty accessing school, and social pressure. CONCLUSIONS: Policy and programs should work to address the underlying social and economic determinants of transactional sexual exploitation through structural interventions that reduce gender inequalities to accessing school and securing basic needs. Further quantitative and qualitative research to better understand the complexities of this issue is warranted.

Interrelatedness of child health, protection and well-being: an application of the SAFE model in Rwanda.

This study examines the core components of children's basic security and well-being in order to examine issues central to improving child protection in Rwanda. Sources of data included 15 focus groups with adults, 7 focus groups with children ages 10-17, and 11 key informant interviews with child protection stakeholders, including representatives from international NGOs, community-based groups, and the Rwandan Government, all of which took place in April and May of 2010. Participants painted a complex picture of threats to children's basic security in Rwanda. Three key themes were pervasive across all interviews: (1) deterioration of social and community cohesion in post-genocide Rwanda; (2) the cascading effects of poverty; and (3) the impact of caregiver illness and death on the caregiving environment. Consistent with the SAFE (Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security) model of child protection, participants rarely elaborated on a child protection threat independent of other basic security needs and rights. Findings suggest a need for integrated approaches to child protection that recognize this interrelatedness and extend beyond issue-specific child protection responses. This study contributes to a growing body of work highlighting the interrelated nature of child protection threats and the implications of adaptive and dangerous survival strategies that children and families engage in to meet their basic security needs. Analysis of this interrelatedness provides a roadmap for improving policies and implementing integrated and robust child protection strategies in Rwanda and other settings.

Sex trafficking and health care in Metro Manila: identifying social determinants to inform an effective health system response.

This social science case study examines the sex trafficking of women and girls in Metro Manila through a public health lens. Through key informant interviews with 51 health care and anti-trafficking stakeholders in Metro Manila, this study reports on observations about sex trafficking in Metro Manila that provide insight into understanding of risk factors for sex trafficking at multiple levels of the social environment: individual (for example, childhood abuse), socio-cultural (for example, gender inequality and a "culture of migration"), and macro (for example, profound poverty caused, inter alia, by environmental degradation disrupting traditional forms of labor). It describes how local health systems currently assist sex-trafficking victims, and provides a series of recommendations, ranging from prevention to policy, for how health care might play a larger role in promoting the health and human rights of this vulnerable population.

Protecting the children of Haiti

Article published in February, 2010 on the New England Journal of Medicine (NEJM) 362(9) about children's situation on Haiti after the earthquake. It includes photos.