Purity, privacy and procreation : constructions and experiences of sexual and reproductive health in Assyrian and Karen women living in Australia

It is widely recognised that sexual and reproductive health services are underutilised by culturally and linguistically diverse migrant communities, leading to risk of poor health outcomes. This study examined the constructions and experiences of reproductive and sexual health, and associated services, in Assyrian and Karen women who had arrived in Australia as refugees. Forty two women, across a range of age groups and marital status, participated in five focus groups, with thematic analysis and positioning theory used to analyse the results. Two major themes were identified. The first, the ‘Premarital Chastity Imperative’ centres on the cultural prohibition of coital hetero-sex before marriage, and taboos associated with same-sex relationships. This has implications for unmarried women’s access to sexual health services, such as contraception, cervical screening, and abortion; prohibition of sex education and communication about sex; and lack of recognition of non-heterosexual identities. The second theme, ‘Marital Sex and Reproductive Imperative’, positioned coital sex and motherhood as mandatory within marriage, and was associated with women’s inability to refuse marital sex, limited knowledge about contraception and sexual pain, acceptance of fertility services, as well as lack of recognition of post-natal depression. It is concluded that health care workers need to be aware of cultural constructions of sex and sexuality, as well as the construction of gendered roles within heterosexual relationships, when designing and offering sexual health services to non English speaking or migrant communities.