Human trafficking is an international problem that involves involuntary or forced labor. This can occur in a range of settings including sex work, agriculture, manufacturing, and hospitality. Patients may present in the gynecology office with sexually transmitted infections, pregnancy, mental health conditions, poor health or neglect, substance use disorders, and injuries. Providers should be familiar with red flags for trafficking and screen patients appropriately. With a positive screen, the patient’s safety needs to be immediately assessed. Trafficking can be reported to the National Human Trafficking Hotline. Providers should be aware of and follow local laws for reporting. Appropriate care should be provided to the patient based on presenting symptoms, including a history and physical exam, sexually transmitted infection testing, imaging, and mental health screenings as indicated. There are limited data regarding outcome of pregnancies in people who are trafficked. Care should be provided using trauma-informed principles.

In 1999, a Bangladeshi woman claimed she had been enslaved by the Second Secretary of the Bahrain Mission to the United Nations in New York City and his wife.1 After signing a contract, in which she agreed to work for their household as a domestic servant, she stated her passport was confiscated by the couple, and she was left to care for their children and perform household duties that held her in near involuntary servitude2 – akin to trafficking in persons. In response, the defendants claimed to be protected by diplomatic immunity that makes serving diplomats exempt from the jurisdiction of foreign courts. Although the case was eventually settled for an undisclosed amount of damages that the Bahrani couple paid to the domestic worker,3 in its statement of interest, the US Department of State categorically emphasized that serving diplomats and their family members hold immunity from suit in the United States for both official and private acts.

Human trafficking is a global public health problem that affects people of all races, nationalities, socioeconomic classes, and genders. Human traffickers prey on the vulnerable, strip them of their basic human rights and inflict physical and psychological damage to their victims and their communities. The true scope of the problem is unknown because of the hidden nature of the crime. Over 40 million people are estimated to be victims of human trafficking worldwide – 25% of whom are children. Over 24 million people are thought to be trapped in forced labor and 4.8 million in sex trafficking. Women and girls are estimated to be the majority of victims and account for 71% of victims of human trafficking and 99% of sexual exploitation. However, trafficking of men, boys and other genders is highly underrecognized. Additionally, urban areas may have a high density of diverse under regulated or under paid employment that could be particularly difficult for clinicians to identify human trafficking. Clinicians, particularly in the emergency department, have the responsibility to identify, protect, and provide resources to people experiencing human trafficking.

In the concluding chapter, the author reiterates how the hyper-exploitation of filhas de criação is sustained by an affective architecture of domination that interlocks morality and family to produce affective captivity. Zooming out from informal adoption, she highlights the role of consciousness-raising and leveraging transnational connections in order to eradicate labor exploitation. She also explores the relevance of this work for a more robust racial and gender analysis of human trafficking and labor exploitation around the world. In doing so, the author critiques the tendency to criminalize all informal family arrangements and, instead, promotes alternative approaches that are culturally relevant and realistic for Brazil’s uncertain future. There are glimmers of hope that emerge from the individual journeys of the women in this study. However, the more significant finding is that the level of structural violence that they experience, paired with their affective captivity in their oppressors’ lives, offers a chilling commentary that the most powerful weapon used in the service of domination can be love.