“Praying for freedom”: a story of labor trafficking during pregnancy

Published:January 21, 2023DOI:
      Given the scant literature and data that exist on labor trafficking in general, obstetricians and gynecologists have very limited awareness of the effect of pregnancy on individuals affected by labor trafficking. Labor trafficking is the use of force, fraud, or coercion to compel an individual to provide a service. Our current understanding of this topic lacks the narratives of survivors who have lived experiences with this intersection. This study presented the story of a labor-trafficked person navigating the healthcare system throughout her pregnancy to shed light on an important presentation of labor trafficking in women's healthcare settings. The insufficient attention afforded to and the stereotypical views of labor trafficking do not often include the experiences of pregnant women. Therefore, presenting examples of labor trafficking, such as in this case study, are important to combat implicit structural and institutional biases that interfere with survivor identification. In addition to sharing one survivor's story, this article presents a trauma-informed approach to setting up socioculturally sensitive, developmentally appropriate, and inherently empowering conversations within healthcare settings to assess for exploitation and connect victims to resources. This case and framework are very important for obstetrician-gynecologists as they are uniquely positioned to screen and care for pregnant labor-trafficked people. Given the well-described “dual exploitation” of those experiencing intimate partner abuse and trafficking, clinical settings that focus on women's health and reproductive healthcare are important touchpoints for the identification, resource coordination, and management of pregnant-trafficked people.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • International Labour Organization
        Walk Free, International Organization for Migration. Global estimates of modern slavery: forced labour and forced marriage.
        2022 (Available at Accessed October 18, 2022)
        • Office to Monitor and Combat Trafficking in Persons
        2017 Report on U.S. government efforts to combat trafficking in persons.
        US Department of State, 2017 (Available at) (Accessed May 1, 2022)
      1. Lee S. Crime victim awareness and assistance through the decades. National Institute of Justice. 2019. Available at:https://nij.ojp. gov/topics/articles/crime-victim-awareness-and-assistance-through-decades. Accessed May 1, 2022.

      2. International Labor Organization. A global alliance against forced labour. 2005. Available at: Accessed May 1, 2022.

        • Lederer LJ
        • Wetzel CA.
        The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities.
        Ann Health Law. 2014; 23: 61
        • Gillispie V
        • Russo JA
        • Arora KS.
        Human trafficking ACOG Committee Opinion Summary Number 787.
        Obstet Gynecol. 2019; 134: 662-663
      3. ACOG Committee Opinion No. 518: intimate partner violence.
        Obstet Gynecol. 2012; 119: 412-417
        • Chisolm-Straker M
        • Stoklosa H.
        Human trafficking is a public health issue: a paradigm expansion in the United States.
        Springer Cham, Berlin, Germany2017
        • FitzGerald C
        • Martin A
        • Berner D
        • Hurst S
        Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review.
        BMC Psychol. 2019; 7: 29
      4. International Organization for Migration. The Counter Trafficking Data Collaborative: global data hub on human trafficking. Available at: Accessed March 1, 2022.

      5. Bessel S. Fact sheet: human trafficking and domestic violence. The Human Trafficking Legal Center. 2018. Available at: Accessed July 1, 2022.

        • Koegler E
        • Howland W
        • Gibbons P
        • Teti M
        • Stoklosa H.
        When Her Visa Expired, the Family Refused to Renew It,” intersections of human trafficking and domestic violence: qualitative document analysis of case examples from a major Midwest City.
        J Interpers Violence. 2022; 37: NP4133-NP4159
        • Dovydaitis T.
        Human trafficking: the role of the health care provider.
        J Midwifery Womens Health. 2010; 55: 462-467
        • Nightingale S
        • Brady G
        • Phimister D
        • O'Doherty L
        Experiences of pregnancy and maternity care for women exposed to human trafficking and sexual exploitation: a systematic review and qualitative evidence synthesis.
        Evid Based Midwif. 2020; 18: 6-16
        • Spear DL.
        Human trafficking. A health care perspective.
        AWHONN Lifelines. 2004; 8: 314-321
      6. Chico LC, Pagila A. Assisting survivors of human trafficking: multicultural case studies. Human Trafficking Search. 2017. Available at: Accessed February 28, 2022.

      7. CommonSpirit Health, HEAL Trafficking, Pacific Survivor Center. PEARR tool: trauma-informed approach to victim assistance in health care settings. 2021. Available at: Accessed February 28, 2022.

        • Alpert EJ
        • Ahn R
        • Albright E
        • Purcell G
        • Burke TF
        • Macias-Konstantopoulos WL.
        Human trafficking: guidebook on identification, assessment, and response in the health care setting.
        Massachusetts General Hospital and Massachusetts Medical Society, 2014 (Available at) (Accessed May 1, 2022)
      8. HEAL Trafficking. HEAL trafficking and hope for Justice's protocol toolkit. 2017. Available at: Accessed February 28, 2022.

      9. HEAL Trafficking. Patient resources. Available at: Accessed February 28, 2022.