Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review

(2022) 22:403 Davidson et al. BMC Public Health https://doi.org/10.1186/s12889-022-12576-4 Open Access RESEARCH Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review Natasha Davidson1*, Karin Hammarberg1, Lorena Romero2 and Jane Fisher1 Abstract Background: Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods: A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers’ (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results: The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions: Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and *Correspondence: 1 Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Davidson et al. BMC Public Health (2022) 22:403 Page 2 of 37 develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women. Keywords: Refugees, Women, Sexual and reproductive health, Health care providers, Access Background Globally, the number of people who are forcibly displaced both within countries and across borders as a result of conflict, persecution, violence or natural disasters has grown by over 50% in the last 10 years. In 2009, 43.3 million people were forcibly displaced, increasing to 79.5 million at the end of 2019 [1]. Of those, 45.7 million comprise internally displaced people, 26 million refugees and 4.2 million asylum-seekers [1]. Forcibly displaced people include those who have meet the United Nations criteria for being a refugee [2], those seeking asylum who are not yet granted refugee status and internally displaced people who have fled their region of origin within their country but have not crossed an international border. In general, refugee and displaced people with past and current migration experiences are considered vulnerable members of the community. The experiences and potential vulnerabilities of women and girls differ significantly from those of men and boys. Women are often afforded lower social status than men which places them in a position of dependency to men. Lack of educational opportunities make it more difficult for women to access decision-making positions and safe employment opportunities. At least half the forcibly displaced people are women and girls [3] with many living for protracted periods in refugee camps in poor conditions [4]. We acknowledge the importance of person-first language but in the interests of brevity, throughout this paper we refer to women from refugee-like backgrounds as “refugee and displaced women”. This term signifies the context of women’s refugee-like backgrounds and experiences. By definition refugee and displaced women have fled their country or region of origin. The refugee experience places these women in situations which create vulnerability. Pre-migration experiences caused by violence, torture, rape or witnessing the torture or killing of family or friends are associated with poor psychological and physical health outcomes [5]. Postmigration stress also contributes to poor general health, particularly in refugee and displaced women [6]. Most refugee and displaced women have not voluntarily chosen to leave their country of origin, often depart at short notice, have lengthy journeys within their own country or crossing international borders. They may be separated from family members in transit or at the time of resettlement, have reduced social support systems, b (...truncated)