Familial Child Sexual Exploitation in the U.S.
Joy Lo, MD, FAAP
Introduction
Every child should have the opportunity to grow up feeling safe and loved. Ideally, this occurs within the environment of family. When a child is victimized, the impact to their well-being can be deep, pervasive, and long-lasting; when a child is victimized by the very people who are supposed to care for them, even greater harm may result. Of the many types of victimizations a child can experience, sexual abuse in the context of material gain to the abuser is one that creates extreme trauma and consequences, especially when the abuser is a family member. The purpose of this paper is to explore the literature on familial child sexual exploitation in the United States: to gather what we know, identify gaps, and determine directions in which to move forward.
Defining the problem
The Office of Juvenile Justice and Delinquency Prevention states the “commercial sexual exploitation of children (CSEC) refers to a range of crimes of a sexual nature committed against children and adolescents,” including prostitution, survival sex, child sexual abuse material, and performing in sexual venues (Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, 2014).
All CSEC is child sexual abuse (CSA). Not only is CSEC a subset of CSA, but the two are often interrelated. Research has shown that early abuse, especially sexual abuse, is a significant risk factor for future sexual exploitation (Brandt et al., 2021; Cole et al., 2016; Fedina et al., 2019). Furthermore, Estes and Weiner (2002) emphasize the related nature of CSA, child sexual assault, and child sexual exploitation as a “continuum of abuse” (p. 15). In the last 20 years, research – and myths – about human trafficking have proliferated. Much of the literature on sex trafficking in minors has focused, with good reason, on runaway/homeless youth with histories of multiple adversities who are trafficked by non-family members or engaging in survival sex. Additionally, online child sexual abuse material (CSAM) are increasingly in the news. These are all important. In this paper, I discuss a lesser-known subgroup of CSEC – CSEC that is facilitated or committed by a family member of the victimized child.
Familial CSEC has distinct characteristics, which lead to specific implications. Familial CSEC is child sexual abuse in which a family member or caregiver profits or benefits in a manner beyond sexual acts with a child (Reid et al., 2015). It is also CSEC that is facilitated by a family member or caregiver and when the family member or caregiver exploits the child sexually for something of value (Allert, 2022; Brandt et al., 2018; Raphael, 2020; Reid et al., 2015; Smith et al., 2009).
Where does the data come from?
The research on familial CSEC come from a variety of sources. Many studies include data from social service cases and interviews with social service providers (Brandt et al., 2018; Cole et al., 2016; Cole & Sprang, 2015; Edwards et al., 2022; Reid et al., 2015; Sprang and Cole, 2018). Some include records, surveys, and in-depth interviews of law enforcement (Allert, 2022; Estes & Weiner, 2002; Mitchell et al., 2010). Nichols et al. (2022) conducted surveys with social, healthcare, and legal professionals working with human trafficking survivors. Other studies derive information from survivors themselves (Perkins & Ruiz, 2017; Raphael, 2020; Reed et al., 2019). These studies, while mostly local, come from several regions of the country. Allert (2022), Estes and Weiner, (2002) and Mitchell et al. (2010) conducted studies with data from across the U.S.. Unfortunately, no reliable national data summarizing prevalence or other details of CSEC exists; however, there are three national databases that contain useful information. They are the FBI’s National Incident-Based Reporting System (NIBRS) (Finkelhor & Ormrod, 2004), the National Human Trafficking Hotline (Polaris Project, 2016), and the National Child Abuse and Neglect Data System, run by the U.S. Department of Health and Human Services (Child Maltreatment 2019, 2021).
Findings
According to several studies, familial CSEC ranges from 12%-82% of CSEC cases (Allert, 2022; Child Maltreatment 2019, 2021; Cole & Sprang, 2014; Edwards et al., 2022; Finkelhor & Ormrod 2004; Mitchell et al., 2010; Nichols et al., 2022; Perkins & Ruiz, 2017; Polaris 2016; Reed et al., 2019; Reid et al., 2015; Sprang & Cole, 2018). While this range is wide, it demonstrates that familial CSEC can comprise a significant portion of children and youth who experience sexual exploitation. According to justice professionals interviewed by Allert (2022), the rate of familial CSEC (26% in her study) is likely erroneously low due to insufficient disclosure, lack of evidence, and plea bargaining.
Mothers were the most common traffickers, ranging from 63-64.5% (Reid et al., 2015; Sprang & Cole, 2019). At times, the mother would act with another trafficker, often the mother’s paramour (Allert, 2022; Raphael, 2019) or another relative (Sprang & Cole, 2018). If the mothers were not the trafficker, they were often aware of their children’s victimization (Reed et al., 2019; Reid, 2015; Sprang & Cole, 2018). Reid et al. (2015) state that the mother-daughter dyad was the most common perpetrator-victim dyad of familial CSEC in their study. This finding is significant. Traditionally, mothers are thought to be nurturing and loving. If mothers are involved in domestic violence, they are often assumed to be the victims and not the perpetrators. Also, “pimps” are most commonly pictured as men. We may have an implicit bias against a reality of a mother as her child’s trafficker. Other common familial traffickers are fathers, cousins, uncles, and other caregivers (Raphael, 2019; Reid, 2015; Sprang & Cole, 2018).
Geographically, the studies showed more familial trafficking in rural than urban areas, which is opposite of data seen in youth involved with non-familial traffickers or with no trafficker (Cole & Sprang; 2014; Edwards et al., 2022; Nichols et al., 2022; Perkins & Ruiz, 2017; Sprang & Cole, 2018). Perkins and Ruiz (2017) found in their study that of the youth that had a trafficker, the rural victims were more often trafficked by family members, contrasting with the urban victims, who were more often trafficked by non-family members. Sprang and Cole (2018) found that rural professionals had less training on human trafficking; for that reason, as well as fewer resources in rural areas, they posited that familial trafficking was allowed to continue undetected in rural regions, compared with urban regions.
Child sexual abuse material (CSAM) may also be perpetrated by family members (Finkelhor & Ormrod, 2004; Mitchell et al., 2005; Seto et al., 2018; Smith, 2009; Sprang & Cole, 2018). The NIBRS reflects that 25% of victims of CSAM with identifiable offenders were exploited by family members (Finkelhor & Ormrod, 2004). Mitchell et al. (2005) found in their study of 796 cases of juvenile prostitution that 44% of CSAM were disseminated by family members. Using data from the National Center for Missing and Exploited Children regarding CSAM, Seto et al. (2018) found that “while most cases involved male offenders who were unrelated to the child, cases involving female offenders, younger children, or more egregious content were more likely to involve familial offenders” (p. 3).
The main characteristic that distinguishes CSEC from other forms of CSA is that someone is profiting materially, above the sexual act alone. In familial CSEC the most common motivation was found to be money, a close second being drugs (Allert, 2022; Mitchell et al., 2010; Raphael, 2019; Reed et al., 2019; Reid et al., 2015; Smith et al., 2009; Sprang & Cole, 2018). Other motivations included housing and supporting the family (Raphael, 2019; Reed et al., 2019; Smith et al., 2009).
Edwards et al.’s study (2022), which included 698 victims of child trafficking in the Kentucky welfare system, documented that family-controlled child trafficking was more often reported by the victim’s relatives or non-relative community members than by professionals. Contrarily, Sprang & Cole (2018) found that minors sexually exploited by their families were more often identified by professionals: 51.6% of their cases were identified in a hospital emergency room, and 45.1% of the cases were discovered during a police investigation, often an investigation of the trafficker’s drug related activity. Interestingly, Sprang and Cole (2018) found that about 1/5 of their victims had been to emergency rooms multiple times with no identification or suspicion of abuse raised. These details reflect the difficulty in identifying familial trafficking as well as the crucial role professionals play in identification, and also reflects the need for training of such professionals. The familial trafficking cases in Edwards et al.’s study were more likely to be unsubstantiated or unfounded compared to trafficking cases without family members. Sprang and Cole (2018) found that of findings, neglect was the most common maltreatment identified – in their study 93.5% had a primary finding of neglect, whereas 9.7% had a finding of sexual abuse. This misidentification is relevant, as it does not fully express what the child has experienced and has implications for victim services, prosecution of the perpetrator, and data accuracy.
Compared to CSEC victims with non-familial or no trafficker, familial CSEC victims were more likely to be younger and reflect a wider range of ages (Edwards et al., 2022; Mitchell et al., 2010; Nichols et al., 2022; Raphael, 2019; Reid et al., 2015; Sprang & Cole, 2018). Reid et al. (2015) found the age of initial exploitation in familial CSEC was 4-17, whereas those trafficked by non-family members were 11-17 years old at initiation. In Sprang and Cole’s (2018) sample, familial CSEC victims’ ages ranged from 6 to 17 years old at time of identification. Familial CSEC victims have a higher rate of poly-victimization (Cole et al., 2016; Reid et al., 2015). They are less likely to be using drugs and alcohol and less likely to be runaways (Reid et al., 2015; Sprang & Cole, 2018), which can be partially due to their younger ages – these factors, if higher, could increase opportunities to be detected. They were more likely to have witnessed domestic violence (Reid et al., 2015). They were more likely to be involved with child welfare, while being less likely to be involved with the juvenile justice system (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018). They frequently moved residences (Estes & Weiner, 2006), which could make detection of cases more difficult. They were more likely to have family members involved in commercial sex. Sex work is sometimes intergenerational (Allert, 2022; Fedina et al., 2019; Mitchell et al., 2010; Puigvert et al., 2019; Reed et al., 2019). As such, sex work may be normalized, even expected, and intergenerational trauma is perpetuated (Nichols et al., 2022; Raphael, 2019; Reed et al., 2019). Fedina et al. (2019) cited 35% of their child trafficking victims had family members in sex work. Additionally, victims of familial CSEC had high truancy rates. According to Sprang and Cole (2018), 86.4% of their cases showed “extreme” absenteeism from school.
Outcomes
As familial CSEC research is in its infancy, outcomes specific to this population are not well-defined. We can draw some inferences from research on victims of CSEC, who frequently suffer from developmental, physical, mental, relational, and social consequences, some of which may be severe and long-term (Brandt, 2021; Cole et al., 2016; Cole & Sprang, 2014; Hopper, 2017; Raphael, 2019; Reed et al., 2019; Reid et al., 2015; Sprang & Cole, 2018). These outcomes include complex developmental trauma, PTSD, depression, anxiety, attachment disorders, difficulty with relationships, and higher rates of future interpersonal violence and revictimization. Despite having lower drug usage when identified, they are at high risk for substance use later in life (Cole et al., 2016). Self-harm, suicidal ideation, and suicide attempts are not uncommon sequelae (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018). Sprang & Cole (2018) found that almost ½ of their familial CSEC victims reported at least one suicide attempt. And over 80% of them were diagnosed with PTSD. Additionally, CSEC victims often suffer reproductive impacts, including multiple sexually transmitted infections and multiple pregnancies. Many of them suffered physical violence (Brandt et al., 2021; Cole et al., 2016; Hopper, 2017; Reid et al., 2015; Sprang & Cole 2018).
