nach oben

International Journal of Behavioral Medicine

Erschienen in:

15.06.2017

“In My Culture, We Don’t Know Anything About That”: Sexual and Reproductive Health of Migrant and Refugee Women

verfasst von: Christine Metusela, Jane Ussher, Janette Perz, Alexandra Hawkey, Marina Morrow, Renu Narchal, Jane Estoesta, Melissa Monteiro

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 6/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Migrant and refugee women are at risk of negative sexual and reproductive health (SRH) outcomes due to low utilisation of SRH services. SRH is shaped by socio-cultural factors which can act as barriers to knowledge and influence access to healthcare. Research is needed to examine constructions and experiences of SRH in non-English-speaking migrant and refugee women, across a range of cultural groups.

Method

This qualitative study examined the constructions and experiences of SRH among recent migrant and refugee women living in Sydney, Australia, and Vancouver, Canada. A total of 169 women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, India, Sri Lanka and South America participated in the study, through 84 individual interviews, and 16 focus groups comprised of 85 participants. Thematic analysis was used to analyse the data.

Results

Three themes were identified: “women’s assessments of inadequate knowledge of sexual and reproductive health and preventative screening practices”, “barriers to sexual and reproductive health” and “negative sexual and reproductive health outcomes”. Across all cultural groups, many women had inadequate knowledge of SRH, due to taboos associated with constructions and experiences of menstruation and sexuality. This has implications for migrant and refugee women’s ability to access SRH education and information, including contraception, and sexual health screening, making them vulnerable to SRH difficulties, such as sexually transmissible infections and unplanned pregnancies.

Conclusion

It is essential for researchers and health service providers to understand socio-cultural constraints which may impede SRH knowledge and behaviour of recent migrant and refugee women, in order to provide culturally safe SRH education and services that are accessible to all women at resettlement irrespective of ethnicity or migration category.

The term migrant and refugee is used in this paper to refer to people from a non-English speaking background who have emigrated from their country of origin and resettled elsewhere. In Australia, the term Culturally and Linguistically Diverse (CALD) is used to describe such individuals.

World Health Organisation. Mental health aspects of women’s reproductive health: a global review of the literature. Geneva: W.H.O; 2009.

World Health Organisation. Measuring sexual health: conceptual and practical considerations and related indicators. Geneva: W.H.O; 2010.

Aggleton P, Campbell C. Working with young people—towards an agenda for sexual health. Sex Relation Ther. 2000;15(3):283–96. doi:10.1080/14681990050109863.CrossRef

World Health Organisation. Defining sexual health: report of a technical consultation on sexual health. Geneva: W.H.O; 2006.

Botfield JR, Newman CE, Zwi AB. Young people from culturally diverse backgrounds and their use of services for sexual and reproductive health needs: a structured scoping review. Sex Health. 2016;13(1):1–9. doi:10.1071/SH15090.PubMed

Henderson S, Kendall E. Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Aust J Prim Health. 2011;17(2):195–201. doi:10.1071/PY10065.CrossRefPubMed

Ussher JM, Rhyder-Obid M, Perz J, Rae M, Wong TWK, Newman P. Purity, privacy and procreation: constructions and experiences of sexual and reproductive health in Assyrian and Karen women living in Australia. Sex Cult. 2012;16(4):467–85. doi:10.1007/s12119-012-9133-6.CrossRef

Manderson L, Allotey P. Storytelling, marginality, and community in Australia: how immigrants position their difference in health care settings. Med Anthropol. 2003;22(1):1–21. doi:10.1080/01459740306767.CrossRefPubMed

McMichael C, Gifford S. “It is good to know now…before it’s too late”: promoting sexual health literacy amongst resettled young people with refugee backgrounds. Sex Cult. 2009;13(4):218–36. doi:10.1007/s12119-009-9055-0.CrossRef

10.

Carballo M, Nerukar A. Migration, refugees, and health risks. Emerg Infect Dis. 2001;7(Suppl 3):556–60.CrossRefPubMedPubMedCentral

11.

Keygnaert I, Vettenburg N, Roelens K, Temmerman M. Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. BMC Public Health. 2014;14(1):1–13. doi:10.1186/1471-2458-14-416.CrossRef

12.

McMichael C, Gifford S. Narratives of sexual health risk and protection amongst young people from refugee backgrounds in Melbourne, Australia. Cult Health Sex. 2010;12(3):263–77. doi:10.1080/13691050903359265.CrossRefPubMed

13.

de Anstiss H, Ziaian T. Mental health help-seeking and refugee adolescents: qualitative findings from a mixed-methods investigation. Aust Psychol. 2009:1–9. doi:10.1080/00050060903262387.

14.

Benson J, Maldari T, Williams J, Hanifi H. The impact of culture and ethnicity on women’s perceived role in society and their attendant health beliefs. InnovAiT. 2010;3(6):358–65. doi:10.1093/innovait/inp227.CrossRef

15.

Ngum Chi Watts MC, Liamputtong P, Carolan M. Contraception knowledge and attitudes: truths and myths among African Australian teenage mothers in Greater Melbourne, Australia. J Clin Nurs. 2014;23(15–16):2131–41. doi:10.1111/jocn.12335.CrossRefPubMed

16.

Manderson L, Kelaher M, Woelz-Stirling N, Kaplan J, Greene K. Sex, contraception and contradiction among young Filipinas in Australia. Cult Health Sex. 2002;4(4):381–91. doi:10.1080/1369105021000041034.CrossRef

17.

Rawson H, Liamputtong P. Culture and sex education: the acquisition of sexual knowledge for a group of Vietnamese Australian young women. Ethn Health. 2010;15(4):343–64. doi:10.1080/13557851003728264.CrossRefPubMed

18.

Beck A, Majumdar A, Estcourt C, Petrak J. "We don’t really have cause to discuss these things, they don’t affect us": a collaborative model for developing culturally appropriate sexual health services with the Bangladeshi community of Tower Hamlets. Sex Transm Infect. 2005;81(2):158–62. doi:10.1136/sti.2004.012195.CrossRefPubMedPubMedCentral

19.

Shoveller J, Chabot C, Soon JA, Levine M. Identifying barriers to emergency contraception use amount young women from various social groups in British Columbia, Canada. Perspect Sex Reprod Health. 2007;39:13–20.CrossRefPubMed

20.

Meldrum RM, Liamputtong P, Wollersheim D. Sexual health knowledge and needs: young Muslim women in Melbourne, Australia. Int J Health Serv. 2016;46(1):124–40. doi:10.1177/0020731415615313.CrossRefPubMed

21.

Ngum Chi Watts MC, McMichael C, Liamputtong P. Factors influencing contraception awareness and use: the experiences of young African Australian mothers. Refugee Stud. 2015;28(3):368–87. doi:10.1093/jrs/feu040.CrossRef

22.

Fenton KA. Strategies for improving sexual health in ethnic minorities. Curr Opin Infect Dis. 2001;14(1):63–9.CrossRefPubMed

23.

Kebede MT, Hilden PK, Middelthon A-L. Negotiated silence: the management of the self as a moral subject in young Ethiopian women’s discourse about sexuality. Sex Educ. 2014;14(6):666–78. doi:10.1080/14681811.2014.924918.CrossRef

24.

Rogers C, Earnest J. Sexual and reproductive health communication among Sudanese and Eritrean women: an exploratory study from Brisbane, Australia. Cult Health Sex. 2015;17(2):223–36. doi:10.1080/13691058.2014.967302.CrossRefPubMed

25.

Allotey P, Manderson L, Baho S, Demian L. Reproductive health for resettling refugee and migrant women. J Health Issues. 2004;78:12–7.

26.

Guerin PB, Allotey P, Elmi FH, Baho S. Advocacy as a means to an end: assisting refugee women to take control of their reproductive health needs. Women Health. 2006;43(4):7–25. doi:10.1300/J013v43n04_02.CrossRefPubMed

27.

Richters J, Khoei EM. Concepts of sexuality and health among Iranian women in Australia. Aust Fam Physician. 2008;37(3):190–2.PubMed

28.

Wray A, Ussher JM, Perz J. Constructions and experiences of sexual health among young, heterosexual, unmarried Muslim women immigrants in Australia. Cult Health Sex. 2013;16(1):76–89.CrossRefPubMed

29.

Gifford SM, Bakopanos C, Dawson M-T, Yesilyurt Z. Risking for protection: discourses around ‘safe sex’ among Chilean, Turkish and second-generation Greek women living in Melbourne, Australia. Ethn Health. 1998;3(1):95–116. doi:10.1080/13557858.1998.9961852.CrossRefPubMed

30.

Gagnon AJ, Merry L, Robinson C. A systematic review of refugee women’s reproductive health. Refuge. 2002;21(1):6–17.

31.

Mcmullin JM, De Alba I, Chávez LR, Hubbell AF. Influence of beliefs about cervical cancer etiology on pap smear use among Latina immigrants. Ethn Health. 2005;10(1):3–18. doi:10.1080/1355785052000323001.CrossRefPubMed

32.

Salad J, Verdonk P, de Boer F, Abma TA. “A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?” A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer. Int J Equity Health. 2015;14(1):1–13. doi:10.1186/s12939-015-0198-3.CrossRef

33.

Levy V, Prentiss D, Balmas G, et al. Factors in the delayed HIV presentation of immigrants in Northern California: implications for voluntary counseling and testing programs. J Immigr Minor Health. 2007;9(1):49–54. doi:10.1007/s10903-006-9015-9.CrossRefPubMed

34.

Yakubu BD, Simkhada P, van Teijlingen E, Eboh W. Sexual health information and uptake of sexual health services by African women in Scotland: a pilot study. Int J Health Prom Educ. 2010;48(3):79–84. doi:10.1080/14635240.2010.10708186.CrossRef

35.

Rademakers J, Mouthaan I, de Neef M. Diversity in sexual health: problems and dilemmas. Eur J Contracept Reprod Health Care. 2005;10(4):207–11.CrossRefPubMed

36.

Kreuter MW, McClure SM. The role of culture in health communication. Annu Rev Public Health. 2004;25(1):439–55. doi:10.1146/annurev.publhealth.25.101802.123000.CrossRefPubMed

37.

Vissandjee B, Desmeules M, Cao Z, Abdool S, Kazanjian A. Integrating ethnicity and migration as determinants of Canadian women’s health. BMC Womens Health. 2004;4(Suppl 1):S32.CrossRefPubMedPubMedCentral

38.

Garrett P, Dickson H, Whelan A, Whyte L. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications. Aust NZ Health Policy. 2010;7(1):1–13.CrossRef

39.

Tran M, Young L, Phung H, Hillman K, Willcocks K. Quality of health services and early postpartum discharge: results from a sample of non-English-speaking women. J Qual Clin Pract. 2001;21(4):135–43.CrossRefPubMed

40.

Tsianakas V, Liamputtong P. What women from an Islamic background in Australia say about care in pregnancy and prenatal testing. Midwifery. 2002;18(1):25–34.CrossRefPubMed

41.

Nguyen HN, Liamputtong P. Sex, love and gender norms: sexual life and experience of a group of young people in Ho Chi Minh City, Vietnam. Sex Health. 2007;4(1):63–9. doi:10.1071/SH06023.CrossRefPubMed

42.

Beiser M. The health of immigrants and refugees in Canada. Can J Public Health. 2005;96(Suppl 2):S30–44.PubMed

43.

Browes NC. Comprehensive sexuality education, culture and gender: the effect of the cultural setting on a sexuality education programme in Ethiopia. Sex Educ. 2015;15(6):655–70. doi:10.1080/14681811.2015.1065476.CrossRef

44.

Dyck I. Travelling tales and migratory meanings: South Asian migrant women talk of place, health and healing. Soc Cult Geogr. 2006;7(1):1–18. doi:10.1080/14649360500452772.CrossRef

45.

Quelopana AM, Alcalde C. Exploring knowledge, belief and experiences in sexual and reproductive health in immigrant Hispanic women. J Immigr Minor Health. 2014;16(5):1001–6. doi:10.1007/s10903-013-9807-7.CrossRefPubMed

46.

Hach M. Common threads, common practice: working with immigrant and refugee women in sexual and reproductive health. Collingwood: Multicultural Centre for Women’s Health; 2012.

47.

Kreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2003;30(2):133–46. doi:10.1177/1090198102251021.CrossRefPubMed

48.

World Health Organisation. Developing sexual health programmes. Geneva: W.H.O; 2010.

49.

Ussher JM, Perz J, Metusela C, et al. Negotiating discourses of shame, secrecy, and silence: migrant and refugee women’s experiences of sexual embodiment. Arch Sex Behav. 2017; doi:10.1007/s10508-016-0898-9.

50.

Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Huberman AM, editor. Thousand Oaks: Sage; 1994.

51.

Creswell JW. Research design. Qualitative, quantitative and mixed method approaches. London: Sage; 2009.

52.

Lambert SD, Loiselle CG. Combining individual interviews and focus groups to enhance data richness. J Adv Nurs. 2008;62(2):228–37. doi:10.1111/j.1365-2648.2007.04559.x.CrossRefPubMed

53.

Krueger RA. Focus groups: a practical guide for applied research. Thousand Oaks: Sage; 2014.

54.

Burr V. Social constructionism. New York: Routledge; 2015.CrossRef

55.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef

56.

Ussher JM, Perz J, Gilbert E. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer. 2015;15(1):1–18. doi:10.1186/s12885-015-1243-8.CrossRef

57.

Rose G. Situating knowledges: positionality, reflexivities and other tactics. Prog Hum Geogr. 1997;21(3):305–20.CrossRef

58.

Al Omari O, Abdel Razeq NM, Fooladi MM. Experience of menarche among Jordanian adolescent girls: an interpretive phenomenological analysis. J Pediatr Adolesc Gynecol. 2016;29(3):246–51. doi:10.1016/j.jpag.2015.09.005.CrossRefPubMed

59.

Cooper SC, Koch PB. “Nobody told me nothin”: communication about menstruation among low-income African American women. Women Health. 2007;46(1):57–78. doi:10.1300/J013v46n01_05.CrossRefPubMed

60.

Hawkey A, Ussher JM, Perz J, Metusela C. Experiences and constructions of menarche and menstruation across migrant and refugee women. Qual Health Res. 2016; doi:10.1177/1049732316672639.

61.

Kissling EA. Bleeding out loud: communication about menstruation. Fem Psychol. 1996;6(4):481–504. doi:10.1177/0959353596064002.CrossRef

62.

Hawkey A, Ussher JM, Perz J. Regulation and resistance: experiences and constructions of premarital sexuality in the context of migrant and refugee women. J Sex Res. 2017; in press.

63.

Helmer J, Senior K, Davison B, Vodic A. Improving sexual health for young people: making sexuality education a priority. Sex Educ. 2015;15(2):158–71. doi:10.1080/14681811.2014.989201.CrossRef

64.

Dean J, Mitchell M, Stewart D, Debattista J. Intergenerational variation in sexual health attitudes and beliefs among Sudanese refugee communities in Australia. Cult Health Sex. 2016;1–15. doi:10.1080/13691058.2016.1184316.

65.

Martinez A, Phillips KP. Challenging ethno-cultural and sexual inequities: an intersectional feminist analysis of teachers, health partners and university students’ views on adolescent sexual and reproductive health rights. J Hum Sex. 2008;17(3):141–59.

66.

Suphanchaimat R, Kantamaturapoj K, Putthasri W, Prakongsai P. Challenges in the provision of healthcare services for migrants: a systematic review through providers’ lens. BMC Health Serv Res. 2015;15(1):1–14. doi:10.1186/s12913-015-1065-z.CrossRef

67.

Cleland J, Ali MM. Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Lancet. 2006;368(9549):1788–93. doi:10.1016/S0140-6736(06)69738-9.CrossRefPubMed

68.

Drummond PD, Mizan A, Brocx K, Wright B. Using peer education to increase sexual health knowledge among West African refugees in Western Australia. Health Care Women Int. 2011;32(3):190–205. doi:10.1080/07399332.2010.529215.CrossRefPubMed

69.

Sawade O. Lessons, challenges, and successes while working on the ‘Triangle’ of education, gender, and sexual and reproductive health. Gend Dev. 2014;22(1):127–40. doi:10.1080/13552074.2014.889339.CrossRef

70.

Ussher JM, Perz J, Metusela C, et al. Sexual and reproductive health of migrant and refugee women. Research report and recommendations for healthcare providers and community workers. Penrith, N.S.W: Western Sydney University; 2017. doi:10.4225/35/59223a9b97acf.

71.

Heard E, Auvaa L, Pickering C. Love bugs: promoting sexual health among young people in Samoa. Health Promot J Austr. 2015;26(1):30–2. doi:10.1071/HE14055.CrossRefPubMed

72.

McMillan K, Worth H. The impact of socio-cultural context on young people’s condom use: evidence from two Pacific Island countries. Cult Health Sex. 2011;13(3):313–26. doi:10.1080/13691058.2010.529945.CrossRefPubMed

73.

Maleku A, Aguirre RTP. Culturally competent health care from the immigrant lens: a qualitative interpretive meta-synthesis (QIMS). Soc Work Public Health. 2014;29(6):561–80. doi:10.1080/19371918.2014.893417.CrossRefPubMed

Titel: “In My Culture, We Don’t Know Anything About That”: Sexual and Reproductive Health of Migrant and Refugee Women
verfasst von: Christine Metusela
Jane Ussher
Janette Perz
Alexandra Hawkey
Marina Morrow
Renu Narchal
Jane Estoesta
Melissa Monteiro
Publikationsdatum: 15.06.2017
Verlag: Springer US
Erschienen in: International Journal of Behavioral Medicine / Ausgabe 6/2017
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-017-9662-3

Springer Medizin

Abstract

Purpose

Method

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2017

The Relation of Light-to-Moderate Alcohol Consumption to Glucose Metabolism and Insulin Resistance in Nondiabetic Adults: the Moderating Effects of Depressive Symptom Severity, Adiposity, and Sex

Fasting Glucose and the Risk of Depressive Symptoms: Instrumental-Variable Regression in the Cardiovascular Risk in Young Finns Study

‘If You Choose to Abort, You Have Acted As an Instrument of Satan’: Zimbabwean Health Service Providers’ Negative Constructions of Women Presenting for Post Abortion Care

“Not Brain-washed, but Heart-washed”: A Qualitative Analysis of Benevolent Sexism in the Anti-Choice Stance

Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture

Breastfeeding (Un)Covered: Narratives of Public Breastfeeding on Romanian Discussion Forums