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

ABSTRACT: BACKGROUND:In 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. METHODS:Employing 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. RESULTS:The 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. CONCLUSION:Australian 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.

SUBMITTER: Mengesha ZB

PROVIDER: S-EPMC5519071 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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

Mengesha Zelalem B ZB Perz Janette J Dune Tinashe T Ussher Jane J

PloS one 20170720 7

<h4>Background</h4>In 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. The ...[more]

PMID: 28727833

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Project description:IntroductionSocial determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.AimThe aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.Materials and methodsThis study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.ResultThree important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.ConclusionThe key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

Project description:In Australia and Canada, the sexual health needs of migrant and refugee women have been of increasing concern, because of their underutilization of sexual health services and higher rate of sexual health problems. Previous research on migrant women's sexual health has focused on their higher risk of difficulties, or barriers to service use, rather than their construction or understanding of sexuality and sexual health, which may influence service use and outcomes. Further, few studies of migrant and refugee women pay attention to the overlapping role of culture, gender, class, and ethnicity in women's understanding of sexual health. This qualitative study used an intersectional framework to explore experiences and constructions of sexual embodiment among 169 migrant and refugee women recently resettled in Sydney, Australia and Vancouver, Canada, from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, India, and South America, utilizing a combination of individual interviews and focus groups. Across all of the cultural groups, participants described a discourse of shame, associated with silence and secrecy, as the dominant cultural and religious construction of women's sexual embodiment. This was evident in constructions of menarche and menstruation, the embodied experience that signifies the transformation of a girl into a sexual woman; constructions of sexuality, including sexual knowledge and communication, premarital virginity, sexual pain, desire, and consent; and absence of agency in fertility control and sexual health. Women were not passive in relation to a discourse of sexual shame; a number demonstrated active resistance and negotiation in order to achieve a degree of sexual agency, yet also maintain cultural and religious identity. Identifying migrant and refugee women's experiences and constructions of sexual embodiment are essential for understanding sexual subjectivity, and provision of culturally safe sexual health information in order to improve well-being and facilitate sexual agency.

Project description:Dengue has been a major public health concern in Australia. This study has explored the spatio-temporal trends of dengue and potential socio- demographic and ecological determinants in Australia. Data on dengue cases, socio-demographic, climatic and land use types for the period January 1999 to December 2010 were collected from Australian National Notifiable Diseases Surveillance System, Australian Bureau of Statistics, Australian Bureau of Meteorology, and Australian Bureau of Agricultural and Resource Economics and Sciences, respectively. Descriptive and linear regression analyses were performed to observe the spatio-temporal trends of dengue, socio-demographic and ecological factors in Australia. A total of 5,853 dengue cases (both local and overseas acquired) were recorded across Australia between January 1999 and December 2010. Most the cases (53.0%) were reported from Queensland, followed by New South Wales (16.5%). Dengue outbreak was highest (54.2%) during 2008-2010. A highest percentage of overseas arrivals (29.9%), households having rainwater tanks (33.9%), Indigenous population (27.2%), separate houses (26.5%), terrace house types (26.9%) and economically advantage people (42.8%) were also observed during 2008-2010. Regression analyses demonstrate that there was an increasing trend of dengue incidence, potential socio-ecological factors such as overseas arrivals, number of households having rainwater tanks, housing types and land use types (e.g. intensive uses and production from dryland agriculture). Spatial variation of socio-demographic factors was also observed in this study. In near future, significant increase of temperature was also projected across Australia. The projected increased temperature as well as increased socio-ecological trend may pose a future threat to the local transmission of dengue in other parts of Australia if Aedes mosquitoes are being established. Therefore, upgraded mosquito and disease surveillance at different ports should be in place to reduce the chance of mosquitoes and dengue cases being imported into all over Australia.

Dataset Information

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

Publications

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

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