Sexual and reproductive health care of refugee and migrant women in Australia : a mixed methods study of health care professional perspectives

Abstract

Cultural and linguistic diversity in Australia, mainly attributed to the Government's migration programs, is increasing with 49% of the population having been born overseas or having either one or both parents born in a foreign country. Notably, women account for a significant proportion of the total Australian female population, and women account for half of all migrants to Australia. Women from refugee and backgrounds often experience poor sexual and reproductive health (SRH) outcomes and face several barriers in accessing SRH care at individual, provider and system levels in host countries. In Australia, barriers to SRH services for refugee and migrant women and perspectives on improving access to and the utilization of SRH care are addressed exclusively from end-user perspectives. Understanding the views and experiences of health care professionals (HCPs) in providing SRH care to refugee and migrant women is crucial in helping to ensure the SRH needs of these women are met. This study involved a sequential mixed methods design to examine the views and experiences of HCPs in providing SRH care to refugee and migrant women in Australia. Commencing with a thematic meta-synthesis of the experiences of refugee and migrant women in accessing SRH care in Australia, an online survey to identify HCP reported barriers and facilitators of providing SRH care to refugee and migrant women followed which was completed by seventy-nine HCPs. Concurrently, forty-six of these HCPs undertook a Q study exploring refugee and migrant women's SRH in Australia to identify the challenges HCPs perceive in providing SRH care to these women. Then, twenty-one HCPs from this initial sample participated in a semi-structured interview to explore in further depth the barriers and facilitators in providing SRH care to refugee and migrant women that had been identified from the previous stages of the project. Finally, the findings of the systematic review, survey, Q and qualitative analyses were combined through a process of triangulation that enables these data sets to be connected and interpreted simultaneously through convergence and corroboration. The study was informed by the socio-ecological model, situated within a critical realist epistemological paradigm. Overall, three overarching themes were identified across the socio-ecological framework as barriers that impact refugee and migrant women's access and utilisation of SRH care, as well as care provision: The Vulnerable Woman, The "Unprepared" Health Care Provider, and Healthcare System Gaps. HCPs reported vulnerabilities related to refugee and migrant women such as country of origin experiences, resettlement priorities, linguistic and cultural barriers to communication, culture and gender roles, poor knowledge about their body, SRH and available services significantly influence their access and utilisation of SRH care and care provision in several ways. Furthermore, HCPs' lack of preparedness in relation to their knowledge, training and confidence to provide SRH care to refugee and migrant women was a barrier to the SRH care of refugee and migrant women. Participants also reported on factors associated with the health system such us lack of services and resources and difficulty of navigating the system that further compromised refugee and migrant women's access and utilisation of SRH care. The implications of the research findings suggest that interventions to improve refugee and migrant women's access and utilisation of SRH care could focus on the provision of culturally sensitive SRH education to the women, reduction of cross-cultural communication barriers, and engagement of HCPs in an ongoing process of improving cultural competency. It is also argued that further research is needed to understand refugee and migrant men's perspectives about gender roles, cultural norms and joint family planning decisions including their knowledge and attitude towards SRH.

Date of Award	2018
Original language	English