Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

Abstract

BackgroundIn Australia only 2.2% of published health research has focused on multi-cultural health despite the increase of culturally and linguistically diverse populations. Research on the perceptions and experiences of health care professionals (HCPs) in engaging with refugee and migrant women is also lacking. Given the integral role of HCPs in providing sexual and reproductive health (SRH) care for these populations, an understanding of the challenges they experience is required. Therefore, this study sought to examine the perspectives and practices of Australian HCPs with regard to the provision of SRH care for refugee and migrant women.MethodsEmploying qualitative methods, twenty-one semi-structured interviews were conducted with HCPs representing various professions, work experiences, cultural backgrounds, age and healthcare sectors. The interviews were analysed using thematic analysis and the socio-ecological model was utilised to interpret the data.ResultsThe complexities of HCP’s engagement with refugee and migrant women were identified in three major themes: Being a Migrant; Gender Roles and SRH Decision-making; and Women in the Healthcare System. HCPs discussed the impact of accessing SRH care in women’s country of origin and the influence of re-settlement contexts on their SRH knowledge, engagement with care and care provision. Perception of gender roles was integral to SRH decision-making with the need to involve male partners having an impact on the provision of women-centred care. Barriers within the healthcare system included the lack of services to address sexual functioning and relationship issues, as well as lack of resources, time constraints, cost of services, and funding.ConclusionAustralian HCPs interviewed reported that migrant and refugee women do not have appropriate access to SRH care due to multifaceted challenges. These challenges are present across the entire socio-ecological arena, from individual to systemic levels. Multiple and multidimensional interventions are required to increase SRH utilisation and improve outcomes for refugee and migrant women.

Family planning and Afghan refugee women and men living in Melbourne, Australia: new opportunities and transcultural tensions

“…In this study, these paradigms were used to critically examine the literature, develop research tools and interpret the findings. As in prior sexual health research (Mengesha et al 2017), the socioecological model of health was used as an organising framework for analysis and presentation of findings. This study adopted an innovative approach by applying the cultural studies' notion of 'transculturalism' to explore the complex dynamics of culture and social change around family planning.…”

“…The findings of this research suggest that general practitioners are in a key position to support Afghan women and men in their quest to find a suitable contraceptive method by: providing more information on the range of birth control options available; informing them of the potential side effects; prompting follow-up appointments; and, nurturing longer-term engagement. However, service-level constraints within the health care setting must be addressed in order to achieve this (Mengesha et al 2017).…”

La consejería en anticoncepción y los proveedores de salud

“…15 Es significativo resaltar que los proveedores señalan sus debilidades y piden espacios de capacitación en la temática, e incluso apoyo institucional 16 y más aún cuando manifiestan lo valioso de reconocer el rol que merecen los individuos que hacen uso de este tipo de servicios. 17 El estudio de Kelly et al, 12 relata que algunos profesionales de la salud han tenido que modificar su lenguaje técnico científico para llevarlo a un lenguaje más acorde con el implementado por los pacientes. De allí, el valor de que el proveedor adquiera conocimientos relacionados con las ciencias sociales y humanas que le permitan entender las singularidades de las personas que son representadas en sus características socioeconómicas, étnicas, ideológicas, religiosas, raciales, de género y de multiculturalidad.…”

“…Este bloque temático permitió identificar una diversidad de contrastes que están dispuestos en la gestión dada a los programas de anticoncepción, y que llevan a repercutir de forma negativa en la educación para la salud que los proveedores dan a la comunidad en materia de regulación de la fecundidad durante el ciclo de vida fértil que tienen las personas. 17,20 Entre los aspectos que deterioran la atención, el estudio de Espinoza Gutiérrez resalta el escaso tiempo de consulta y el débil seguimiento dado a los usuarios de estos programas. 21 Para Schivone & Glish, 22 la consejería en anticoncepción ha de estar centrada en la persona para instar a la práctica autónoma en torno de la anticoncepción que termina por reforzar la apropiación del MAC (conocimientos, uso, efectos secundarios, nivel de satisfacción, entre otros), en respuesta a que teniendo como referentes estos aspectos será probable incrementar las tasas de efectividad, la adherencia y la prevención de embarazos no deseados.…”

Novel green space measures and birthweight in Queensland, Australia

“…292 There has been several complex reasons identified for sub-optimal sexual and reproductive healthcare amongst migrant women, ranging from language barriers, gender roles, cultural norms, and difficulty accessing the Australian medical system. 293,294 Migrant women from Asian countries with a high number of Humanitarian visa entries were more likely to attend medical care later in the pregnancy, and attend fewer (or no) antenatal care or post birth follow-up appointments compared with migrant women from Asian countries with fewer Humanitarian visa entries. 295 It should be noted that in this study, the women from a humanitarian source country had higher birthweights, suggesting that perhaps the care is not the only factor affecting their pregnancy outcomes.…”