1

Health Impact Framework/Research Paper

Sex Trafficking in Nigeria

Anne Peternel

Delaware Technical Community College

NUR 310 Global Health

Dr Dora Eyong

11/03/2022
 2

Introduction

Sex trafficking is a hot topic in the modern world. The US Department of Justice defines

human trafficking as “a crime involving the exploitation of a person for labor and services of

commerciall sex”. The identification of persons who are being trafficked is high on the list of

concerns in today’s world. Walk Free reports that 1.4 million people are in slavery as of 2018,

and that’s only what can be tracked. In fact, it is a part of triage protocol in acute care settings to

assess the risk or likelihood of the patient being trafficked based on their injuries and behaviors.

Flyers are posted up in hospitals with phone numbers to call and identification of victimes is part

of hospital training. Still, it is hard to imagine being raised in a culture where modern slavery is

accepted, expected and encouraged. Nigeria is just that. . Nigeria is described as “a country of

origin, transit and destination” by the US department of state and the Euopean Union Agency for

Asylum in 2021. Nigeria experiences great financial revenue from the business of trading

humans without consequences as their cultural beliefs surrounding the worth of vulnerable

populations justify using them for profit, regardless of the effect it has on their health, both

mentally and physically. It is critical for those who have taken an oath to protect and provide

forthe health of others to bring to light and spark a change to abolish these practices in every

corner of the world.

Application of sex trafficking to the Health Impact Pyramid

Health Impact pyramid

The Health Impact Pyramid from Thomas Friedan will be utilized to explore how to improve

conditions in Nigeria and protect from sex trafficking and in doing so improve the health of their
 3

country as a whole. The pyramid has five tiers, each level for a different area of health

intervention (Friedan, 2010). Interventions includ, in ascending order; socioeconomic factors,

context adjustment so that the healthy choice is the natural first choice, long lasting protective

interventions, clinical interventions, counseling and education. By initiating interventions on

each level the theory states that lasting effective change will occur in whatever they’ve been

applied to.

Socioeconomic factors

Being female, poor, living in a rural area, age (children and young adults), uneducated or low

education levels, and general geography (living in or near Nigeria) are socioeconomic factors

that affect the likelihood of being trafficked. The culture and religion, predominately muslim and

christian with influence from old tribal beliefs, also have an impact on the acceptance of sex

trafficking in the country. Traffickers take advantage of those who are vulnerable because of the

above factors and utilize them to control and manipulate those they wish to enslave. Keeping the

population largely uneducated, especially women, protects the business of selling humans by

preventing them from knowing that it is wrong and they are in fact worthy and not meant to be

used and sold for someone elses financial and sexual gain. Lack of education prevents victimes

from seeking help before or after they’ve been sold. Starting the brainwashing from a young age

keeps victims from understandign that there are other paths in life for them to make money and

raise their families status. Letting a daughter or sister be trafficked is considered a means for

upward movement in society if that person will be trafficked outside of the country and into

Europe (EASO, 2020). It is a lucrative practice designed to take advantage of those who are

vulnerale with no perceived way out. Because of these factors, it is critical to target poor women

and children in rural and highly scouted geographic areas for victims for sex trafficking.
 4

Education, protection and relief from factors, like money, are going to be a recurring theme

throughout this discussion as a way to make a change in the cultural acceptance and protection of

individuals from becoming slaves. The acceptance of using others for their own pleasure and

gain, especially women, is deeply rooted in the Nigerian culture and will be a serious barrier to

overcome.

Context adjustment for healthy choices to be the natural choice

It is difficult to apply a change of context to this public health topic as many of these victims are

chosen by others, they do not typically make the decision to be a slave. However, that being said,

the target for the change in context is actually the families who volunteer their daughters and

children to slavers and those who actively participate in the trade of humans. Global pressure

with a grossly negative attitude towards the practice and those who facilitate it should be applied

as an incentive to choose a different means of financial and social gain. Resources should be

made available to vulnerable populations in the form of financial opportunities so that sex

trafficking is not an attractive option to consider.

Long-Lasting Protective Interventions

New legislature by the Nigerian government identifying sex trafficking as an actual crime and

ascribing consequences for those who facilitate and participate in it. Legislature and enforcement

should NOT be applied to victims themselves. Task forces formed by the Nigerian government

and support groups to protect vulnerable populations from being recruited.

Clinical Interventions
 5

Clinical interventions should include treatment for long and short term consequences for victims

and attempting to identify victims when they come into care facilites. Female circumcision,

physical abuse, sexually transmitted diseases, addictions and mental trauma are part of what

victims and survivors carry with them. It is critical for care providers who are involved in

victims care to be aware of what they may have or are currently experiencing and how to care for

them holistically. The US Department of Health reports the following modalities for helping with

PTSD recovery; cognitive therapy, cognitive behavioral therapy, exposure therapy, eye

movement desensitation and reprocessing, and stress inoculation training (Clawsen et al, 2010).

Physical care would be whatever is needed based on their experience and providing specialty

services such as sexual assault nurses.

Counseling and Education

Education for victims should include that safe and consenusal sex is their right. That sex

trafficking is abuse, assault, and wrong. For women and children, to know that they do not

belong to the men in their lives and their whims and wants. Nigerian culture specific education

about the social norms taught to them from birth are not necessarily correct nor are standards to

hold themselves to. Their worth as people are not ascribed to how obedient they are to the male

in their life. Counseling provided in the means listed in the previous section on how to care for

themselves and the mental trauma they’ve been victims of.

Future interventions

Future interventions should incorporate all of the above towards continued improvements in

culture and environment for the people of Nigeria. Safe houses or other protective places for

those who feel they are at risk of being recruited to or taken by recruiters for sex trafficking.
 6

Increasing criminalization of sex trafficking with heavy enforcement for those who violate the

law and human rights. Heavy international pressure on the Nigerian government to enforce

legislature and protection for their women and children. Media exposure and promotion of the

experience of Nigerian women and victims of sex trafficking.

Culture of Nigeria

Nigeria is a tribal country that was only united under one name due to English Colonization.

Because of this, there is a lack of nationalism and consistency across the board in all that is

required to run a country. Their society still follows a caste system dictated by how much wealth

a person, family or tribe has (Every Culture, Nigeria). It is a patriarchal society meaning males

are the leader and decision maker in the family unit and outside of the home. Women typically

do not contest this belief and predominant religions in the region have biblical or theological

“evidence” to support it (Ajayi et al, 2022). Harvard’s country profile reports estimates of the

religious make up of Nigerai being 50% Muslim, 40-45% Christian and the rest indigenous

religons/practices. As put forth in these religions, so does Nigerian culture that bad behaviors are

because of the “devil” or women being the temptation of man (meaning the male gender in this

context). Being in a violent region of the world helps affirm these gender beliefs and practices as

procreation is extremely important to continue fighting, by having more bodies to fight, and

preventing the elimination of a people in certain areas. Women are considered a “weaker” sex, a

belief which is accepted by women of this culture d/t lack of education of what consists of abuse,

free will, and the worth of a woman. They are taught by their own mothers that they are objects

to be used however their husband wants. Women are expected to be obedient and submissive in

all things in their role of service to the family and community. Bride price is still practiced,

which is when a payment for a woman in return for marriage thus constricts their choice in
 7

partner, allowing socioeconomic factors to emphsize their role of submission (Lwahas, 2017).

Marriage also affects the families status in local society, preventing women from standing up for

themselves out of fear for the repercussans their family may experience. This attitude specifically

applies to (first-born) daughters, who are expected to sacrifice themselves for the economic well-

being of the family (EASO 2021). Another practice that is accepted in their culture is Child

marriage. Again, another way of enforcing the role of the woman, prevent the ability to be

educated, fight back due to raising their children and keeping house (Lwahas, 2017).

Nigerian health beliefs and practices

The government is supposed to provide health care and train medical professionals. However,

violent and political upheaval prevent money from being invested into a healthcare system and

having providers to provide general healthcare. Pharmacies regularly run out of medications due

to this. Nigeria practices a combination of western and traditional practices in urban areas and

more traditional practice in rural areas that do not have access or financial ability to western

modalities. Many indigenous people do not trust western practices and will not utilize it. The

health of Nigeria is very poor, preventable diseases run rampant causing many avoidable deaths

and lifelong disabilites (Every Culture, Nigeria).

Professional opportunities

Nursing professional opportunities present themselves in the form of advocacy, education, and

protection of vulnerable people. Similar to any role and problem in healthcare. This

responsibility to find opportunity occurs on all levels, from personal exposure and education on

an international level inspiring change and education for all who need it. There are many

programs already in place for nursing and other medical professionals to help those in need of
 8

general healthcare as well as specialized care for victims of sex trafficking that is taken for

granted in first world countries.

Conclusion

Nigerian culture and dominating religious views regarding women and children enable the

practice of sex trafficking to be accepted and allowed to continue. Public health interventions

need to be inacted on all levels of Friedan’s health pyramid in order to intiate a change not only

in the culture but to protect the health and wellness of the citizens of Nigeria. Without change,

women and children will continue to victims of a modern slave system which is unacceptable. It

is the responsibility of those in healthcare with a professional responsibility to others to ensure

that all people are safe and have the opportunity to live in good health.
 9

References

Ajayi, C., Chantler, K., & Radford, L. (2022, February 28). The role of cultural beliefs, norms,
and practices in Nigerian women's experiences of sexual abuse and violence. Violence
against women. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739597/

Curry, T. (n.d.). Nigeria. Countries and Their Cultures.

https://www.everyculture.com/Ma-Ni/Nigeria.html

European Union . (2021, April). Nigeria Trafficking in Human Beings. EASO.

https://euaa.europa.eu/sites/default/files/publications/2021_04_EASO_Nigeria_Traffickin
g_in_Human_Beings.pdf

Ewang, A. (2022, March 8). Nigeria risks falling further behind on Women's Equality. Human
Rights Watch. https://www.hrw.org/news/2022/03/08/nigeria-risks-falling-further-
behind-womens-equality

Frieden, T. R. (2010). A framework for Public Health Action: The Health Impact Pyramid.
American Journal of Public Health, 100(4), 590–595.
https://doi.org/10.2105/ajph.2009.185652

Harvard Divinity School. (2022). Nigeria. Religion and Public Life at Harvard Divinity School.
https://rpl.hds.harvard.edu/religion-context/country-profiles/nigeria

Institute for Health Metrics and Evaluation. (2010). GBD Profile: Nigeria - institute for health
metrics and evaluation. Health Data.
https://www.healthdata.org/sites/default/files/files/country_profiles/GBD/
ihme_gbd_country_report_nigeria.pdf

Kangaspunta, K., Sarrica, F., Serio, G., Whelan, K., Samson, J., & Wills, C. (2021, January).
Trafficking in persons. United Nations : Office on Drugs and Crime.
https://www.unodc.org/unodc/data-and-analysis/glotip.html

Lwaha, S. (2017, April 3). Understanding gender roles in Northern Nigeria. CEC Journal: Issue
3. https://scalar.usc.edu/works/cec-journal-issue-3/understanding-gender-roles

Williamson, E., Dutch, N. M., & Clawson, H. (2010, April 14). Evidence-based mental
health treatment for victims of human trafficking. ASPE: Office of the assistant secretary
for planning and evaluation.