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

1. 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

2. Agenda
 Overview of M&E of Trafficking
 Question & Answer
 Group work
 Large group discussion

3. 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

4. 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.

5. 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.”

6. 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

7. 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

8. 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

9. 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

10. Methods
 Literature review
 Qualitative research study
 Semi-structured interviews with experts in:
 gender
 global health
 HIV/AIDS
 counter-trafficking
 M&E

11. 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

12. 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

13. 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.

14. 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.

15. Finding 3
 Evidence base is lacking
 Improved monitoring and evaluation
practices related to the effects of TIP
are needed

16. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. Days 2 & 3
 Input on areas of measurement
 Small group work on developing indicators
 Plenary group session to build consensus on
all indicators

23. 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

24. 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

25. Any Questions/Comments?

26. Discussion
 Break into small groups
 Select 1-2 discussion questions
 Appoint someone to report back to the large
group
 20-30 minutes

27. 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.

28. www.measureevaluation.org