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Monitoring and Evaluation of Global Sex Trafficking: What Do We Really Know? Focus on Gender and Health

Monitoring and Evaluation of Global Sex Trafficking: What Do We Really Know? Focus on Gender and Health



Presented by Abby Cannon and Evis Farka Haake at the October 2013 American Evaluation Association Annual Conference.

Presented by Abby Cannon and Evis Farka Haake at the October 2013 American Evaluation Association Annual Conference.



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  • Presentation – 20 minQ&A – 15Group work – 30Discussion – 20
  • Trafficking in persons is a complex, politically charged, and often-contentious human rights issue. A fundamental struggle faced by the counter-trafficking sphere is defining the phenomenon. For this reason, data collection and measuring has been an issue. Force, fraud and coercion for the purposes of exploitation are usually the common threads in the definitions of TIP.
  • In part due to the difficult nature of counting people that have been trafficked, as well as varying definitions of trafficking, estimates of number of people trafficked world wide range. Few studies cite numbers as small as 500,000, but most estimates depict a much larger and pervasive issue with 27 million and 20.9 million victims “conservatively” estimated. Despite the large estimations of how many people are trafficked, in 2012, there were only 47,000 victims identified, according to the US State Department. In order the fill this large gap between estimation and document victims, improved M&E is necessary, including methods and approaches used to reach this particularly hidden population.
  • In addition to varying definitions of trafficking, other policies and strategies to fight trafficking have had unintended and sometimes negative consequences. Two of the most common approaches to trafficking have been “curbing immigration and banning prostitution.” Unfortunately, equating TIP with illegal migration or sex work has created collateral damage for many victims. For example… Suppressing legal migration can force individuals into the hands of traffickers as their only option for migrationSex work vs. trafficking – confusing the two harms the rights of neither sex workers or trafficking victims were servedIn order to understand the situation of M&E and trafficking, a qualitative study was conducted– Abby will tell you more.
  • The first step in this formative research project was a literature review, which is used not only to understand the intersection of gender, global public health, HIV/AIDS, and trafficking in persons, but also to identify current measurement gaps interfering with the better understanding of these interrelated fields. While M&E practices in TIP are improving, many challenges remain. The literature identifies specific issues in the M&E of TIP, and also the need for improved discourse between actors in TIP, gender, and global health. Sex trafficking can be an area of intense debate because of different perceptions of both the morality and the legality of sex work and how these perceptions and legal implications play out in the arena of counter-trafficking. This paper does not focus on these issues, but it is crucial to acknowledge them and to recognize the potential constraints they many have on any recommendations.
  • - Eighteen interviews were conducted - M&E interviews focused primarily on methods, tools, and indicators deployed in measuring the size and location of TIP, the effects of TIP on health, as well as the M&E practices used in the field by counter-trafficking programs to track their successes and progress- Informationanalyzed following the Qualitative Analysis Guide of Leuven (QUAGOL) approachThe goal of the interviews was to gain an understanding of knowledge and practices of experts in these disciplines.
  • Gender impacts health outcomes, including the risk of HIV, access to health care, and maternal and child health. Evidence documents the correlation between higher levels of gender equality and better health outcomes. This applies to interventions responding to Trafficking in Persons (TIP). A gender perspective is critical to TIP response and will acknowledge trafficking in both men and women and their unique needs; and address the differential impacts of policies on men and women. A gender focus should include men and boys, and help us understand who is involved in the process of trafficking, including but not limited to traffickers, victims, and those who purchase trafficked goods and services.
  • Impacts on global health:Not only does trafficking adversely affect health in a variety of ways, but there is also evidence that individuals who have been trafficked for commercial sexual exploitation have a higher prevalence of HIV than individuals in sex work who were not trafficked.,, Trafficked people are at risk for a range of mental health conditions such as depression and PTSD, increased risk of HIV, violence and mental distress, sexual violence, contraceptive failure and poor MNCH outcomesReproductive health, gender-based violence, mental health and HIV experts recognize that TIP is a very important area at the intersection of gender and healthSex trafficking contributes to the spread of HIV, but the extent of the contribution depends on the epidemic in a specific location, and is unclear because the number of people currently being held in a situation of sex trafficking is unknown. If you would like more examples on association of HIV and sex trafficking, we can offer a few more examples in the Q&A.
  • Age of trafficking (younger than 14 showed significantly increased risk)Destination city (Mumbai showed greater risk than other Indian cities)
  • Association found between HIV status and age of trafficking, with younger ages more likely to be HIV-positiveDuration of confinement in brothels was positively associated with HIV-positive status. For every month in captivity, there is a 3 to 4 percent increase risk in HIV infection.
  • There are many challenges facing M&E in the human trafficking field that must be addressed, including the ways in which M&E of TIP and HIV/AIDS programs overlap. There are currently inadequate indicators, methods and tools to track where and to what extent human trafficking is happening, how TIP is affecting heath, and what programs are making the largest impact in counter-trafficking.
  • Because TIP negatively affects health and increases risk of HIV/AIDS and because there are several points of interaction in the prevention, care, and treatment of the two, HIV and counter-trafficking programs should work together to improve impact.  
  • Definitions of TIP vary adding to the complexity of data collection and measurementEach sector provides a small and biased subset of all cases, e.g. criminal justice and survivor service agenciesData is not comparable across sectors, governments, and NGOs
  • Potential discussion topics:Methods for data collection?Are we missing any major areas of measurement?How does the work you do intersect with trafficking?What are the main areas around trafficking that need evaluation?Methods?

Monitoring and Evaluation of Global Sex Trafficking: What Do We Really Know? Focus on Gender and Health Monitoring and Evaluation of Global Sex Trafficking: What Do We Really Know? Focus on Gender and Health Presentation Transcript

  • Monitoring and Evaluation of Global Sex Trafficking: What Do We Really Know? Focus on Gender and Health Abby Cannon, Gender Specialist Evis Farka Haake, M&E Associate American Evaluation Association Annual Conference Washington D.C. October 17, 2013
  • Agenda  Overview of M&E of Trafficking  Question & Answer  Group work  Large group discussion
  • Objectives of the Presentation  Provide an overview of common forms of trafficking  Discuss the challenges for conducting M&E of trafficking  Discuss efforts and opportunities to advance the current state of M&E of trafficking
  • Definition: Trafficking in Persons UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (Palermo Protocol): “The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.” Source: UN (2000). Protocol to Prevent Suppress and Punish Trafficking in Person, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime.
  • Trafficking in Persons (TIP) Definitions  United States - the Trafficking Victims Protection Act (TVPA) definition: “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.”
  • Size of the problem  Estimates range from 2.4 million¹ to 27 million trafficking victims worldwide BUT  47,000 identified trafficking victims² 1. International Labour Organization. 2012. ILO Global estimate of forced labour: Results and methodology. Geneva. Accessible at http://www.ilo.org/wcmsp5/groups/public/---ed_norm/--declaration/documents/publication/wcms_182004.pdf 2. US Department of State. 2013. Trafficking in Persons Report. Washington, DC. Accessible at: http://www.state.gov/j/tip/rls/tiprpt/2013/index.htm
  • 20.9 million people in forced labour State-imposed forced labour 2 200 000 (10%) Forced sexual exploitation 4 500 000 (22%) Forced labour exploitation 14 200 000 (68%) 1. International Labour Organization. 2012. ILO Global estimate of forced labour: Results and methodology. Geneva. Accessible at http://www.ilo.org/wcmsp5/groups/public/---ed_norm/--declaration/documents/publication/wcms_182004.pdf
  • Unintended Consequences Equating TIP with illegal migration or sex work has created collateral damage for many victims.  Legal migration vs. trafficking  Sex work vs. trafficking
  • Exploratory Qualitative Study  A formative, qualitative study was conducted in 2012/2013 on the monitoring and evaluation of trafficking in persons as it relates to gender and global health, particularly HIV/AIDS.  Aimed to identify and understand the successes and challenges in the M&E of human trafficking
  • Methods  Literature review  Qualitative research study  Semi-structured interviews with experts in:  gender  global health  HIV/AIDS  counter-trafficking  M&E
  • Finding 1 A gender and health perspective is critical in TIP.  acknowledges trafficking in both men and women  includes those involved in the process of trafficking
  • Finding 2  Consensus that TIP has important impacts on global health  Higher HIV prevalence among individuals that have been trafficked  Increased risk for:  mental health conditions including depression and PTSD  sexual violence, contraceptive failure, poor MNCH outcomes, gender-based violence, TB
  • Example: Sex trafficking and increased HIV risk A study among repatriated women and girls in Nepal found several factors within trafficking to be associated with increased risk of HIV infection:  Age of trafficking (younger than 14 showed significantly increased risk)  Length of time in servitude  Serving in multiple brothels  Destination city  Nearly 9 in 10 individuals who developed TB were HIV co-infected. . Silverman, J. G., Decker, M. R., Gupta, J., Maheshwari, A., Willis, B. M., & Raj, A. (2007). HIV prevalence and predictors of infection in sex-trafficked nepalese girls and women. JAMA : The Journal of the American Medical Association, 298(5), 536542.
  • Example: Sex trafficking and increased HIV risk  2006 study in India  HIV prevalence of 22.9% among women and girls rescued from brothels in Mumbai.  Association found between HIV status and age of trafficking  For every month in captivity, there was a 3% to 4% increased risk of HIV infection  No differences in HIV status based on nationality, marital status, or number of sex work clients per day were identified. Silverman, J. G., Decker, M. R., Gupta, J., Maheshwari, A., Patel, V., & Raj, A. (2006). HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India. Journal of Acquired Immune Deficiency Syndromes, 43(5), 588-593.
  • Finding 3  Evidence base is lacking  Improved monitoring and evaluation practices related to the effects of TIP are needed
  • Finding 4  Trafficking can be a contentious arena; however, improved discourse between gender, public health, HIV/AIDS, M&E, and TIP professionals could have profound impact on HIV and trafficking programs.
  • Main Recommendation A meeting of experts from each discipline is needed to:  focus on opportunities and help create M&E frameworks, indicators, and best practices  identify promising approaches, methods and tools to be used in M&E of TIP as it relates to health and gender  formulate a learning agenda that would help in moving this field forward
  • Expert Consultation on Indicator Development for Monitoring and Evaluation of Trafficking in Persons within the Context of Gender and Health Washington, DC October 1-3, 2013
  • Consultation Objectives  Day 1: Areas of measurement  Attain consensus on the critical areas to TIP within the context of gender and health  Days 2-3: Indicators  Develop set of indicators of these areas for program managers, policymakers, & others  Discuss strategy for dissemination, field-testing new indicators
  • Representatives from:  International Organization for Migration  International Labour Organization  UNICEF  USAID  U.S. State Department  NIH/NIDA  Researchers from top universities o 2 international universities o 3 US universities  NGO representatives
  • Day 1  TIP Policies and Definitions in the International Context  Operationalizing sex trafficking in research and practice  Health and Human Trafficking  Child trafficking  Challenges of Sampling and Data collection  Overview from ILO and IOM on data collection
  • Days 2 & 3  Input on areas of measurement  Small group work on developing indicators  Plenary group session to build consensus on all indicators
  • Existing Gaps and Challenges     Identification of victims Definitions of TIP vary Limited measurement of policy or programming impact Limited availability of data o Each sector provides a small and biased subset of all cases o Data is not comparable
  • Areas of Measurement  Policies and Law Prevention  Law enforcement  Health Sector o Health service providers  Non-health services o Education o Community  Other areas: o Referral mechanisms
  • Any Questions/Comments?
  • Discussion  Break into small groups  Select 1-2 discussion questions  Appoint someone to report back to the large group  20-30 minutes
  • MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide.
  • www.measureevaluation.org