The life of a woman is always being challenged in patriarchal societies like Pakistan. The challenges markedly increase when woman is out of her home. A decade ago, deprived domestic circumstances made a poor girl, Amra, leave her home to secure a better job and stable income1. The innocent little girl, with more than twenty girls, was unaware that they were being trafficked outside Pakistan. Indignities and exploitation started after they crossed the border. After entering a new country, Amra was sold and was forced to marry a man against her will. Amra, over the period of time, suffered physical, sexual and psychological traumas. Such scenarios reflect the cruel realities of women trafficking that are repeated around the world. Women are physically beaten, raped, isolated, and economically deprived to create a reliance on traffickers2. All this has major health consequences, but despite this, trafficking has not been considered as health related cooncern3. Therefore, it is a high time to address concerns of women trafficking and its impact collectively. Therefore, there is need to understand the aspect of women trafficking.
Trafficking: A Concept: /Cruel reality
According to the United Nations Population Fund (UNPF), "perhaps 4 million persons per year" are trafficked (Effects & Consequences). Human trafficking is one of the major concerns in most regions in the world, and is considered as one of the fastest growing areas of international criminal activity4. About 800,000 people are trafficked, each year, worldwide for forced labor, domestic servitude, or sexual exploitation5. The largest number of victims trafficked internationally still come from Asia, over 225,000 from Southeast Asia each year6. Although men are also persecuted, but predominantly those trafficked are women and children4. The Global Alliance against Trafficking defines women trafficking in the following manner:
"All acts involved in the recruitment and/or transportation of a woman within and across national borders for worked or services by means of violence or threat of violence, abuse of authority or dominant position, debt-bondage, deception or other forms of coercion"7.
Trafficking is distinguished from smuggling which lies in individual's freedom of choices. In smuggling, a person may choose and arrange to be smuggled into a country, whereas in trafficking a person freedom is taken away and is forced into a situation of exploitation (Viverette).
Underline Causes:
Pakistan is considered as a significant source, destination, and transit for human trafficking, especially for women8. Many societies still favor sons and view girls as an economic burden4.
Like other regions in the globe, women in Pakistan are the most vulnerable to the trafficking phenomenon which is associated with feminization of poverty, gender discrimination, inequality in education; and ignorance about legal rights. Women are frequently trafficked for domestic service, childcare, and as brides9, 10. However, all these actions of crimes remain silent. A study by the National Commission for Child Welfare and Development (NCCWD) pointed that, due to cultural and religious factors, commercial sexual activity is kept underground12.
The link between gender and poverty is evident all over the world12, including Pakistan. The International Rights Monitoring (IHRM) report supports that, in Pakistan, due to poverty, 44% of women opt sex as a way to generate income12. Moreover, early marriages and dowry practices are also common here. And so, traditional dowry related practices amplify the economical burdens, forcing parents to sell their daughters1. Human Rights Commission of Pakistan (HRCP) states that:
In Swat (in the North West Frontier province, NWFP), a woman could be bought for no more than Rs 10,000 (1US$=Rs60). In Sindh and Balochistan, the selling of daughters as young as 10 years to suitors willing to pay their families money ranging from Rs 30,000 to Rs 40,000 was reported. Reference
Illiteracy is another major associational factor with women trafficking. In poorer regions of the world, lack of education and employment opportunities leads the societies into crime like human trafficking (Human Trafficking: Definition, Prevalence, and Causes). In Pakistan, literacy rate is 39% in female and 51.6% in male18. Lack of education makes it hard for women to find alternative jobs, and they have little choice for work or find other ways to support their family.
As a result, they work in more unsafe atmosphere with low salaries, brutal labor as domestic servant, factory servant, and prostitution?. Hence, the educational discrepancy is also the reason for widespread of trafficking.
Furthermore, in the country like Pakistan most of the people are unaware about their legal rights; or if they may not raise the issue human rights. Due to inefficiency and inadequate knowledge about rights, women lead to get the fatality of abuse like trafficking1. Moreover, weak legislation and poor enforcement of trafficking laws are also cited as factors contributing to trafficking in Pakistan. [1]
Above reviews depict that in Pakistan; women's trafficking is interconnected with socio-cultural, gender, and economical inequalities and inequities that could result into various health hazards for women. be resulted women into various health threats.
Areas of Concerns:
Women trafficking accompany potential lifelong and/or life threatening health consequences22. However, the health risks associated with human trafficking, especially for women have not been well-documented13. One of the few studies on trafficking that has focused on health was conducted in Europe13. Available data suggests several areas of concern of women trafficking as: violence to wellbeing; risk to reproductive health; maladaptive coping by using of illicit drugs; and inaccessible to health care facilities. Despite the violence and harm inherent in most trafficking situations, there remain limited evidences on the individual and public health implications of any form of human trafficking, including Pakistan. (Trafficking in persons: a health concern). Moreover, lack of access to health care affects the achievement of the Millennium Development Goals, including combating HIV and other diseases, improving maternal health, and promoting gender equality and empowering women (Health & Human Trafficking).
The most obvious and the direct health effects of trafficking are psychological, physical and sexual violence. Trafficking leads to weaken mental equilibrium of the woman or girl. Victims feel constant terror, guilt, embarrassment, hopelessness, denial, and self blame throughout their lifespan20. Physical abuse results in victims getting injuries such as bruises, broken bones, head wounds, stab wounds, mouth and teeth injuries, and it can even lead to death22. Moreover, sexual abuse and coercion into involuntary sexual acts can lead to unwanted pregnancies, and gynecological complications23. In Pakistan, these women are even misused and threatened by their ex-husbands if they refuse to have sex with him1.
The further category of health threats of trafficking encompasses threats to reproductive health. Officials estimate that about 200,000 women between 12 and 30 years of age were trafficked for purposes of sexual exploitation from Bangladesh to Pakistan. [2] Thus, involvement in the sex industry is associated with an increase risk of infertility, ectopic pregnancy, and malignancies associated with Sexual Transmitted Diseases (STDs) (e.g. cervical cancer and AIDs) (Cheema 6).
A study found that the absence of emotional and social support has enormous implications for women's ability to withstand and cope with the stress of their situation13. Consequently, these sufferers lead into maladaptive coping practices such as using illicit drugs and /or alcohol, and subsequently develop addiction. More so, in patriarchal societies, trafficked women are often socially stigmatized, and thus, difficult to regain her social status. Separation, divorce, unwanted pregnancy and being victims of rape lead women in various social stigmas1.
In addition, limited accessibility of health care is also due to the social stigma associated with trafficking and limited sources22. In country like Pakistan, the often outcomes, for the women involved in trafficking, are limited resources and an unstable livelihood (Cheema 6). Additionally, a study has highlighted a number of key issues in relation to health care access, which include, lack of multi-dimensional services; limited mobility to these services; and culture as a barrier2. As a result, trafficked victims are at a greater risk of complications arising from undiagnosed and untreated physical, psychological, and sexual health concerns22. A review concluded that in Pakistan, women are exposed to serious and numerous health risks which impacts the nation's and the world's public health (Spear, 2004).
Looking at the cruelty of the issue, role of health care professionals can play a pivotal role, in order to protect women and girls from severe health consequences.
Framework for Care:
Trafficking in women is now recognized as one of the global public-health issue21. Hence, numerous interventions would be required at all levels of care. Trafficking, especially of women, can be intervened at three levels: 'prevention of trafficking', 'protection of victims', and 'prosecution of traffickers'26.
Prevention of Trafficking: Lack of awareness of the general population regarding the menace also continues to be an issue. Therefore, there is a strong need to strengthen the nation's knowledge and understanding about this serious crime; it effects on individuals; and identification of useful strategies to impede this inhuman act.
Prevention can be done through public awareness campaigns and by incorporating health and human trafficking information into existing programs, policies, education and curricula28. Therefore, both governmental and non-governmental organizations should work in tandem to combat trafficking in Pakistan. In this respect, Ministry of Interior produced and distributed a film about the dangers of trafficking on state television and to vulnerable populations along the borderline of India27. Lawyers for Human Rights and Legal Aid (LHRLA) took up the issue of trafficking of women in Pakistan, for the first time, and its one year project aimed at raising awareness about trafficking30.
There is also needed that the awareness and sensitization with the concept of trafficking is done at an early age, via the school health curricula. Moreover, awareness could also be increased through media. Additionally, initiatives to make women resourceful by establishing educational, technical, vocational, health and infrastructure projects can also prevent women trafficking. Above all, technical training is strongly recommended for all the professionals on preventive measures against women trafficking.
Protection of Victims: Unfortunately, victims are traumatized even if they are lucky enough to arrive back home. They are usually stigmatized in their homes and in their social circle. These poor victims can be protected or supported by providing them various resources, such as hotlines, shelters, and counseling services. Although the Pakistani government does make plans, their implementation remains questionable. According to……. "Protection for victims of commercial sexual exploitation remained limited; internally trafficked women could access 25 Federal government-run "Women's Centers" or 276 provincial government-run "Darul Aman" centers offering medical treatment, vocational training, and legal assistance to abused women and children."29 Though, the government claims that the services are available for trafficked victims including shelter, legal aid, and medical and psychological care, many victims are not always being provided with this assistance and there is hardly any secure shelter for the victims of trafficking in Pakistan.8
Hence, providing protection to these victimized women is highly proposed by providing shelters for rescued women within the communities; rescuing and repatriating the trafficked women; and reintegrating rescued women into society. Moreover, equal opportunities for participation in economic activities could be provided by empowering the victims, thus making them independent. As weak infrastructure and budgetary implications further limits the situation, there is a need to have intersectoral collaboration in order to reduce this gap.
Prosecution of Traffickers: The Government of Pakistan does not fully comply with the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so29. The constitution of Pakistan prohibits slavery, all forms of forced labor, and trafficking in human beings. [3] In August 2002, the federal cabinet passed the Prevention and Control of Human Trafficking Ordinance. [4] The Prevention and Control of Human Trafficking Ordinance imposes a punishment of imprisonment for up to 10 years and a fine on anyone who "purchases, sells, harbors, transports, provides, detains, or obtains a child or a woman through coercion, kidnapping, or abduction or by giving or receiving any benefit" for trafficking the child or woman into or out of Pakistan for the purpose of "exploitative entertainment." [5] The punishment increases to imprisonment for up to 14 years and a fine if the offense involved kidnapping or abduction. [6] The Prevention and Control of Human Trafficking Ordinance also provides certain benefits to the victims. These benefits include allowing the victim to extend their stay in Pakistan; [7] paying compensation and expenses to the victim; [8] or making arrangements for shelter, food, and medical care of a victim who is an unaccompanied child or a destituted woman. [9] However, despite these efforts, including the prosecution of some trafficking offenses, the government has not shown evidence of progress in addressing such serious issue.
The government cannot achieve significant progress in terms of curbing this phenomenon without a comprehensive approach8. For one, law enforcement agencies must be aware of the difference between human smuggling and human trafficking and how to deal with people involved in these very different activities8. Another thing is that, training would be required for legal professionals and judges for awareness related to trafficking. Illiteracy and unawareness about the law is another subject of concern; therefore, facilities available for provision of legal advice and support to the victims to bring their cases to the courts should be made available.
Conclusion:
Women's trafficking is one of the major concerns in this part of the world. In Pakistan, feminization of poverty, gender discrimination, inequality in education; and ignorance about legal rights women are the most common determinants to women trafficking. As a result, these victims could undergo various distressing outcomes such as violence to health, especially for reproductive health; use of substance abuses; and limited accessibility to health care facilities. Steps to facilitate health care providers in assisting the victims to be aware of such breach needs to be. Hence, numerous interventions would be required at three levels: 'prevention of trafficking', 'protection of victims,' and 'prosecution of traffickers.' From holistic perspective of care, a health professional can play a pivotal role by providing preventive awareness raising and educational programs in order to protect women and girls from severe health consequences. The determinants and consequences of trafficking need to be addressed at the national level as early as possible. Moreover, the Government with other collaborators should take steps, and put action into mechanisms to improve, monitor and network to fights against trafficking.
