Bick Debra, Howard Louise M, Oram Sian, Zimmerman Cathy
Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital London, United Kingdom.
Section of Women's Mental Health, Institute of Psychiatry and Neuroscience, David Goldberg Centre, King's College London, De Crespigny Park, London, United Kingdom.
PLoS One. 2017 Nov 22;12(11):e0187856. doi: 10.1371/journal.pone.0187856. eCollection 2017.
Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians' perspectives of maternity care for trafficked persons.
Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women.
Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women's movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low.
More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care. Given the prevalence of sexual exploitation and abuse among trafficking survivors, clinicians should ensure antenatal care and screening for sexually transmitted infections can be readily accessed by women. Clinicians require specialised training alongside designated pathways and protocols with clear referral options to ensure confidential maternity care tailored to each woman's needs.
尽管被贩运的妇女和青少年面临无保护或被迫性行为的风险，但关于贩运幸存者的孕产妇保健研究却很少。我们探讨了在英国处于被贩运状态期间怀孕的妇女的医疗保健需求、服务使用情况和面临的挑战，以及临床医生对被贩运者孕产妇保健的看法。
对从英格兰法定和志愿部门组织招募的贩运幸存者进行横断面调查和定性访谈，并对孕产妇临床医生和家庭医生进行定性访谈，以进一步深入了解这些妇女报告的经历。
在参与一项大型贩运幸存者研究的98名妇女中，有28名（29%）报告在被贩运期间有过一次或多次怀孕，本文报告了她们的数据。其中12名（42.8%）妇女报告在被贩运期间至少有一次堕胎，25名（89.3%）经历过某种形式的心理健康障碍。19名（67.9%）妇女在被贩运前遭受过身体虐待，9名（32.%）遭受过性虐待。四分之一的妇女被贩运用于性剥削，6名用于家务奴役，2名用于体力劳动。幸存者和临床医生描述了服务方面的挑战，包括贩运者对妇女行动的限制、对如何获得孕产妇保健的了解不足、对医疗保健权利的理解不佳以及对保密问题的担忧。孕产妇保健临床医生认识到贩运的潜在指标，但认为培训将有助于他们识别和应对受害者。主要局限性包括研究结果反映的是已经脱离被贩运状态的妇女，然而由于一些妇女最近才脱离被贩运状态，回忆困难可能较低。
超过四分之一的妇女在被贩运期间怀孕，这表明孕产妇服务是识别和护理的重要接触点。鉴于贩运幸存者中性剥削和虐待的普遍性，临床医生应确保妇女能够方便地获得产前护理和性传播感染筛查。临床医生需要接受专门培训，同时制定指定的途径和协议，并提供明确的转诊选择，以确保根据每个妇女的需求量身定制保密的孕产妇保健服务。
