The Modern Slavery Core Outcome Set: A Survivor-Driven Consensus on Priority Outcomes for Recovery, Wellbeing, and Reintegration.

There is no consensus on the outcomes needed for the recovery and reintegration of survivors of modern slavery and human trafficking. We developed the Modern Slavery Core Outcome Set (MSCOS) to address this gap. We conducted three English-language reviews on the intervention outcomes sought or experienced by adult survivors: a qualitative systematic review (4 databases, 18 eligible papers, thematic analysis), a rapid review of quantitative intervention studies (four databases, eight eligible papers, content analysis) and a gray literature review (2 databases, 21 websites, a call for evidence, 13 eligible papers, content analysis). We further extracted outcomes from 36 pre-existing interview transcripts with survivors, and seven interviews with survivors from underrepresented groups. We narrowed down outcomes via a consensus process involving: a three-stage E-Delphi survey (191 respondents); and a final consensus workshop (46 participants). We generated 398 outcomes from our 3 reviews, and 843 outcomes from interviews. By removing conceptual and literal duplicates, we reduced this to a longlist of 72 outcomes spanning 10 different domains. The E-Delphi produced a 14-outcome shortlist for the consensus workshop, where 7 final outcomes were chosen. Final outcomes were: "long-term consistent support," "secure and suitable housing," "safety from any trafficker or other abuser," "access to medical treatment," "finding purpose in life and self-actualisation," "access to education," and "compassionate, trauma-informed services." The MSCOS provides outcomes that are accepted by a wide range of stakeholders and that should be measured in intervention evaluation.

Forced labor and health-related outcomes. The case of beggar children.

BACKGROUND: Limited qualitative research indicates that beggar children might be victims of forced labor, and/or modern slavery. However, research quantifying the manifestations and health-related implications of forced child begging is missing in the literature. Because forced child begging might be physically, mentally, socially and morally harmful to children, research on the subject is needed to inform policymaking. OBJECTIVE: This study addressed the gap in the literature on child begging. The work aimed to examine whether beggar children are victims of forced labor, as well as to identify the manifestations of forced labor in beggar children, and assess whether forced child begging relates to deteriorated health-related quality of life and mental health. PARTICIPANTS AND SETTING: The study focused on the capital city of Greece, Athens, where beggar children are not a hard-to-reach group. Cross-sectional data were collected in 2011, 2014, 2018 and 2022, with 127 beggar children taking part in the study. METHODS: The study adopted the Anti-Slavery International research toolkit, which sets methodological guidelines on researching child begging. A scale was developed to quantify forced child begging based on the International Labour Organization's definition of forced labor. Multivariate regressions were performed with a view to answering the research questions. RESULTS: The study found that most beggar children were forced by others to beg, experienced threats of violence, physical and verbal harassment aimed at forcing them to beg, and difficulty in terms of being allowed by others to stop begging. Moreover, it was found that forced child begging was positively associated with living with unknown people, hunger due to food unavailability the previous week, and negatively associated with native beggar children. In addition, it was discovered that forced child begging was negatively associated with health-related quality of life and mental health for beggar children. CONCLUSION: Based on the study's findings, child begging encompasses elements of coercion and the deprivation of human freedom. These factors collectively amount to instances of forced labor and/or modern slavery. Policies should ensure that beggar children are removed from harm's way, and that those forcing children to beg are brought to justice, thus preventing forced child begging. Policies to reduce poverty, which constitutes the root of forced child begging, should also be considered. The goal is to create a protective environment where children can thrive, free from forced labor. In line with Sustainable Development Target 8.7, policy makers should take immediate and effective measures to eradicate forced labor, and end modern slavery.

Institutional Logics in the UK Construction Industry's Response to Modern Slavery Risk: Complementarity and Conflict.

There is a growing understanding that modern slavery is a phenomenon 'hidden in plain sight' in the home countries of multinational firms. Yet, business scholarship on modern slavery has so far focussed on product supply chains. To address this, we direct attention to the various institutional pressures on the UK construction industry, and managers of firms within it, around modern slavery risk for on-site labour. Based on a unique data set of 30 in-depth interviews with construction firm managers and directors, we identify two institutional logics as being integral to explaining how these companies have responded to the Modern Slavery Act: a market logic and a state logic. While the institutional logics literature largely assumes that institutional complexity will lead to a conciliation of multiple logics, we find both complementarity and continued conflict in the logics in our study. Though we identify conciliation between aspects of the market logic and the state logic, conflict remains as engagement with actions which could potentially address modern slavery is limited by the trade-offs between the two logics.

Exacerbating Pre-Existing Vulnerabilities: an Analysis of the Effects of the COVID-19 Pandemic on Human Trafficking in Sudan.

COVID-19 has caused far-reaching humanitarian challenges. Amongst the emerging impacts of the pandemic is on the dynamics of human trafficking. This paper presents findings from a multi-methods study interrogating the impacts of COVID-19 on human trafficking in Sudan-a critical source, destination, and transit country. The analysis combines a systematic evidence review, semi-structured interviews, and a focus group with survivors, conducted between January and May of 2021. We find key risks have been exacerbated, and simultaneously, critical infrastructure for identifying victims, providing support, and ensuring accountability of perpetrators has been impeded. Centrally, the co-occurrence of the pandemic and the democratic transition undercut the institutional and governance capacity, limiting the anti-trafficking response and exposing already vulnerable groups to increased risks of human trafficking. Findings point to increased vulnerabilities for individuals with one or more of the following identities: migrants, refugees, females, and informal labourers.

The debt trap, a shadow pandemic for commercial sex workers: Vulnerability, impact, and action.

This research paper is a stringent analysis of the condition of commercial sex workers in India and what is happening to them in this pandemic-stricken time. The study details their economic condition and what is forcing them to borrow money from treacherous lenders despite knowing the risks behind it. Apart from being exploited financially, they are also becoming vulnerable for sexual, emotional, and physical exploitation, worsening their situation even further. The research findings show that 90% of commercial sex workers in red light areas will be forced into a debt trap that is non-repayable in their lifetime, making it a massive movement of commercial sex workers entering into bonded labour, another form of modern-day slavery. Apart from the financial peril, poverty is forcing them to be in a situation of major health hazard. Being deprived of customers for so long, they might be forced to work in this uncertain situation making it an optimum ground for a super-spread of the virus. A rapid assessment method has been used to collect the data from numerous commercial sex workers across the nation. The collected data are analysed using qualitative analysis and also visualized for better understanding. As a means to provide tangible alternative solutions to the problem, the study strongly recommends occupational training programs for commercial sex workers that provide a transition into alternative livelihoods, government action against predatory high-interest loans, and the redevelopment of red light areas where economic returns can be reinvested into commercial sex worker retraining programs.

Corrigendum: Human trafficking: Results of a 5-year theory-based evaluation of interventions to prevent trafficking of women from South Asia.

[This corrects the article DOI: 10.3389/fpubh.2021.645059.].

Global Health Care Experiences of Female Survivors Who Experienced Trafficking: A Meta-Ethnography.

INTRODUCTION: Most nurses and midwives do not feel adequately prepared to respond to the complex trauma and social and cultural needs of female clients who have experienced trafficking. There are data to support a lack of knowledge among health care providers about the types of human trafficking as well as poor structural supports within health care systems. The purpose of this review was to gain a more comprehensive understanding of the global health care experiences of females who have experienced trafficking. METHODS: Noblit and Hare's 7-step meta-ethnographic approach was used. We analyzed constructs, concepts, themes, and metaphors using reciprocal translations. The guidelines for preferred reporting the synthesis of qualitative research were adhered to enhancing transparency (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). RESULTS: The collaborative search process in the PsycINFO, CINAHL, and Scopus databases resulted in 7 high-quality research studies published between January 2016 and January 2021. Most studies explored individuals' experiences of trafficking and views of health care services, challenges, and service use barriers. A total of 228 female survivors who experienced trafficking participated. They primarily experienced trafficking within different parts of North America, Eastern Europe, Africa, and South and Southeast Asia. Three main themes emerged: privacy, confidentiality, and identity problems; powerlessness; and clinician recognition and responsiveness. DISCUSSION: All participants reported being exposed to extremely high levels of physical and mental abuse before, during, and after exiting trafficking. Therefore, clinicians will require ongoing training and clearer guidance from clinical leadership to adequately care for the varying health needs of women and girls who have experienced trafficking or are currently in a trafficking situation. Adoption of a culturally sensitive, patient-centered, and trauma-informed approach is needed, as clients' reasons for staying in a trafficking situation vary. Relationships of trust should be formed in which rapport is cocreated and in which members of the health care team and client work hand in hand together to envision, identify, and pursue future-oriented and strength-based goals toward healing.

Change in Rhetoric but not in Action? Framing of the Ethical Issue of Modern Slavery in a UK Sector at High Risk of Labor Exploitation.

This article shows how the ethical framing of the contemporary issue of modern slavery has evolved in UK construction, a sector in which there is a high risk of labor exploitation. It also examines how these framing dynamics have inhibited the emergence of a common framework of action to deal with the issue. We draw on both framing theory and the literature on the discursive construction of moral legitimacy. Our longitudinal analysis reveals that actors seeking to shape the debate bring their own moral schemes to justify and construct the legitimacy of their frames. Actors cluster their views around five evolving frames: human rights issue (later shifting to hidden crime), moral issue, management issue (later shifting to human moral obligation), social justice issue, and decent work issue-which promote particular normative evaluations of what the issue is, who is responsible, and recommendations for action. Our study contributes to a dynamic and political understanding of the meaning making of modern slavery. We identify the antecedents and conditions that have forestalled the emergence of new patterns of action to tackle modern slavery in the UK construction sector thereby evidencing the effects of the interplay of morally competing frames on field-level change. Supplementary Information: The online version contains supplementary material available at 10.1007/s10551-021-05013-w.

Protecting people with communication disability from modern slavery: Supporting Sustainable Development Goals 8 and 16.

PURPOSE: The 2030 Agenda for Sustainable Development identifies the need for inclusive societies and justice for people who experience, or are at risk of experiencing, modern slavery. The primary objective of this commentary paper is to consider current research and practice in relation to the protection of people with communication disability from modern slavery. The paper considers the role of SLPs in developing and disseminating accessible information to help achieve decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16). RESULT: This paper considers five areas for protecting people with communication disability from modern slavery: (1) accessible information, (2) advocacy, (3) rights-based approaches, (4) improved understanding about access to services, and (5) education. Practice examples are discussed across each of these areas, with a focus on accessible information. CONCLUSION: This commentary asserts that information about modern slavery must be accessible so that people with communication disability experience inclusion, safety, and justice. SLPs are well placed to implement communication strategies, such as accessible information, to help protect people with communication disability from modern slavery. This commentary paper focuses on SDG 8 and SDG 16 and also addresses SDG 1, SDG 3, SDG 4 and SDG 10.

Confronting the Business Models of Modern Slavery.

Despite growing attention from companies and regulators looking to eradicate modern slavery, we know little about how slavery works from a business perspective. We address this gap by empirically examining innovations in the business models of modern slavery, focusing on how the business models of slavery in advanced economies have evolved since slavery was legally abolished. While continuities exist, novel business models have emerged based on new actors, activities, and linkages. We categorize these as four innovative models per actors involved (producer/intermediary) and how value is created and captured (revenue generation/cost reduction), and discuss implications for research, policy, and practice.

The unequal impact of Covid-19 on the lives and rights of the children of modern slavery survivors, children in exploitation and children at risk of entering exploitation.

This article discusses the unequal impact of Covid-19 on the lives of the children of survivors of modern slavery, child victims of exploitation and children at risk of exploitation in the UK. It draws on research that has analysed the risks and impacts of Covid-19 on victims and survivors of modern slavery. It explores how pandemic responses may have hindered these children's rights to education, food, safety, development and participation and representation in legal processes. It suggests that the pandemic should be used as an impetus to address inequalities that existed pre-Covid-19 and those that have been exacerbated by it.

Paper: violence, abuse and exploitation among trafficked women and girls: a mixed-methods study in Nigeria and Uganda.

BACKGROUND: Africa is the global region where modern-slavery is most prevalent, especially among women and girls. Despite the severe health consequences of human trafficking, evidence on the risks and experiences of trafficked adolescents and young women is scarce for the region. This paper addresses this gap by exploring the intersections between violence, migration and exploitation among girls and young women identified as trafficking survivors in Nigeria and Uganda. METHODS: We conducted secondary analysis of the largest routine dataset on human trafficking survivors. We used descriptive statistics to report the experiences of female survivors younger than 25 years-old from Nigeria and Uganda. We also conducted 16 semi-structured interviews with adolescents identified as trafficked in both countries. We used thematic analysis to explore participants' perceptions and experiences before, during and after the trafficking situation. RESULTS: Young female survivors of human trafficking in Nigeria and Uganda are exposed to a range of experiences of violence before migration, during transit and at destination. The qualitative data revealed that children and adolescents migrated to escape family poverty, violence and neglect. They had very low levels of education and most had their studies interrupted before migrating. Family members and close social contacts were the most common intermediaries for their migration. During transit, sexual violence and hunger were common, especially among Nigerians. Participants in both the quantitative and qualitative studies reported high levels of violence, deception, coercion, withheld wages and poor working conditions at destination. The adolescents interviewed in the qualitative study reported severe mental suffering, including suicide attempts. Only one reported the prosecution of perpetrators. CONCLUSIONS: Our findings suggest that interventions to prevent or mitigate the negative impact of adverse childhood experiences can contribute to preventing the trafficking of adolescents in Nigeria and Uganda. These interventions include social protection mechanisms, universal access to education, social service referrals and education of parents and carers. Importantly, effective prevention also needs to address the systemic conditions that makes trafficking of female adolescents invisible, profitable and inconsequential for perpetrators.

Prevalence of complex post-traumatic stress disorder in survivors of human trafficking and modern slavery: a systematic review

Background and objectives. The human rights violation of human trafficking and modern slavery could be described as multiple and prolonged traumatisation. This corresponds to the type of trauma identified as most likely to be associated with ‘complex post-traumatic stress disorder’ (CPTSD) as identified in the new 11th edition of the International Classification of Diseases (ICD-11). This review aims to collate the evidence of complex post-traumatic stress disorder in populations that have been trafficked, with the intention to highlight important considerations to be made in terms of managing survivor's health care needs and minimising further traumatisation. Methods Five databases were searched using key terms related to human trafficking, modern slavery, and complex post-traumatic stress disorder. Results Five studies reporting on a total of 342 participants were included in the review. These studies indicated that an average of 41% of survivors of modern slavery and human trafficking had CPTSD. This was higher than the 14% diagnosed with PTSD. Post-trafficking stress, endured whilst living in refugee camps, was higher in individuals with CPTSD than in those living with PTSD. Healthcare was more difficult to access by populations with PTSD and CPTSD compared to those with no diagnosis. Conclusion There is a high prevalence of CPTSD in modern slavery and trafficking survivors therefore a need for identification and specialised treatment. Consideration should be given to consequent biopsychosocial needs, particularly access to healthcare and minimisation of post-trafficking stress.

A erradicação do trabalho escravo até 2030 e os desafios da vigilância em saúde do trabalhador / Eradicating slave labour by 2030: the challenge of worker health surveillance

Resumo A erradicação das formas contemporâneas de escravidão é uma relevante questão científica, social e institucional. De fato, esforços globais têm sido feitos para compreender, mapear e eliminar a escravidão contemporânea, como um dos objetivos do Desenvolvimento Sustentável das Nações Unidas até 2030. Entretanto, pouca atenção tem sido dada para o lugar da vigilância em saúde do trabalhador (VISAT) nas estratégias e lutas pela erradicação dessas relações de exploração. Para suprir essa lacuna, este artigo discute o trabalho escravo contemporâneo (TEC) e suas especificidades no Brasil, na perspectiva da VISAT. Inicialmente, destacamos as relações entre trabalho escravo, saúde do/a trabalhador/a e a vigilância em saúde e, em seguida, apresentamos três desafios da vigilância para o enfretamento do TEC: o desafio de caracterizar setores econômicos, regiões e populações afetadas; o de identificar determinantes, riscos e efeitos à saúde; e o de fortalecer práticas e serviços de saúde do trabalhador para desencadear ações de formação, informação e intervenção em regiões de maior presença de TEC. Conclui-se que a vigilância em saúde do trabalhador pode trazer contribuições significativas para emancipação de trabalhadores em contextos de trabalho escravo.

Abstract Eradicating modern slavery is a relevant scientific, social, and institutional challenge issue. Indeed, efforts are being made globally to understand, map, and eradicate contemporary slavery as a target of the United Nations Sustainable Development Goals by 2030. However, little attention has been given to the Occupational Health Surveillance (VISAT) in the strategies and struggle against exploiting relationships. In order to fill this gap, the paper discusses contemporary slave labor (CSL) and its specificities in Brazil from an occupational health surveillance perspective. We initially highlight the link between CSL, occupational health, and occupational health surveillance (VISAT). We then present three VISAT challenges to addressing CSL: the challenging task of characterizing economic sectors and populations most affected; identifying determinants, risks, and effects on health; and strengthening occupational health practices and services to trigger specific actions regarding formation, information, and intervention in regions of high CSL prevalence. We conclude that Occupational Health Surveillance can play an essential role in the emancipation of workers engaged in slavery relationships.

Interventions to support the mental health of survivors of modern slavery and human trafficking: A systematic review.

BACKGROUND: Modern slavery is a term which incorporates a range of exploitative situations that involve the violation of human rights and the subjugation of individuals. It presents a significant public health concern. Post-release, survivors of modern slavery have complex mental health needs. Whilst mental health provision is a component of international and national policy, the delivery of evidence-based support remains a gap in the global anti-slavery response. AIM: To identify and synthesise the evidence base for mental health interventions developed and evaluated for use in a post-slavery survivor population. METHODS: A systematic literature review was undertaken. The review protocol was prospectively registered with PROSPERO and followed the PRISMA guidance in its reporting. A multi-stage search strategy was utilised to retrieve studies. Quality appraisal was undertaken using the QualSyst tool. Due to heterogeneity in study design, a narrative approach to synthesising the findings was undertaken. RESULTS: Nine studies met the final inclusion criteria. The narrative synthesis clustered the studies in three themes: study design and population; type of intervention; and outcomes reported. The included studies focussed on specific subpopulations, namely child soldiering, child labour or sex trafficking. CONCLUSION: This review has highlighted not only important theory-practice gaps in relation to the provision of evidence-based mental health support but scant evidence limited to specific sub-groups (child soldiering, child labour or sex trafficking). The emphasis placed on PTSD within the interventions tested risks mental health support becoming exclusionary to those with other needs. When assessing intervention efficacy, the complex socio-political context in which survivors exist as well as the increasing emphasis on holistic care, personal recovery and lived experience need to be considered. Taking this into account, the case can be made for the inclusion of a wider range of non-clinical outcomes in the assessment of mental health intervention effectiveness.

Human Trafficking: Results of a 5-Year Theory-Based Evaluation of Interventions to Prevent Trafficking of Women From South Asia.

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings.

Cutting edge or ignored resource: assessing the uptake and content of the NHS e-Learning for healthcare on "identifying and supporting survivors of modern slavery".

BACKGROUND: Across the last decade, healthcare emerged as a critical space for combatting modern slavery. Accurate and informative training of healthcare professionals is, therefore, essential. In the UK, the National Health Service (NHS) plays a central role in the identification and care of survivors. With training at the local-level variable, an e-Learning programme was developed. We ask: has this programme reached NHS staff? Is it accurate? Should the e-Learning approach be replicated around the world? METHOD: A Freedom of Information request has been sent to the NHS's Health Education England for data held on registrations, sessions and completions since 2014. An open session was used to assess the content. RESULTS: Across the past 5 years, there have been 31 191 registrations (≈2% of the workforce) and 1763 completed sessions (≈0.12%). Uptake remains low. We also identify deficiencies in the ways the programme represents modern slavery, and how the program engages with the complexities of national and international law and UK policy, as well as reporting mechanisms. CONCLUSIONS: e-Learning, while flexible and on-going, must be engaging and, we suggest, accompanied by in-person sessions. Materials should be co-produced with survivors and healthcare workers around the world to improve interest and relevance. Updating content regularly is critical.

Unaccompanied asylum-seeking children and young people - Understanding their journeys towards improved physical and emotional health.

In 2018, approximately 20,000 unaccompanied children and young people applied for asylum in a European Union country. Unaccompanied asylum-seeking children present with significant emotional and physical health needs. These needs are likely the result of the situation that led them to leave their home, the difficult journeys they make to reach safety and their living circumstances after arriving at their destination. Maintaining engagement with both screening and therapeutic health services is challenging. A stepwise approach to delivery of services is recommended so as not to overwhelm them. Case studies and personal practical experience are used to highlight key learning points.

The impact of human trafficking in relation to maternity care: A literature review.

OBJECTIVE: To map the relevant literature and inform future research on the issues related to and experiences of pregnancy and maternity care for women who have been trafficked. DESIGN: A scoping review was undertaken to identify literature on the issues and experiences of pregnancy and maternity care for women who have been trafficked. RESULTS: 45 papers were identified and six key themes were derived from the literature: the impact of trafficking on health; access to maternity care; experiences of maternity care; social factors; knowledge and experience of staff; and identification and referral. KEY CONCLUSIONS: Women who have been trafficked are at risk of physical and emotional health issues that may affect maternal and fetal outcomes. Multiple barriers to care exist for women who have been trafficked, and social factors including housing, poverty and dispersal policies may impact upon both health and access to care. Healthcare staff do not feel adequately prepared to respond to the needs of this vulnerable group and no midwifery-specific guidance exists. IMPLICATIONS FOR PRACTICE: Midwives need awareness of the complex range of health and social factors that may affect women who have been trafficked. Midwives and maternity care professionals require more specialised training to better identify, refer and support women who have been trafficked.