Experiences of pregnancy and maternity care for women exposed to human trafficking and sexual exploitation: a systematic review and qualitative evidence synthesis

Background: Human trafficking is a form of modern-day slavery which health care providers may encounter at different stages of the trafficking process and recovery. Contact with someone in health care may be the victim’s only opportunity to explain their situation. However, the evidence to inform identification, referral and care of trafficked people is extremely limited. Aims: To identify and synthesise peer-reviewed qualitative evidence of pregnancy journeys in the context of trafficking and exploitation. Methods: A systematic review was undertaken to critically evaluate studies that had examined women’s experiences of pregnancy and maternity services. One thousand six hundred and twenty-two studies were identified across eight databases and 13 studies included (n=883 women). The Critical Appraisal Skills Programme (CASP 2018) assessment tool was used to evaluate quality, and thematic synthesis applied (Thomas & Harden 2008). Findings: Eight descriptive themes emerged: barriers to health care, late access to maternity care, continuity of care, communication, stigma, physical, sexual and mental health problems, physical, sexual and emotional abuse, and care of baby. These themes were developed into three analytical themes: Access, Person-centred, Poor health, with an underpinning theme of Safeguarding. Conclusions: This literature review identified trafficked women’s experiences in pregnancy which included many barriers to accessing appropriate health care in a timely manner, and physical, sexual and mental health needs which were a result of illness or abuse. Trafficked women face numerous health issues which undermine their capacity to contribute to work, family and community life. The underpinning theme of Safeguarding relates to protecting and responding to the needs of both a woman and her children together. ‘POPPY’ represents the three analytical themes - POor health; Person-centred; People who need us to say Yes to access; with the underpinning theme of Safeguarding the mother and baby together. Thus, it captures the essential elements of recognising signs and providing an informed, compassionate response to victims of trafficking and sexual exploitation.