Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

Abstract

Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. “Fierce Autonomy” emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.

Keywords

commercial sexual exploitation sex trafficking health care girls young women agency fierce autonomy qualitative interviews United States

Get full access to this article

View all access options for this article.

References

Arevian

A. C.

O’Hora

Jones

, et al. (2018). Participatory technology development to enhance community resilience. Ethnicity & Disease, 28(Suppl 2), 493–502. DOI: 10.18865/ed.28.S2.493.

Bantjes

Swartz

(2019). “What can we learn from first-person narratives?” The case of nonfatal suicidal behavior. Qualitative Health Research, 29(10), 1497–1507. https://doi.org/10.1177/1049732319832869.

Barnert

E. S.

Kelly

M. A.

Godoy

Abrams

Bath

(2019). Behavioral health treatment “Buy-in” among adolescent females with histories of commercial sexual exploitation. Child Abuse & Neglect, 100(2020), 104042. https://doi.org/10.1016/j.chiabu.2019.104042

Barnert

E. S.

Kelly

M. A.

Ports

Godoy

Abrams

Bath

(2019). Understanding commercially sexually exploited adolescent females’ access, utilization, and engagement in healthcare: “Work around what I need.” Women’s Health Issues, 29(4), 315–324. https://doi.org/10.1016/j.whi.2019.02.002

Bay-Cheng

L. Y.

Fava

N. M.

(2014). What puts “at-risk girls” at risk? Sexual vulnerability and social inequality in the lives of girls in the child welfare system. Sexuality Research and Social Policy, 11(2), 116–125. http://dx.doi.org/10.1007/s13178-013-0142-5

Bejarano

Fuzzell

Clay

Leonard

Shirley

Wysocki

(2015). Shared decision making in pediatrics: A pilot and feasibility project. Clinical Practice in Pediatric Psychology, 3(1), 25–36. https://doi.org/10.1037/cpp0000086

Bounds

Julion

W. A.

Delaney

K. R.

(2015). CSE of children and state child welfare systems. Policy, Politics, & Nursing Practice, 16, 17–26. http://dx.doi.org/10.1177/1527154415583124

Brand

P. L. P.

Stiggelbout

A. M.

(2013). Effective follow-up consultations: The importance of patient-centered communication and shared decision making. Paediatric Respiratory Reviews, 14(4), 224–228. https://doi.org/10.1016/j.prrv.2013.01.002

Charles

Gafni

Whelan

(1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least 2 to tango). Social Science & Medicine, 44(5), 681–692. https://doi.org/10.1016/s0277-9536(96)00221-3

10.

Charmaz

(1995). Grounded theory. In Smith

Harré

Langenhove

(Eds.), Rethinking methods in psychology (pp. 27–65). Sage.

11.

Charmaz

(2000). Grounded theory: Objectivist and constructivist methods. In Denzin

Lincoln

(Eds.), Handbook of qualitative research (2nd ed., pp. 509–535). Sage.

12.

Charmaz

(2006). Constructing grounded theory: A practical guide through qualitative analysis. Sage.

13.

Charmaz

(2014). Constructing grounded theory. Sage.

14.

Cook

M. C.

Barnert

Ijadi-Maghsoodi

Ports

Bath

(2018). Exploring mental health and substance use treatment needs of commercially sexually exploited youth participating in a specialty juvenile court. Behavioral Medicine, 44(3), 242–249. https://doi.org/10.1080/08964289.2018.1432552

15.

Courtois

(2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41(4), 412–425. https://doi.org/10.1037/0033-3204.41.4.412

16.

Coyne

(2008). Children’s participation in consultations and decision-making at health service level: A review of the literature. International Journal of Nursing Studies, 45(11), 1682–1689. https://doi.org/10.1016/j.ijnurstu.2008.05.002

17.

Coyne

Amory

Kiernan

Gibson

(2014). Children’s participation in shared decision-making: Children, adolescents, parents and healthcare professionals’ perspectives and experiences. European Journal of Oncology Nursing, 18(3), 273–280. https://doi.org/10.1016/j.ejon.2014.01.006

18.

Crickard

E. L.

O’Brien

M. S.

Rapp

C. A.

Holmes

C. L.

(2010). Developing a framework to support shared decision making for youth mental health medication treatment. Community Mental Health Journal, 46, 474–481. https://doi.org/10.1007/s10597-010-9327-z

19.

Fedina

Williamson

Perdue

(2016). Risk factors for domestic child sex trafficking in the United States. Journal of Interpersonal Violence, 34(13), 2653–2673. https://doi.org/10.1177/0886260516662306

20.

Greenbaum

J. V.

Crawford-Jakubiak

J. E.

(2015). Child sex trafficking and commercial sexual exploitation: Health care needs of victims. American Academy of Pediatrics, 135(3), 566–574. https://doi.org/10.1542/peds.2014-4138

21.

Greenbaum

J. V.

Yun

Todres

(2018). Child trafficking: Issues for policy and practice. Journal of Law, Medicine & Ethics, 46, 159–163. https://doi.org/10.1177%2F1073110518766029

22.

Greenhalgh

Annandale

Ashcroft

Barlow

Black

Bleakley

. . .Ziebland

(2016). An open letter to the BMJ editors on qualitative research. British Medical Journal, 352, Article i563. https://doi.org/10.1136/bmj.i563

23.

Hooks

(1984). Feminist theory from margin to center. South End Press.

24.

Ijadi-Maghsoodi

Bath

Cook

Textor

Barnert

(2018). Commercially sexually exploited youths’ health care experiences, barriers, and recommendations: A qualitative analysis. Child Abuse & Neglect, 76(2018), 334–341. https://doi.org/10.1016/j.chiabu.2017.11.002

25.

Institute of Medicine, & National Resource Council. (2013). Confronting commercial sexual exploitation and sex trafficking of minors in the United States. The National Academies Press.

26.

Kattari

S. K.

Hasche

(2016). Differences across age groups in transgender and gender non-conforming people’s experiences of health care discrimination, harassment, and victimization. Journal of Aging and Health, 28(2), 285–306. https://doi.org/10.1177/0898264315590228

27.

Katz

A. L.

Webb

S. A.

(2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), Article e20161485. https://doi.org/10.1542/peds.2016-1485

28.

Kelly

M. A.

Barnert

Godoy

Thompson

Cook

Ports

. . .Bath

(2017). Understanding the mental health and substance use disorder treatment needs for commercially sexually exploited girls: A partnership with the STAR court. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 177. https://doi.org/10.1016/j.jaac.2017.09.083

29.

Knight

Kokanović

Ridge

Brophy

Hill

Johnston-Ataata

Herrman

(2018). Supported decision-making: The expectations held by people with experience of mental illness. Qualitative Health Research, 28(6), 1002–1015. https://doi.org/10.1177/1049732318762371

30.

Lalor

McElvaney

(2010). Child Sexual Abuse, Links to Later Sexual Exploitation/High-Risk Sexual Behavior, and Prevention/Treatment Programs. Trauma, Violence, & Abuse, 11(4), 159–177. https://doi.org/10.1177/1524838010378299

31.

Lederer

L. J.

Wetzel

C. A.

(2014). The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law, 23(1), 61–91.

32.

Lincoln

Y. S.

Guba

E. G.

(1985). Naturalistic inquiry. Sage.

33.

MacDonald

J. M.

Gagnon

A. J.

Mitchell

Di Meglio

Rennick

J. E.

Cox

(2011). Include them and they will tell you: Learnings from a participatory process with youth. Qualitative Health Research, 21(8), 1127–1135. https://doi.org/10.1177/1049732311405799

34.

Meyer

H. M.

Mocarski

Holt

N. R.

Hope

D. A.

King

R. E.

Woodruff

(2020). Unmet expectations in health care settings: Experiences of transgender and gender diverse adults in the Central Great Plains. Qualitative Health Research, 30(3), 409–422. https://doi.org/10.1177/1049732319860265

35.

Morse

(1995). The significance of saturation [Editorial]. Qualitative Health Research, 5, 147–149. https://doi.org/10.1177/104973239500500201

36.

Morse

J. M.

(2016). Qualitative health research: Creating a new discipline. Routledge. https://doi.org/10.4324/9781315421650

37.

Muftic

L. R.

Finn

M. A.

(2013). Health outcomes among women trafficked for sex in the United States: A closer look. Journal of Interpersonal Violence, 28(9), 1859–1885. https://doi.org/10.1177/0886260512469102

38.

National Institute on Drug Abuse. (2012). Comorbidity. https://www.drugabuse.gov/related-topics/comorbidity

39.

Nicholas

D. B.

Newton

A. S.

Calhoun

Dong

deJong-Berg

M. A.

Hamilton

Shankar

(2016). The experiences and perceptions of street-involved youth regarding emergency department services. Qualitative Health Research, 26(6), 851–862. https://doi.org/10.1177/1049732315577605

40.

Powell

Asbill

Loius

Stoklosa

(2018). Identifying gaps in human trafficking mental health service provision. Journal of Human Trafficking, 4(3), 256–269.

41.

Rafferty

(2008). The impact of trafficking on children: Psychological and social policy perspectives. Child Development Perspectives, 2(1), 13–18. https://doi.org/10.1111/j.1750-8606.2008.00035

42.

Ravi

Pfeiffer

M. R.

Rosner

Shea

J. A.

(2017a). Identifying health experiences of domestically sex-trafficked women in the USA: A Qualitative Study in Rikers Island Jail. Journal of Urban Health-bulletin of the New York Academy of Medicine, 94(3), 408–416. https://doi.org/10.1007/s11524-016-0128-8

43.

Ravi

Pfeiffer

M. R.

Rosner

Shea

J. A.

(2017b). Trafficking and trauma insight and advice for the healthcare system from sex-trafficked women incarcerated on Rikers Island. Medical Care, 55(12). https://doi.org/10.1097/MLR.0000000000000820

44.

Sahl

Knoepke

(2018). Using shared decision making to empower sexually exploited youth. Journal of the American Academy of Child & Adolescent Psychiatry, 57(11), 809–812. https://doi.org/10.1016/j.jaac.2018.07.873

45.

Sapiro

Johnson

Postmus

J. L.

Simmel

(2016). Supporting youth involved in domestic minor sex trafficking: Divergent perspectives on youth agency. Child Abuse & Neglect, 58(2016), 99–110. https://doi.org/https://doi.org/10.1016/j.chiabu.2016.06.019

46.

Stoklosa

MacGibbon

Stoklosa

(2017). Human trafficking, mental illness, and addiction: Avoiding diagnostic overshadowing. AMA Journal of Ethics, 19(1), 23–34. https://doi.org/10.1001/journalofethics.2017.19.1.ecas3-1701

47.

Trafficking Victims Protection Act of 2000, H.R. 3224, United States Congress, P-L 106-386 Division A 103(8)2000. https://www.state.gov/j/tip/laws/61124.htm

48.

Varma

Gillespie

McCracken

Greenbaum

(2015). Characteristics of child CSE and sex trafficking victims presenting for medical care in the United States. Child Abuse & Neglect, 44, 98–105. https://doi.org/10.1016/j.chiabu.2015.04.004

49.

WestCoast Children’s Clinic. (2012). Research to action: Sexually exploited minors (SEM) needs and strengths. http://www.westcoastcc.org/WCC_SEM_Needs-and-Sts_FINAL.pdf

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

0.10 MB

0.05 MB