Barriers to the access and utilization of healthcare for trafficked youth: A systematic review

Background: Healthcare has been identified as an important target for training on identification of trafficked youth. Survivors of human trafficking experience challenges in accessing healthcare, both during enslavement and in survivorship. Objective: To examine the current evidence in the literature regarding barriers to healthcare faced by trafficked youth. Methods: A systematic review of the literature was conducted using the PRISMA guidelines. Through an electronic database search, articles were screened and included if they primarily addressed victims or survivors of child trafficking and focused on barriers to healthcare or problems accessing healthcare. Articles were assessed for overall quality. Data from the articles selected for review were organized into major themes using a framework analysis. Results: Of 3,274 articles resulting from the search, 8 were included in the review. Three subthemes were coded and classified as extrinsic, intrinsic, and systemic barriers. Extrinsic barriers included trafficker control, physical confinement, and influence of peers. Intrinsic barriers included discrimination, confidentiality, trust in healthcare providers, knowledge of the healthcare system, and emotional reluctance. Systemic issues inherent to the healthcare system included healthcare provider knowledge, complex registration process, language barriers, appointment times, and service coordination. Conclusion: The combination of extrinsic, intrinsic, and systemic barriers leads to reduced utilization and access to medical services for trafficked youth. While extrinsic and intrinsic factors are difficult to eliminate given the clandestine nature of human trafficking, systemic barriers can be eliminated through improving effective training for healthcare providers on identification of victims and implementing trauma sensitive care.