Objectives: The commercial sexual exploitation of children (CSEC), including sex trafficking of minors, is considered a severe form of abuse and violence against minors. We use a public health lens to examine perceptions regarding the context and process of CSEC and sex trafficking of minors in the Boston area, the response of the health care sector, and opportunities to improve the health and well-being of exploited/trafficked minors.

Methods: Using case study methodology, we conducted 22 semi-structured qualitative interviews of 25 key anti-trafficking stakeholders active in the Boston area.

Results: Key informants identified CSEC involving boys, girls, and transgender youth as a local problem. Many social and economic factors facilitate sex trafficking, including child sexual abuse, domicile instability, and financial insecurity. The health needs of commercially sexually exploited minors are numerous, and local health care services are variable, particularly in the realm of mental health. Various factors function as barriers to a greater health care sector response, including low awareness of CSEC and sex trafficking of minors among health care providers. Gaps in CSEC prevention and response include early recognition of signs and symptoms, CSEC-knowledgeable trauma-sensitive health care services, and emergency shelter.

Conclusions: CSEC, including sex trafficking of minors, is a recognized occurrence in the Boston area that requires a multidisciplinary response across multiple sectors. A more robust health care system response in coordination with other active stakeholders could help enhance the overall impact of local anti-CSEC/trafficking efforts. Increased health trainings, policy advocacy, and the use of multidisciplinary teams may be an effective way to partner across sectors and ensure wraparound services for exploited youth.

Key Take Away Points

  • CSEC/sex trafficking of minors is another form of child maltreatment
  • CSEC/sex trafficking of minors is occuring in the Boston metropolitan area
  • Boy, girls, and transgendered youth are affected
  • The social determinants of CSEC/sex trafficking are numerous
  • Health services for this vulnerable population are lacking and various barriers exist, including low awareness among health care providers
  • Closing the gaps in the health care system response may enhance the overall impact of anti-CSEC/trafficking efforts in the area

Author Biography

Dr. Wendy Macías-Konstantopoulos, MD, MPH is a board-certified practicing emergency physician at Massachusetts General Hospital (MGH), assistant professor in the Department of Emergency Medicine at Harvard Medical School, Director of the Violence Intervention and Advocacy Program in the MGH Department of Emergency Medicine, Medical Director of the Human Trafficking Initiative in the MGH Department of Emergency Medicine’s Division of Global Health & Human Rights, and Medical Director of the MGH Freedom Clinic for trafficking survivors. A graduate from the Harvard School of Public Health, Dr. Macías-Konstantopoulos has lectured nationally and internationally on health and human trafficking, represented MGH at the 2008 United Nations Global Forum to Fight Human Trafficking in Vienna, and worked with the International Organization for Migration’s Counter-Trafficking Unit in Indonesia. She is a member of the New Hampshire Commission to Combat Human Trafficking, the Training and Education Implementation Committee of the Massachusetts Interagency Human Trafficking Policy Task Force, and the SOAR to Health & Wellness Technical Working Group for the U.S. Department of Health and Human Services. She recently assisted the Administration of Children and Families at the U.S. Department of Health and Human Services develop and pilot an educational training for health care providers in the Boston area on the clinical assessment and response to human trafficking survivors in the health care setting. She is also the current Chair of the Massachusetts Medical Society Committee (MMS) on Violence Intervention and Prevention, and senior co-author of the MMS-MGH Human Trafficking Guidebook on Identification, Assessment, and Response in the Health Care Setting.


The present research was made possible through a generous faculty development award (WMK) funded by the Massachusetts General Hospital Office of the President and the Massachusetts General Physicians Organization.