Health Care for Women International

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Prevalence of violence against indigenous women

victims of human trafficking and its implications
on physical injuries and disabilities in Monterrey
city, Mexico

Arun Kumar Acharya

To cite this article: Arun Kumar Acharya (2019): Prevalence of violence against
indigenous women victims of human trafficking and its implications on physical injuries
and disabilities in Monterrey city, Mexico, Health Care for Women International, DOI:
10.1080/07399332.2018.1564612

To link to this article: https://doi.org/10.1080/07399332.2018.1564612

Published online: 12 Mar 2019.

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HEALTH CARE FOR WOMEN INTERNATIONAL
https://doi.org/10.1080/07399332.2018.1564612

Prevalence of violence against indigenous women

victims of human trafficking and its implications on
physical injuries and disabilities in Monterrey
city, Mexico
Arun Kumar Acharya
a
Department of Anthropology, Sambalpur University, Sambalpur, India

ABSTRACT
Human trafficking victims suffer different kinds of physical
abuse and torture that cause severe physical injuries. During
2016–17 a total of 68 indigenous labor and sex-trafficking
women victims were surveyed in Monterrey city, Mexico to
explore the prevalence of violence against them and its implica-
tions on physical injuries and disabilities. We found that women
reported different types of injuries and long term disabilities.
Considering the level of violence and occupational hazards
faced by victims, we suggest there is an urgent need to create
instruments in the Mexican national human trafficking program
to address the unmet health needs of the victims.

Trafficking of women and young girls is a public health concern (Bales,

2012; International Labour Organization (ILO), 2012; Pocock, Kiss, Oram,
& Zimmerman, 2016) and recently it has received global attention due to
its multi-faceted causes and consequences, where a large number of
women, children and men are trafficked into different forms of labor, and
sexual exploitation (World Health Organization (WHO), 2012). The United
Nations defines human trafficking as the recruitment, transportation, trans-
fer, harboring or receipt of people, by means of the threat or use of force
or other forms of coercion or abduction, fraud, deception, through the
abuse of power or of a position of vulnerability or by giving or receiving
payments or benefits to achieve the consent of a person having control
over another person for the purpose of exploitation. Exploitation shall
include at a minimum the exploitation of the prostitution of others or other
forms of exploitation, forced labor or services, slavery or practices similar to
slavery, servitude or the removal of organs (United Nations, 2000).
Current global estimates suggest that approximately 21 million (ILO,
2012) to 27 million (Bales, 2012) people are trafficked at any given time,

CONTACT Arun Kumar Acharya acharya_77@yahoo.com Department of Anthropology, Sambalpur

University, Jyoti Vihar, Burla, Sambalpur, 768019 Odisha, India.
ß 2019 Taylor & Francis Group, LLC
2 A. K. ACHARYA

and nearly 70 to 80 percent of trafficking victims are women and girls

and 97 percent of those are trafficked for sexual exploitation (United
Nations Office on Drugs and Crime (UNODC), 2014). Previously,
researchers have reported that victims of human trafficking experience
extreme levels of exploitation, violence, and suffer a wide range of phys-
ical health problems and injuries such as broken bones, musculoskeletal
injuries, gastrointestinal difficulties, dental and oral health issues, back
pain, pelvic pain, brain injury, weight loss, kidney infection, sexually
transmitted diseases, among others (Falb et al., 2011; IOM, 2008; Pocock
et al., 2016; Stoakes, Kelly, & Kelly, 2015; Zimmerman, Hossain, & Watts,
2011; Zimmerman et al., 2008). For people who are trafficked, violence
and risk of injuries are a continuous process throughout the period of
exploitation, and it persists even after the individual leaves the trafficking
situation. Thus, unlike most other victims of crime, girls and women vic-
tims of human trafficking have a prolonged and repeated trauma that may
result in short and long-term physical injuries and disabilities (UNODC,
2014; WHO, 2012).
In the case of Mexico, attention on the human trafficking problem has
increased in the last decade. For example, Lydia Cacho, a Mexican jour-
nalist and human rights activist is a pioneer in unveiling the human traf-
ficking network in Mexico. In her book Esclavas del poder: un viaje al
coraz
on de la trata sexual de mujeres y ni~ nas en el mundo [Slaves of
Power: A Journey to the Heart of the Sex Trafficking of Girls and Women
Around the World], she describes how young women and girls in Mexico
are lured through false promises of employment and forced into sexual
exploitation in different parts of the World (Cacho, 2010). In a recent
study on “Human Trafficking and Sex Industry: Does Ethnicity and Race
Matter?” Guti
errez Chong (2014), stated that indigenous women in
Mexico are highly exposed to trafficking due to structural poverty, mar-
ginalization, social exclusion and a traditional patriarchal culture.
Although, there is an increasing literature on human trafficking in the
Mexican context, no systematic study has been carried out in the country
to understand the dynamics of human trafficking, particularly among the
indigenous population and the violence they experience in their day-to-
day life and its implications on injuries and disabilities. Thus, presenting
an example from Monterrey city, Mexico, this article explores the preva-
lence of violence against indigenous women victims of human trafficking
and its implication on different types of physical injuries and disabilities.
Furthermore, this analysis will contribute to the design of effective inter-
vention programs at national and international levels to address the
unmet health needs, and especially the mental and physical care, required
for victims of trafficking.
 HEALTH CARE FOR WOMEN INTERNATIONAL 3

Background
The 2017 Trafficking in Persons Report provided by the U.S. Department
of State indicates that Mexico is a source, transit and destination country
for women, children and men subjected to sex trafficking and forced labor.
Mexican women, children as well as men are exploited in forced labor in
agriculture, domestic service, food processing factories, construction, the
informal economy, begging, and vending in both the United States and
Mexico. The groups most vulnerable to human trafficking in Mexico
include women, children, indigenous people, individuals with mental or
physical disabilities, migrants, and LGBTI Mexicans (United States
Department of State (USDOS), 2017).
Mexico ranked second in the world in terms of prostitution of under-age
persons (Monroy, 2010) and human trafficking for the purpose of sexual
exploitation, and Mexico has become a public concern, especially with
respect to child prostitution (Esteinou, 2011), as children from economic-
ally marginalized areas are lured through false promises and exploited sexu-
ally by American tourists (Council on Hemispheric Affairs (COHA), 2009;
Ru
ız Torres, 2003). This rapid increase in the number of children for com-
mercial sexual exploitation is due to factors such as deterioration of living
conditions of poor families, promotion of child prostitution by close family
members, use of sexual activities as a means of survival by street children
who have escaped from an abusive home, recruitment of children as sex
workers by organized crime networks and illegal transfer of children as sex
workers from developing countries to developed countries (Azaola &
Estes, 2003).
In the last few years, some significant effort has been made to under-
stand both the domestic and international trafficking in persons in Mexico
(Comisi
on Nacional de los Derechos Humanos (CNDH), 2012; Montalvo,
2014; USDOS, 2016), however, our previous research indicates that traffick-
ing of women and children has increased and every year approximately
10,000 people are trafficked within Mexico, particularly to the following six
cities: Cancun, Acapulco, Mexico City, Tijuana, Ciudad Juarez and
Monterrey, and approximately 5,000 are trafficked into the United States
(Acharya & Bryson, 2014). We also observed that there are four main fac-
tors that are responsible for trafficking of women in Mexico: (1) family fac-
tors (including domestic violence, physical abuse by step father, etc.), (2)
economic factors (including poverty, unemployment and household eco-
nomic problems), (3) social factors (including gender discrimination, sexual
abuse, etc.), and (4) personal factors (including marriage to boyfriend, to
earn more money, etc.).
In addition, along the U.S.-Mexico border the trafficking of women has
become a lucrative business (Ugarte, Zarate, & Farley, 2003). Young girls
4 A. K. ACHARYA

are lured through false promises of employment and a better life in the
United States, most of them are raped or violated sexually in transit and
they also suffer a higher grade of mental and physical health degradation
(Acharya & Sanchez-Martinez, 2018; Ugarte et al., 2003). Women and men
who are trafficked for the purpose of sexual and labor exploitation often
experience high rates of physical violence, sexual violence and have had
serious physical injuries at work, victims who experience extremely exces-
sive overtime at work, limited freedom, poor living conditions, threats, or
severe violence were more likely to report symptoms of depression, anxiety,
and post-traumatic stress disorder (Kiss et al., 2015; Krug, 2002; Pocock
et al., 2016; Shandro et al., 2016; Zimmerman et al., 2011; Zimmerman
et al., 2008; Zimmerman & Watts, 2003). With this background, it is
important to consider that violence and exploitation of human trafficking
victims by their perpetrator have long term physical health consequences
on the victims, which we have analyzed in this study taking the example of
Monterrey, Mexico.

Methods
Data collection
Women victims of human trafficking are treated as a hidden population,
and it is extremely difficult to establish a reliable sampling frame. This
tends to make randomized sampling strategies unsuitable. Therefore, a
snowball sampling technique was utilized during our fieldwork. Interviews
of trafficked women were carried out in two steps: the first step involved
establishing contact with key informants to identify sex and labor traffick-
ing victims, and the second step was to interview women victims of human
trafficking.

Step 1: Identification of key informant

To identify sex trafficking victims in Monterrey, Mexico, we first reached
out to an undergraduate student named “Jennifer” whose sister (Cindy)
works at a table dance bar as a waitress. We approached Cindy seeking her
collaboration with this project, because she had good knowledge of the area
and businesses in downtown Monterrey. Once we discussed the project
with Cindy, she said she would try to help, but because it is difficult for
her to move from one place to another, she was unsure about whether she
would be able to locate many indigenous women victims of trafficking.
After few days, Cindy contacted us over telephone and shared information
of one woman and the name of the brothel where she was working.
 HEALTH CARE FOR WOMEN INTERNATIONAL 5

On the other hand, for labor trafficking victims, we contacted a woman

named “Veronica” who is currently working as a housemaid and living in
the municipality of Juarez.1 Veronica also works as a leader in her indigen-
ous community, and therefore has good knowledge of women and girls
who might be victims of labor trafficking.

Step 2: Interview with girls and women victims of trafficking

After receiving the information on victims of sex trafficking, Francisco
Ontiveros, a postgraduate student at the Instituto de Investigaciones
Sociales [Social Science Research Institute], Universidad Aut
onoma de
Nuevo Le
on [Autonomous University of Nuevo Leon] and myself, visited
the designated brothel and contacted the woman. We described the study
to her and mentioned that Cindy had given us her name and location.
After a short conversation, we paid the requested amount of $200 pesos for
30 min, and to keep our identity secret from the brothel owner and traf-
fickers, we went to a private room to talk more openly [this is a common
practice in researching a clandestine phenomenon such as human traffick-
ing (Kara, 2010; Silverman et al., 2011)].
To get information on victims of labor trafficking, Veronica was arrang-
ing interviews with young girls who are currently working as housemaids
and living in exploitative conditions in the municipality of San Pedro
Garza Garc
ıa and in Monterrey. After concluding the interview, we asked
Cindy and Veronica to help us find more indigenous women who are vic-
tims of sex and labor trafficking, we also offered to pay her $100 pesos per
woman in return. Using the snowball technique, we were able to interview
indigenous women victims of human trafficking in Monterrey city.
All interviews lasted for around 40–50 min, and using the snowball sampling
technique, we interviewed a total of 68 women (N ¼ 68) (22 victims of sex traf-
ficking and 46 victims of labor trafficking) during February 2016 to March
2017 with the help one research assistant. Interviews were conducted in Spanish
and audio taped and followed an open-ended guide that was pilot tested.

Interview with madams and traffickers

In this study we also conducted in-depth interviews with two madams and
two traffickers arranged through our key informants. The main objective of
these interviews was to learn about the life history of the madams and traf-
fickers, how they were trapping young girls, and their views on the women
victims of trafficking.
6 A. K. ACHARYA

Ethical consideration
In this study, before and during the interviews, we followed the WHO eth-
ical and safety recommendations for interviewing women victims of traf-
ficking written by Zimmerman and Watts (2003), including the relevant
ethical and methodology procedures such as safeguarding participants’ con-
fidentiality, anonymity, and safety. It is also necessary to mention here that,
although they agreed to the interview through their friend, we still obtained
their consent and always explained to them the sole purpose of our study,
the subject to be discussed, its risks as well as its benefits. Moreover, we
never asked any questions regarding their ethnic origin that could cause a
discriminatory reaction, nor did we question their sentiments or judge their
decision or character. There were women who became very emotional and
preferred not to continue the interview, so we respected their decision and
stopped at that point. However, in order to include them in the sample of
interviewed women, they were asked to respond whether they, or any of
their family members, speak any indigenous languages. In addition, we
have used pseudonyms in the article to protect the women’s identity.

Data analysis
In this study, we have analyzed the fieldwork information in two ways. The
first was by using SPSS version 17 software, which systemized the socio
demographic data of women victims of trafficking. In each interview, we
obtained information on their current age, marital status, educational level,
indigenous language, sector of exploitation, date since the trafficking took
place, violence, injuries and disabilities they suffered. Secondly, using
Critical Discourse Analysis (CDA), we analyzed the words (discourses) of
the victims of trafficking, which revealed how the traffickers or pimps used
their power to maintain an exploitive situation. From the discourses of the
women victims of human trafficking, we analyzed how traffickers or
madams treat or control victims, how they coerced women into trafficking
situations, what kind of violence persists against the victims and different
types of injuries and disabilities suffered by victims. This qualitative infor-
mation was analyzed together with the quantitative information to under-
stand the magnitude and seriousness of the trafficking problem in Mexico
and its future implications.

Results
Socio-demographic characteristics
The socio-demographic characteristics of indigenous women victims of
trafficking indicate important determining factors of human trafficking as
 HEALTH CARE FOR WOMEN INTERNATIONAL 7

Table 1. Characteristics of indigenous trafficked women in Mexico (N ¼ 68), 2016–17.

Variables Number Percent
Current age
Less than 15 years 11 16.2
16–20 years 19 27.9
21–25 years 7 10.3
More than 25 years 31 45.6
Marital status
Unmarried 34 50.0
Living relationship 11 16.2
Married 19 27.9
Separated/widow/single mother 4 5.9
Education level
Never attend school 10 14.7
Up to primary 35 51.5
Junior high school 18 26.5
More than junior high school 5 7.4
Indigenous language
N
ahuatl 27 39.7
Otom
ı 5 7.3
Mixteco 7 10.3
Others 3 4.4
Do not mention 26 38.2
Source: Based on fieldwork, 2016-17

well as the profile of this illegal market. Out of 68 interviewed indigenous

women victims of trafficking, 30 women (nearly 44%) are younger than
20 years old. However, our analysis indicates that 16% of the women and
girls are younger than 15 years old (see Table 1) and engage in sexual
exploitation, and older women (older than 25 years) mainly engage in the
labor exploitation sectors. According to a young girl Lupita, 23 years old:
Padrotes o Madrotes feel that teenage girls are very good for prostitution and
massage parlors, because clients prefer younger girls, as they are very easy to
control emotionally and physically, also they are highly preferred by clients,
however, older women are very good for domestic work and manual labor,
as they have experience, so they can work easily and adapt in a different
environment (Lupita, 23 years old, Oaxaca state).
On the marital status of victims of trafficking in Monterrey city, we
observed that 50% (34 women) are unmarried, 38% (19 women) are mar-
ried and 16% (11 women) are currently living with their partners. The
bivariate analysis on marital status and the sector of exploitation indicates
that 27 out of 34 unmarried women are currently exploited in the sex sec-
tor, which explains higher recruitment of young, unmarried girls, and
women in the sex market. A brothel owner noted:
Unmarried women are like new clothes; many of them are still virgins and clients
like this type of girls. Married women do not have the same physical glow as an
unmarried one. Many married girls and women have children, so their body does
not have the same economic weight in this place as compared to an unmarried
woman, also clients hate this type of sex worker (Madrote “7”, 47 years, 2016).

On the other hand, a factory owner indicated:

8 A. K. ACHARYA

Map 1. Place of origin of indigenous trafficked women in Mexico, 2016–17. Self-elaboration

from fieldwork.

I never employ unmarried girls, because they are very flirty and disrupt other
employees. Sometimes they develop emotional relationships and physical
relationships, which is not good for my business. Moreover, unmarried girls do not
want to stay for long periods of time on the job, they are very fickle-minded, and
they do not obey my orders, because many of them do not have the pressure of a
family. On the contrary, married women are easy prey because of their family
pressure (Don Pablo, 60 years old, 2016).

In Table 1, we present the educational status of indigenous women vic-

tims of trafficking, which indicates that nearly 15% of them never attended
school, 52% of victims received an elementary education, and 27% studied
until junior high school. In this study we did not ask victims about their
ethnic group, however, we did ask which indigenous language they and
their relatives speak. Analysis indicates that nearly 40% of victims speak
N
ahuatl, 7.3% speak Otom
ı, 10.3% speak Mixteco, 4.4% other indigenous
languages (Mazahua, Huasteco, and Huichol) and 38% of women and girls
did not want to mention their language.
Regarding the place of origin of indigenous women victims of human
trafficking, it can be concluded that most girls and women come from the
central part of Mexico. Over one fourth (25%) of indigenous victims are
from the state of Veracruz, followed by Oaxaca (18%), San Luis Potos
ı
(15%) and Puebla (9%) (see Map 1) and rest are from other states such as
Guerrero, State of Mexico, Mexico City, Hidalgo, and Nayarit.

Factors behind trafficking

Upon analyzing the causes for trafficking among indigenous women and
girls Monterrey city, Mexico, our results indicate that there is a
 HEALTH CARE FOR WOMEN INTERNATIONAL 9

Table 2. Principal causes to enter into trafficking network of indigenous trafficked women in
Mexico (N ¼ 68), 2016–17.
Variables Factors Number Percent
Economic factors Poverty, unemployment, household economic problem 55 81.0
Family factors Domestic violence, dysfunction of families, single mother 46 67.6
Personal factors Marriage to boyfriend, in search of earn more money and migration USA 31 45.6
Source: Based on fieldwork, 2016–17.

combination of factors subsequently related to trafficking in the country.

To understand the causes of human trafficking among indigenous women,
we asked victims during the interviews: What are the main reasons that
resulted in falling into a trafficking network? Most women and girls
responded with more than two causes, which can emphasize that trafficking
is a multi-causal phenomenon. We have classified the responses of victims
into three categories: Economic factors, Family factors and Personal factors,
the results show that 81% of indigenous women victims of trafficking cited
poverty, unemployment and household economic problems as their main
reason for entering into trafficking. Furthermore, nearly 67% of victims of
trafficking said family problems such as domestic violence, dysfunctional
families,2 and being a single mother are the main contributing factors
behind their trafficking situation (see Table 2).
In this regard, Rosita a 16-year-old girl victim of trafficking from the
State of Veracruz said:
Two years back I left my parents and went to Mexico City to live a peaceful life. My
family environment was totally unhealthy, there was always a fight between my
mother and father because of money. Though my mother was working as a
housemaid in the City of Xalapa, it was not sufficient. Even my father asked my
mother to work as a “prostitute” in Xalapa to support the family and when she
didn’t accept he beat her, and thereafter my mother left home and we still have not
heard from her. After my mother, my father put his eyes on me and asked me the
same, to work as a prostitute, when he started forcing me, I left the house with my
boyfriend … however, my boyfriend did the same thing as my father wanted to do
with me … … (Rosita, 16 years old, Veracruz).

However, 46% of victims of trafficking have identified personal factors

such as: marrying their boyfriend, searching to earn more money and
migrating to the U.S. as their principal causes to enter into the trafficking
network in Mexico (see Table 2).

Sectors of exploitation
We have identified different sectors where indigenous women are pri-
marily trafficked and later exploited in the city. The majority of indigen-
ous women victims of trafficking are exploited as sex workers (34%;
n ¼ 23), street vendors (29%, n ¼ 20) and housemaids (24%; n ¼ 16),
10 A. K. ACHARYA

Street vendor,
29% Sex worker, 33.8%

Factory/supermar
ket workers, 2.9%
Construcon
, 1.5% Housemaid,
24% Forced begging,
8.8%

Source: Based on fieldwork, 2016-17

Figure 1. Sectors of exploitation of indigenous trafficked women in Mexico (N ¼ 68), 2016–17.
Source: Based on fieldwork, 2016–17.

Table 3. Time in trafficking of indigenous women in Mexico (N ¼ 68), 2016–17.

Variables Number Percent
Time in trafficking
Less than one year 33 48.52
1–3 years 11 16.2
3–5 years 7 10.3
5–7 years 17 25.0
Source: Based on fieldwork, 2016–17.

some women are also forced into begging and exploited in the construction
industry, maquiladora factories and supermarkets (see Figure 1).
When it comes to the analysis of their time spent in a trafficking situ-
ation, we found that nearly fifty percent (48.52%) of indigenous women
and girls have spent less than one year, whereas one fourth of victims have
spent more than 5 years in trafficking, and some victims who have spent
1–5 years in trafficking (see Table 3). The bivariate analysis on their time
spent in trafficking and their age indicates that women who responded hav-
ing spent more than 5 years, were trafficked at a very early age (younger
than 15 years old), as Rosita said (age 16): la madrina dice que las jovenci-
tas de 12-15 a~ nos valen mucho, somos muy cotizadas por clientes y somos
dinero y oro para este negocio … . Dice que tenemos que trabajar por muchos
nos … [Madrina says that girls between 12 and 15 years old are worth a
a~
lot, we are highly priced by customers … and we are money and gold in
this business … she says we have to work for many years].

Exploitation and violence

Once women and girls are trapped into the sex trafficking industry, it is
quite difficult for them to escape; victims are subject to exploitation and
 HEALTH CARE FOR WOMEN INTERNATIONAL 11

Table 4. Exploitation and violence against indigenous trafficked women in Mexico

(N ¼ 68), 2016–17.
Variables Number Percent
Days worked/week
Everyday 31 45.6
5–6 days 20 29.5
2–4 days 15 22.0
No fixed days 2 2.9
Hours worked per day
Less than 8 hrs 29 42.6
8–10 hrs 9 13.2
More than 10 hrs 30 44.2
Violence type
Physical violence 31 45.6
Sexual violence 29 42.6
Verbal violence and threatening of violence 38 55.9
Not paying and fine 10 14.7
Violence perpetrator
Traffickers/padrote/madrote 43 63.2
Owners 17 25.0
Boyfriend 7 10.3
Clients 1 1.5
Source: Based on fieldwork, 2016–17.

violence in different forms including physical, sexual, as well as verbal

abuse. The findings of our analysis show that the majority of victims
(45.6%) worked seven days a week with no breaks, while nearly 30% of vic-
tims said they worked 5–6 days a week (see Table 4). Similarly, on our
question on how many hours worked per day, the findings indicate that
nearly half of the victims (44.2%) said they worked more than 10 hrs per
day and the majority of these are sexual victims or working as housemaids.
However, some women and girls responded that they work fewer than
8 hrs, most of them work as street vendors or beggars. Maria a 17-year-old
girl who is working as a housemaid said:
I do not have the liberty to decide how many hours I work … because I stay at the
house of my “patron” (employer), oftentimes at midnight, when they need something
from the kitchen they wake me up and ask me to prepare food, coffee, etc. … I
cannot say “no” … if I do, they will fire me. They also do not give me a day off …
sometimes, once a month they will allow me to visit my friends at the “Alameda”3
and also only for few hours …

Victims of trafficking, especially women and girls, experience high levels

of psychological, physical, economic, sexual, verbal and symbolic violence,
for example, in our analysis of violence faced by indigenous women and
girls, it is assumed that the majority of victims (55.9%) face verbal violence
and threatening violence. Moreover, nearly half of the victims (46%) are
subject to physical violence and 42.6% reported sexual violence, including
14.7% of victims have experienced economic violence such as not getting
paid by their employer or being fined at the job (see Table 4). In the
bivariate analysis on the sector of exploitation and violence we observed
12 A. K. ACHARYA

that women and girls who are exploited in the sex industry have reported
higher levels of sexual and physical violence, while victims who work as
housemaids and street vendors report a higher percentage of verbal vio-
lence and threatening violence. In addition, our analysis shows that perpe-
trators are mainly traffickers, padrote and madrote [pimps] or their
employers. For example, 63% of victims reported that their trafficker,
padrote or madrote controls and executes violence over them, and one
fourth of victims of trafficking said their employer violates them, some of
them said their boyfriend is violent with them (see Table 4).

Injuries and disabilities

Victims of trafficking often experience injuries and disabilities due to the
violence and exploitation and thus, we asked victims: “Have you experi-
enced any kind of injuries or disabilities after entering into the trafficking
network?” and in Table 5, we have discussed the descriptive analysis of this
question. In the first instance, we analyzed the injuries suffered by victims
of trafficking and later described the disabilities suffered by indigenous
women and girls. Our findings indicate that victims reported numerous
types of injuries and most of them lead to severe physical damage to the
victims. The most commonly reported injuries are skin damage (67.4%),
followed by eye injuries (53%), mouth and teeth injuries (45.6%).
Nevertheless, there are some victims who reported head injuries (nearly
40%), broken bones (10.3%), and finger injuries (16.2%). Therefore, from
this study we are able to summarize that those participants who are sexu-
ally exploited reported a higher percentage of head injuries, broken bones,
skin damage and eye injuries, and victims of labor exploitation reported a
higher percentage of finger injuries, eye injuries, mouth and teeth injuries,
back pain and ear damage.
About the disabilities suffered by the victims, we have classified these
into three categories: (1) physical disabilities, (2) mental disabilities, and (3)
social disabilities. In physical disabilities, victims of trafficking suffered
multiple physical disabilities, for example 60.3% reported a hearing impair-
ment, followed by mobility impairment (nearly 34%). Some victims
reported suffering from visual impairment (16.2%), speech impairment
(13.2%) and 7.3% of women reported brain injuries. In the bivariate ana-
lysis we found that women who are in an environment of sexual exploit-
ation, housemaids and beggars, reported more physical disabilities.
On mental disabilities, victims of trafficking face moderate to severe psy-
chological trauma, ranging from daily violence to exploitation. From our
current study, we found that 90% of indigenous women victims of traffick-
ing currently suffer from depression and 72% reported they have poor
 HEALTH CARE FOR WOMEN INTERNATIONAL 13

Table 5. Injuries and disabilities among indigenous trafficked women in Mexico

(N ¼ 68), 2016–17.
Variables Number Percent
Injuries among victims
Head injuries 27 39.7
Broken bone 7 10.3
Skin damage 46 67.4
Mouth and teeth injuries 31 45.6
Eye injury 36 53.0
Finger injuries 11 16.2
Others 9 13.2
Disabilities
Physical disabilities
Mobility impairment 23 33.8
Hearing impairment 41 60.3
Visual impairment 11 16.2
Speaking impairment 9 13.2
Brain injury 5 7.3
Mental disabilities
Depression 61 90.0
Poor emotional condition 49 72.0
Social disabilities
Discrimination 68 100.0
Stigma 68 100.0
Source: Based on fieldwork, 2016–17.

mental health conditions (see Table 5). Many victims of trafficking indicate
that due to feelings of helplessness, shame, humiliation, phobias and vio-
lence they develop acute anxiety, which leads to severe depression and
poor mental health conditions. Furthermore, these circumstances lead vic-
tims to develop substance abuse and addictions. In addition to physical and
mental disabilities, victims of trafficking also suffer from social disabilities,
for example, 100% of victims confront two types of social disabilities in
their daily life: discrimination and stigma (see Table 5). From the bivariate
analysis on social disabilities and sectors of exploitation, we suggest that
there is a greater prevalence of discrimination and stigma among the vic-
tims of sexual exploitation and beggars.

Discussion and conclusions

In this study we can highlight that human trafficking profoundly harms
our society and moreover, it has numerous physical and psychological con-
sequences for the victims. Victims of human trafficking live in catastrophic
situations in their daily life. This complex phenomenon involves social, cul-
tural, political and economic factors that create vulnerable situations for
many young women and girls worldwide. As we discussed in this article,
trafficking of indigenous women and girls is not a local problem; it
involves all classes, cultures and geographic regions. The 2017 Human
Trafficking Report of the U.S. Department of State indicates that the indi-
genous population in Mexico is one of the most vulnerable groups victims
14 A. K. ACHARYA

of trafficking for different purposes of exploitation, in the sectors such as

agriculture, domestic service, manufacturing, food processing, construction,
forced begging, the informal economy, and street vending in different cities
throughout the country. The findings of our research indicate that women
victims of trafficking are very young, unmarried and have very little educa-
tion, and the majority of them are from the States of Veracruz, followed by
Oaxaca, San Luis Potos
ı and Puebla (9%). There are numerous studies, for
example Granados Alcantar (2005), Ju
arez-S
anchez (2015) on the indigen-
ous migration that indicates these States are known as “expulsion zones” of
indigenous men and women to different parts of Mexico and the
United States.
This phenomenon is a complex issue in Mexico, which includes push
factors, such as poverty, lack of employment opportunities in the commu-
nity, dysfunctional family and domestic violence, as some of the main rea-
sons why young indigenous girls and women become victims of human
trafficking. Previous studies have addressed the particularities that changes
in the economic, social and family spheres such as domestic violence, phys-
ical and sexual abuse in the family, alcoholism and disintegration of fami-
lies, either through death (leaving orphans and widows) or separation, are
viewed to increase the risk of trafficking, while women leave their houses
in search of a better livelihood in urban areas or other countries (Adepoju,
2005; Huda, 2006; ILO, 2006; IOM, 2008; Pouki, 2012; Russell, 2014).
Moreover, as pull factors for women victims of trafficking in Mexico we
observed reasons such as a better quality of life in Monterrey city, higher
salary and its proximity to the United States which may provide an oppor-
tunity to migrate in the long term. Nevertheless, once they reached the city
they were exploited in different sectors and forced to live in hazardous
environments without proper payment and sufficient days to rest. The sub-
jected exploitation is mainly because of low educational level, scarce eco-
nomic opportunities and social mobility, as compared to non-indigenous
populations. Many of them are employed in informal sectors, where they
work for long hours without a contract, fair payment or social security,
many women are also forced to work in the sex industry.
The findings of our study report that indigenous women and girls vic-
tims of human trafficking suffered a wide range of violence in the hands of
their trafficker, employer and clients, which has severe long-lasting health
consequences. Employers use the vulnerability condition of women and
girls who work as sex workers or in the maquiladora industry and exe-
cute different types of harassment and violence, such as sexual, physical
and psychological (Montiel-Torres, 2009; Scarone Adarga, 2014) and it
continues until the wishes of the perpetrators are met, and as a result
victims are particularly susceptible to various kinds of injuries and
 HEALTH CARE FOR WOMEN INTERNATIONAL 15

disabilities due to this violence (Acharya & Bryson, 2014; Oram et al.,
2016; Zimmerman & Schenker, 2014). Our information gathered about
the injuries and disabilities shows the pattern of abuse and occupational
hazards faced by these victims, which lead to multiple injuries including
skin damage, head injuries, mouth and teeth injuries, and broken bones.
Regarding disabilities, the majority of victims have lower to higher grade
of disabilities, for example many of them have hearing, visual, and
speech impairments. However, it is very striking to observe that 23 vic-
tims out of 68 have mobility impairment, which evidences the prevalence
of violence against victims, it also concludes how victims’ bodies are
treated as “objects” and they are used and reused for economic benefits
by traffickers.
Finally, despite the limitations in this study such as a sample representa-
tion, our research provides urgently needed information of a sub-popula-
tion that is completely invisible in Mexican society. As previously
documented, victims of human trafficking face many injuries which reduce
their chances to live a good post-trafficking life. Similarly, many of them
become permanently disabled, which pushes victims into precarious situa-
tions. It is important that policymakers as well as practitioners become
aware of these issues and include them in anti-trafficking programs. In
2014, the Mexican Government implemented the National program to pre-
vent, punish and eradicate crimes in matters of trafficking in persons and
for the protection and assistance of those victims 2014–2018. Objective 2 of
the program specifies that the States must provide comprehensive care, pro-
tection and assistance to victims of trafficking in persons. The model of care,
protection and assistance composed with an institutional framework that
includes health, education and employment sectors. Although the national
program specifies the comprehensive care for victims of human trafficking,
it does not mention the mental and physical care for these categories of
people. It is therefore necessary for government to create instruments in
the national program to address the unmet health needs of victims of
human trafficking.

Notes
1. The Monterrey city comprises 12 municipalities; Apodaca, Cadereyta Jim
enez,
Escobedo, Garc
ıa, Guadalupe, Ju
arez, Monterrey, Salinas Victoria, San Nicol
as de los
Garza, San Pedro Garza Garc
ıa, Santa Catarina and Santiago.
2. A dysfunctional family is a family in which conflict, misbehavior, and often child
neglect or abuses on the part of individual parents occur continuously and regularly,
leading other members to accommodate such actions (Senthil, 2016).
3. Alameda is a central park, located in the downtown area of Monterrey.
16 A. K. ACHARYA

ORCID
Arun Kumar Acharya http://orcid.org/0000-0002-2696-3038

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