Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel

Abstract

The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.

Eritrean Refugees’ Utilization of Antenatal Services in Israel

“…The qualitative findings enrich understanding of these issues, suggesting that both these indicators of service use might be improved once the barriers of work, a complex health system and miscommunication are addressed. As these barriers have been found to be exacerbated by the precarious legal status of refugees (Fleischman et al., ), the current study provides additional evidence of the permeating negative effect of refugees’ legal status on utilization of healthcare services in Israel (Fleischman et al., ; Gebreyesus et al., ) and other host countries (e.g., Silove et al., ; Ascoly et al., ; Asgary and Segar, ; Chase et al., ). As such, the study findings stress the need for structural changes in their legal status and hence entitlements to health service and health insurance.…”

“…The qualitative data may provide a more general explanation for these tendencies, as Eritrean women report finding the system of antenatal care difficult to navigate and lament a lack of proper communication – two barriers also identified by Gebreyesus et al. () in their study on Eritrean refugees’ access to contraceptive services. The next most frequently used facility in both cities is the Kupat Cholim clinics, run by HMOs.…”

“…Interestingly, Human Rights Watch () and Gebreyesus et al. () do report internal barriers, such as feelings of discrimination and mistrust, in relation to Eritrean refugees’ use of general health services in Israel. The nature of antenatal services, which require frequent attendance for at least 6 months, together with the fragmented Israeli system of antenatal services, may account for the stronger emphasis on external barriers in the current study.…”

“…In similar vein, Gebreyesus et al. () point to the political, social and economic marginalization of Eritrean refugees as a barrier to their use of family planning services in Israel. Michaan et al.…”

“…Meta-reviews have concluded that such utilization is "limited" and "late" (Carolan, 2010: 411), "low" (Correa-Velez and Ryan, 2012: 14) and "less" and "later" than user rates of host country citizens (e.g., Munro et al, 2013: 283). Numerous case studies also point to refugees' problematic or low utilization of health services (e.g., Asgary and Segar, 2011;Correa-Velez and Ryan, 2012;Michaan et al, 2014;Choi et al, 2015;Langlois et al, 2016;Gottlieb et al, 2017), although a few studies argue that there is "no evidence of under-use" (Kiss et al, 2013: 57), that access for refugees is "relatively good" (El Arab and Sagbakken, 2018), and that refugees' demands for health services are "largely met" (Borgschulte et al, 2018: 6). The findings of both positive and negative health service utilization in host countries begs the question of how such use is conceptualized and operationalized, as well as how it is contextualized, that is, what country-specific legislation relates to refugees and their entitlement to health services in the host country.…”