What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants

No evidence, no problem? A critical interpretive synthesis of the vulnerabilities to and experiences of sexual violence among young migrants in Europe

BACKGROUND

Growing evidence indicates that young migrants are particularly vulnerable to sexual violence, however most research has focused on instances of sexual violence occurring in conflict zones and during transit. Much less attention has been given to the vulnerabilities to and experiences of sexual violence among young migrants in Europe.

OBJECTIVES

To understand the scientific evidence regarding the experiences of and vulnerabilities to sexual violence among young migrants (aged 11-30 years) in Europe.

METHODS

A search of three databases resulted in 1279 peer reviewed articles published between 2002 and 2022. Of these, 11 were included in this review. A critical interpretive synthesis methodology was applied.

RESULTS

Few studies investigate sexual violence among young migrants in Europe. The existing studies focus on very specific sub-groups of migrants, and as such, experiences of persons outside these groups are largely absent from the academic discourse. How sexual violence is understood varies across studies, often conflated with other forms of violence, hampering comparisons. However, the results of this review indicate that young migrants in Europe, both male and female, experience sexual violence and there are multiple sources of vulnerabilities at all levels of the socioecological model.

CONCLUSION

The scarcity of research regarding sexual violence among young migrants in Europe could give rise to the perception that no evidence means no problem, resulting in a continued lack of attention to this issue. There is a critical need to address this gap to inform prevention interventions, to identify victims, and to facilitate access to care.

Assessing the health status of migrants upon arrival in Europe: a systematic review of the adverse impact of migration journeys

BACKGROUND

Numerous studies have explored the impact of pre- and post-migration factors on the overall health of migrant populations. The objective of this study is to enhance our understanding of additional determinants affecting migrants' health by examining the impact of the migration phase and related journeys in the European context.

METHODS

We conducted a systematic review of studies published in the MEDLINE, Embase, and Scopus databases from 2003 up to January 5, 2024. We included observational studies reporting information on the health status of migrant populations recorded upon arrival in a country situated in Europe, and on the transit phase, including specific risk factors experienced during the journey or its characteristics. Title and abstract screening were performed using active learning techniques provided by ASReview software. The results of the included studies were presented qualitatively, with a focus on publications that formally assessed the association between the journey and the investigated health outcomes. The systematic review was registered on PROSPERO, CRD42024513421.

RESULTS

Out of 11,370 records screened, we ultimately included 25 studies, all conducted since 2017. Most adopted a cross-sectional design and a quantitative approach, with relatively small sample sizes. The majority of the studies were conducted in Serbia and Italy. Only 14 of them formally assessed the association between different exposures in the transit phase and health outcomes, including mental health, well-being and quality of life, infectious and non-communicable diseases.

CONCLUSION

Epidemiological research focusing on the transit phase in Europe remains limited, with few available studies facing challenges related to data collection, study design and analysis, thereby limiting the interpretability and generalisability of their results. These findings underscore the need for action, prompting the development of adequate and feasible strategies to conduct additional studies focusing on migrant populations during migration journeys.

Strategies for seeking care in the host country among asylum-seeking women who have been victims of sexual violence: A French qualitative study

Background

Incidence of sexual violence among recently arrived asylum-seeking women in France (INCIDAVI) is a French study which found a past year incidence of 26 % for postarrival sexual violence (SV) among asylum-seeking women (ASW). It reported that fewer than 1 out of 10 victims consulted a healthcare professional when SV occurred. These findings raise the question of how ASW who have been victims of SV get involved in care. We aimed to explore the mechanisms and obstacles to seeking care in the host country among this population.

Methods

This qualitative phase of INCIDAVI was based on a grounded theory approach. Twenty semi structured interviews were conducted between February 1, 2022, and July 29, 2022. The interviews explored the conditions under which women talk about SV, the care pathway in France and the perceived consequences of care. We performed an inductive analysis using NVivo® 14 software.

Findings

Life paths of ASW are traversed by SV which influence their health and safety behaviour and can re-expose them to SV. Talking about SV is a rare choice focused on seeking protection. When appropriate care is used, it is perceived as beneficial and leads to a change in the perception of a possible recovery.

Interpretation

The failure of ASW to seek care for SV is shaped by the fact that SV is initially perceived as ordinary. A proactive attitude on the part of carers towards detecting such violence leads to positive experiences of care, which in turn influence women's initial perceptions of SV, enabling them to envisage health recovery.

Intersectionality and Gender-Based Violence: An Empirical Multi-Level Examination of Prevalence and Frequency in Universities and Research Organizations

This article provides a multilevel intersectional analysis of the prevalence and frequency of gender-based violence within universities and other research organizations in Europe. Results show not only the high prevalence of gender-based violence in this context, but also that in contrast to the prevailing discourse, that gender-based violence is not solely a "women's problem", but also a structural issue impacting diverse identities. Data on frequency show that physical and sexual violence usually occurs as isolated incidents, whereas psychological violence and harassment are often repeated.

Coming across a hidden problem in an excluded population in Sweden: professionals' experiences of young migrants' disclosures of sexual violence

Growing evidence suggests that young migrants are particularly vulnerable to sexual violence. As young migrants often lack family and social networks, professionals are often the recipients of disclosures of sexual violence. This study aimed to explore how professionals experience young migrants' disclosures of sexual violence. A qualitative design was used, based on 14 semi-structured interviews with a range of professionals from the public sector and civil society in southern Sweden. The data were analysed using qualitative content analysis. The overarching theme developed was 'coming across the hidden problem of sexual violence in an excluded population' supported by three sub-themes: 'linking structural marginalisation and vulnerability to sexual violence'; 'realising that sexual violence is one among many other concerns'; and 'taking pride in backing up young people betrayed by society'. Professionals expressed a strong sense of responsibility due to the complex vulnerabilities of young migrants and their lack of access to services. This, coupled with the lack of clarity about how to respond to disclosures of sexual violence, can lead to moral distress. There is a need to strengthen support for professionals, including recognition of ethical dilemmas and the establishment of formal connections between organisations making access more straightforward and predictable.

The Role of Intersectionality and Context in Measuring Gender-Based Violence in Universities and Research-Performing Organizations in Europe for the Development of Inclusive Structural Interventions

The aim of the article is to discuss how thinking about gender-based violence intersectionally and in context can not only enrich our understanding but also lead to transformative change in organizations. The article argues that to better understand gender-based violence in universities and research institutions, analyses need to be intersectional and contextual. Such approaches go beyond binary understandings of gender and narrow legalistic definitions of gender-based violence. The article reflects on how to operationalize this to derive starting points for intersectional categories to consider and contextual factors to measure at micro-, meso-, and macro-levels. It concludes that a multilevel intersectional analysis leads to more nuanced knowledge on experiences of gender-based violence and is, therefore, better equipped to inform the development of measures to eradicate the problem in an inclusive way.

Migrant and Refugee Youth's Sexual and Reproductive Health and Rights: A Scoping Review to Inform Policies and Programs

Objectives: Migrants and refugee youth (MRY) in Western nations are less likely to participate in sexual reproductive health (SRH) services. Consequently, MRY are more likely to encounter adverse SRH experiences due to limited access to and knowledge of SRH services. A scoping review was conducted to examine MRY's understanding of and the implications for inclusive sexual and reproductive health and rights (SRHR) programs and policies. Methods: A systematic search of literature across seven academic databases was conducted. Data were extracted following Partners for Dignity and Rights' Human Rights Assessment framework and analysed using the thematic-synthesis method. Results: 38 literature (peer-reviewed, 24 and grey, 14) were considered eligible for inclusion. The findings highlighted significant barriers and the under-implementation of SRHR support and services by MRY. Key policy implications include a need for programs to support MRY's SRHR education, diversity, equity and inclusiveness and privacy protections. Conclusion: The review shows that the emerging evidence on MRY SRHR suggests gaps in practices for resourcing policies and programs that promote sustainable SRH for vulnerable populations. Policies for MRY's SRHR should prioritise programs that focus on diversity, equity and inclusion with targeted education and community resourcing strategies for sustainability.

[Assessment of the Individual Experience of Sexual Violence in War and Forced Displacement and its Consequences Among Male Victims: A Narrative Literature Review]

From a psychological perspective, male survivors of sexual violence in the context of war and forced displacement represent a highly burdened population. An adequate assessment of traumatic events and trauma related disorders is often hampered by both disclosure barriers from the patient side as well as by lack of awareness on the part of healthcare professionals regarding male victimization. Based on a narrative literature review, relevant characteristics of violence and their relation to the diagnostic process are elaborated on eight dimensions of individual experience of violence (form of violence, frequency and severity, perpetrator-victim context, societal discrimination, subjective evaluation, concept of masculinity, culture-specific norms, and trauma sequelae). The dimensions are delineated in a case study. In order to thoroughly assess sexualized experiences of violence, there is a need for sensitivity on the part of practitioners to the signs of male victimization and regular assessment of sexualized violence in male patients. In this context, certainty about the confidentiality of the information disclosed and recognition of the injustice are of central importance for those affected. In the long term, the development of specialized support services for male victims is needed.

Journey Effects? Waiting Periods in European Transit Countries and Subsequent Economic Integration of Refugees in Switzerland

Refugees face difficult journeys to receiving countries. These journeys often include waiting periods in transit countries, as refugees plan and collect resources for the next leg of transit. Sociological theories of waiting suggest that longer sojourns in transit countries may hamper subsequent economic integration in receiving countries. However, studying the effect of journey duration on refugee economic integration is difficult due to data constraints and endogeneity issues. In this article, I leverage a natural experiment. For refugees who entered Switzerland through the European Refugee Relocation Program in 2016 and 2017, waiting periods for relocation from Greece and Italy varied quasi-randomly from three to 17 months. My analysis shows that longer waiting periods in European transit countries did not reduce subsequent labor market participation. However, female refugees who waited longer worked less after arrival than male refugees who had comparable waits. This gap is partially driven by a positive effect of wait times on labor market participation among male refugees. These conditional results have implications for understandings of asylum-seeker integration, the gendered risks and opportunities that arise during refugee journeys, and migration policy making.

Migrant experiences of sexual and gender based violence: a critical interpretative synthesis

BACKGROUND

Gender based violence (GBV) is a critical issue and migrants are at higher risk of experiencing and being victimized by GBV. This critical interpretative synthesis (CIS) examines migrants experiences of GBV with a focus on different migrant groups and experiences at different stages of the migrant journey.

METHOD

The guiding question of this review is: "how do migrants experience gender-based violence?" A total of 84 studies were included in the CIS, of which 67 peer-reviewed academic articles were selected from 2356 studies found on WebofScience, MedLINE, and ProQuest, and 17 relevant studies from the grey literature were selected from the time period 2011 to 2020. All final studies were reviewed and synthesized using a critical inductive approach to formulate the key results.

RESULTS

The results demonstrate a high prevalence of GBV amongst migrants, and in particular among vulnerable migrant groups such as forced migrants and irregular migrants, with an emerging focus on male victims. Findings of the CIS revealed three key themes: 1) Most GBV occurrences are rooted in unequal power dynamics; 2) Victims often live with long-lasting consequences that are worsened by their fear of disclosure and stigmatization; 3) There are differential understandings of victimhood across organizations, communities, and victims themselves. In order to support access, sampling, and methodological challenges in this field of research, this article also reports its findings on common risk-factors identified, consequences and coping mechanisms reported, protection policies targeting GBV, and finally, available databases and data collection methods.

CONCLUSION

Further directions for research should be encouraged to move beyond prevalence reporting into identifying risk-factors and possible prevention in both sexes. In addition, more research on GBV experiences throughout migrants' journeys, and coping mechanisms should be encouraged.

Characteristics and Impacts of Sexual Violence Against Men and Boys in Conflict and Displacement: A Multicountry Exploratory Study

Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence against men and boys may not be rare in Myanmar (northern Rakhine state), Libya, eastern DRC, and South Sudan. Frequently reported forms of violence in these settings were genital violence, forced witnessing of sexual violence, and rape. Sites where violence was often reported included border crossings, along the roadside, and during imprisonment. In host countries, forms of sexual violence included sexual abuse of boys, sexual exploitation particularly of adolescents and persons with diverse sexual orientation and gender identity, and rape. Impacts on survivors involved short- and long-term physical, mental, economic, and familial dimensions. These findings aim to inform sexual violence-related prevention, mitigation, and response efforts in humanitarian settings. More research is warranted, including on sexual violence against men and boys in Somalia, sexual violence by family and community members in conflict and displacement settings, sexual exploitation of adolescent boys, and sexual violence including sexual exploitation of persons with diverse sexual orientation and gender identity.

Migrant women and sexual and gender-based violence at the Colombia-Venezuela border: A qualitative study

Background

Sexual and Gender-Based Violence (SGBV) affects women and girls in multiple ways. During migration and within humanitarian settings, migrant women and girls are exposed to different forms of SGBV and to higher vulnerabilities compared with those men encounter. Survivors of this kind of violence face challenges in accessing healthcare for reasons that not only include legal status, language barriers, discrimination, misinformation on the availability of healthcare services, but also the growing spread of conservative views regarding sexual and reproductive health which pose a considerable threat to human rights. This study was guided by the question of how humanitarian emergency preparedness and response initiatives within four cities at the Colombo-Venezuelan border are addressing SGBV. The goal of this research was threefold: first, to explain the level of implementation of the second goal of the MISP, which is to prevent and respond to the consequences of sexual violence; second, to assess the availability of services for migrants who have experienced some type of sexual violence; and third, to understand the perceptions of migrants regarding sexual and gender-based violence.

Methods and Findings

This study assessed the degree of implementation of the Minimal Initial Service Package (MISP) using a set of tools developed by the Inter-Agency Working Group on Reproductive Health in Crises. This study combined the use of different qualitative methods: i) a literature review; ii) 23 interviews with key informants on sexual and reproductive health; iii) an assessment of 21 health institutions which provide services to migrants; and iv) 24 focus groups with migrants between the ages of 14 to 49 years old (241 participants, of which 121 were women and 120 were men). This research was conducted in four cities at the Colombo-Venezuelan border where there was the highest concentration of migrants. Ethical approval was granted by Profamilia´s Advisory Committee on Research Ethics. Although preventing and managing the consequences of sexual violence is the second objective of the MISP, this study found several barriers for the guarantee of comprehensive healthcare for survivors: Venezuelan migrants do not usually consider that healthcare is a need for them after they have survived sexual violence; SGBV during migration is a common occurrence according to key informants; in three out of four cities there were existing organizations working on SGBV, but not all of them could offer comprehensive healthcare services in response to sexual violence.

Conclusions

In this study, we observed that migrants tend to be more exposed to Sexual and Gender-Based Violence due to the normalization of such forms of violence in the Colombian and Venezuelan cultures. Findings suggest that Venezuelan migrants are facing complex SGBV issues during the humanitarian emergency at the Colombia-Venezuela border. Recommendations include local health systems response teams, governments and host communities working together to address early access to prevention, healthcare, and protection services for the survivors of SGBV; eliminating barriers in access to essential and comprehensive equity-oriented healthcare services; developing the skills and capacities of healthcare services professionals around the proper management of SGBV; and countering misinformation, lowering the stigma associated with migrants in host communities, and broadening migrant´s perceptions of SGBV, gender roles, and xenophobia.

Clinical agreement with self-report of physical violence and torture in women seeking asylum in France

Women are a particularly vulnerable group among persons seeking asylum but are still required to provide clinical evidence of acts of violence inflicted against them. In this study the authors describe patient histories, dermatological lesions and other injuries arising from physical violence and torture in female asylum-seekers attending a specialist outpatient service in France. Twenty-seven women were assessed during 2016-2018. Clinical corroboration of lesions with patients' self-reports was affirmative in >90% (25/27) of cases. Health care services in recipient countries must be configured and resourced to support women seeking asylum, and health care professionals must be receptive and sensitive to women's self-reported histories.

Rape, transactional sex and related factors among migrants in transit through Mexico to the USA

Migrants in transit through Mexico to the USA are at risk of violence, including sexual violence, during the immigration process. This study sought to identify the socio-demographic factors, migration experiences and health conditions associated with the likelihood of sexual violence. A mixed methods study was conducted between 2012 and 2015. The quantitative phase of the work involved a non-random sample (n = 3539) of migrants who were the users of migrant shelters in Mexico. A probit regression model was used to identify the variables associated with the experience of sexual violence by participants. A total of 58 semi-structured interviews took place with migrants who had either experienced sexual violence or who were acquainted with the sexual violence experienced by other migrants. Of those who experienced any kind of violence, 5.7% reported having experienced sexual violence, with statistically significant differences by gender. According to male migrants, women in transit had the advantage of having an 'entry ticket [to the USA] between their legs'. The dynamics of undocumented transit migration provide multiple opportunities for gender-based inequality and sexual violence. We consider the major underreporting of sexual violence due to the stigma and normalisation of violence, in a social context marked by impunity.

Understanding Violence against Women Irregular Migrants Who Arrive in Spain in Small Boats

African irregular migrants risk their lives crossing the Mediterranean Sea in small boats hoping to reach Europe. Women irregular migrants (WIMs) are an especially vulnerable group that suffer from violence and sexual aggression, but little is known about their actual experiences. The objective of our study is to describe and understand the violence against WIMs who arrive in Spain in small boats. A qualitative study based on Gadamer’s phenomenology was used. The data collection included twenty-six in-depth interviews with WIMs. Three main themes arose: “Poverty and discrimination push WIMs into migrating”; “WIMs as a paradigm of extreme vulnerability”, and “WIMs in small boats should raise the alarm”. WIMs who arrive to Europe in small boats have a history of violence, rape, prostitution, forced pregnancy, and human trafficking. Emergency care must include gynecological examinations and must make detecting sexual violence and human trafficking of WIMs part of their care protocols.

Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study

BACKGROUND

this study aimed to describe and understand the experiences and health needs of women irregular migrants during emergency care provision upon arrival in Spain by small boat.

METHODS

a qualitative study based on Gadamer's phenomenology was used. The data collection included 13 in-depth interviews with women irregular migrants and 10 in-depth interviews with key informants. The study took place in the Spanish Red Cross' facilities between February 2017 and April 2018.

RESULTS

two main themes emerged from the data analysis: the need for emergency care focused on women irregular migrants with the sub-themes 'Women irregular migrants as objects of sexual exploitation' and 'The mother-child dyad as the axis in human trafficking'; and developing an emergency care gender policy for women irregular migrants, with the subthemes 'Healthcare in a police-controlled setting: detecting weaknesses' and 'Promoting screening and safety protocols focused on women irregular migrants'.

CONCLUSIONS

women irregular migrants who arrive in Spain by small boat have specific needs and healthcare problems. Due to strict safety conditions during emergency care provision, rape and human trafficking can go unnoticed.

IMPLICATIONS

interdisciplinary care protocols and new health policies that have a gender perspective are needed to improve the emergency care provided to women irregular migrants.

Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015

Objectives

The objectives of the study are to 1) estimate the burden of physical, sexual, and psychological violence among migrants in transit through Mexico to the US; and 2) examine the associations between experiencing violence and sociodemographic characteristics, migratory background, and health status in this vulnerable population.

Method

A cross-sectional study combining qualitative and quantitative methods was carried out from 2009 to 2015 with a sample of 12,023 migrants in transit through Mexico to the US. Information on gender (male, female, and transsexual, transgender and transvestite -TTTs-); nationality; health status; migratory background; and experiences with violence was obtained. Fifty-eight migrants participated in in-depth interviews to explore any experiences of violence during their journey. A descriptive analysis was performed and a probit regression model was applied to analyze the factors associated with violence. Qualitative information was analyzed to understand experiences, meanings and responses to violence.

Results

The overall prevalence of suffering from any form of violence was 29.4%. Nearly 24% reported physical violence, 19.5% experienced psychological violence, and approximately 2% reported sexual violence. TTTs experienced a significantly greater burden of violence compared to men and women. Violence occurred more frequently among migrants from Central American (30.6%) and other countries (40.0%) than it did among Mexican migrants (20.5%). Experiences involving sexual, physical and psychological violence as well as theft and even kidnapping were described by interviewees. Migrants mistrust the police, migration authorities, and armed forces, and therefore commonly refrain from revealing their experiences.

Conclusion

Migrants are subjected to a high level of violence while in transit to the US. Those traveling under irregular migratory conditions are targets of even greater violence, a condition exacerbated by gender inequality. Migrants transiting through Mexico from Central American and other countries undergo violence more frequently than do Mexican migrants. Protective measures are urgently needed to ensure the human rights of these populations.

Conceptualizing sexual and gender-based violence in European asylum reception centers

Background

Sexual and gender based violence (SGBV) is a major public health problem and a violation of human rights. Refugees, asylum seekers and migrants are exposed to a constant risk for both victimization and perpetration. Yet, in the context of European asylum reception centers (EARF) professionals are also considered to be at risk. Our study explores the conceptualization of SGBV that residents and professionals have in this specific context. Further, we intent to identify key socio-demographic characteristics that are associated with SGBV conceptualization for both groups.

Methods

We developed a cross-sectional study using the Senperforto project database. Semi-structured interviews were conducted with residents (n = 398) and professionals (n = 202) at EARF. A principal component analysis (PCA) was conducted to variables related with knowledge on SGBV. Chi-square test and Fisher’s exact test were applied to understand if significant statistical association exists with socio-demographic characteristics (significant level 0.5%).

Results

The majority of residents were male (64.6%), aged from 19 to 29 years (41.4%) and single (66.8%); for professionals the majority were women (56.2%), aged from 30 to 39 years (42.3%) and married (56.8%). PCA for residents resulted in 14 dimensions of SGBV representing 83.56% of the total variance of the data, while for professionals it resulted in 17 dimensions that represent 86.92% of the total variance of the data. For both groups differences in SGBV conceptualization were found according to host country, sex, age and marital status. Specific for residents we found differences according to the time of arrival to Europe/host country and type of accommodation, while for professionals differences were found according to legal status and education skills.

Conclusion

Residents and professionals described different conceptualization of SGBV, with specific types of SGBV not being recognized as a violent act. Primary preventive strategies in EARF should focus on reducing SGBV conceptualization discrepancies, taking into account socio-demographic characteristics.

Prevalence of Sexual Violence in Migrants, Applicants for International Protection, and Refugees in Europe: A Critical Interpretive Synthesis of the Evidence

(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, the development of prevention strategies and care paths focusing on victimised MARs is highly needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Europe and the challenges encountered in research on this topic. (2) Methods: A critical interpretive synthesis of 25 peer-reviewed academic studies and 22 relevant grey literature documents was conducted based on a socio-ecological model. (3) Results: Evidence shows that SV is highly frequent in MARs in Europe, yet comparison with other groups is still difficult. Methodologically and ethically sound representative studies comparing between populations are still lacking. Challenges in researching SV in MARs are located at the intrapersonal, interpersonal, community, societal, and policy levels. (4) Conclusions: Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches could be applied to better grasp the complexity of interplaying determinants of SV in MARs.

Inequity in contraceptive care between refugees and other migrant women?: a retrospective study in Dutch general practice

BACKGROUND

Female refugees are at high risk of reproductive health problems including unmet contraceptive needs. In the Netherlands, the general practitioner (GP) is the main entrance to the healthcare system and plays a vital role in the prescription of contraceptives. Little is known about contraceptive care in female refugees in primary care.

OBJECTIVE

To get insight into GP care related to contraception in refugees and other migrants compared with native Dutch women.

METHODS

A retrospective descriptive study of patient records of refugees, other migrants and native Dutch women was carried out in five general practices in the Netherlands. The prevalence of discussions about contraception and prescriptions of contraceptives over the past 6 years was compared in women of reproductive age (15-49 years).

RESULTS

In total, 104 refugees, 58 other migrants and 162 native Dutch women were included. GPs in our study (2 male, 3 female) discussed contraceptives significantly less often with refugees (51%) and other migrants (66%) than with native Dutch women (84%; P < 0.001 and P = 0.004, respectively). Contraceptives were less often prescribed to refugees (34%) and other migrants (55%) than to native Dutch women (79%; P < 0.001 and P = 0.001). Among refugees from Sub-Saharan Africa, contraception was significantly less often discussed (28.9%) compared with refugees from other regions (67.8%; P < 0.001). More refugees and other migrants had experienced unwanted pregnancies (14% respectively 9%) and induced abortions (12% respectively 7%) than native Dutch women (4% respectively 4%).

CONCLUSION

Contraceptives were significantly less often discussed with and prescribed to refugees and other migrant women compared with native Dutch women. More research is needed to elicit the reproductive health needs and preferences of migrant women regarding GP's care and experiences in discussing these issues. Such insights are vital in order to provide equitable reproductive healthcare to every woman regardless of her background.

Assessing reported cases of sexual and gender-based violence, causes and preventive strategies, in European asylum reception facilities

Background

Sexual and gender-based violence (SGBV) is a widespread public health problem and a violation of human rights rooted in gender and power inequities. Refugees, asylum-seekers and migrants living in European asylum reception facilities (EARF) are especially vulnerable to SGBV. To contribute to closing the gap on systematic and accurate evidence on SGBV, we aim to explore reported cases of SGBV, causes and preventable measures described by residents and professionals from EARF.

Methods

We developed a cross-sectional study using the Senperforto project database. Semi-structured interviews were conducted with residents (refugees, asylum-seekers and unaccompanied minors) and professionals (service and health care providers) at EARF, in 7 European countries. We used IBM® SPSS software to analyze our data. Further, statistical tests – Chi-square Test and Fisher’s exact test (5% significance level) were conducted.

Results

In total 562 respondents: 375 residents (R) and 187 professionals (P) participated in the study. The majority of respondents were male (56.9%), aged 19 to 39 years (67.3%). Respondents described 698 cases of SGBV (R 328, P 370), comprising 1110 acts of multi-types of violence. Respondents from Malta (160) and Belgium (143) reported the highest number of SGBV cases. The main reported causes were frustration and stress (R 23.6%, P 37.6%, p 0.008) and differences related with cultural background (R 19.3%, P 20.3%, p 0.884). Respondents assumed that these acts of violence could be prevented by SGBV prevention interventions (R 31.5%, P 24.7%, p 0.293); improving living conditions (R 21.7%, P 15.3%, p 0.232); and promoting communication (R 16.1%, P 28.2%, p 0.042). The majority of R were not aware of existing preventable measures in the asylum facility or host country. While the majority of P were aware of existing preventable measures in the asylum facility or country. Proposed SGBV prevention strategies in EARF included SGBV sensitization and awareness, improving living conditions and improving communication between R and P.

Conclusion

In the EARF context, SGBV is characterized by multi-types of violence acts, yet R and P believe that prevention is possible. Our results call for urgent integrative prevention strategies that are in line with country-level and international regulations.

A comparative analysis of psychological trauma experienced by children and young adults in two scenarios: evacuation after a natural disaster vs forced migration to escape armed conflict

OBJECTIVES

Little is known about the psychological trauma experienced by children and young adults (CYAs) following displacement after natural disasters vs migration from conflict zones. In both instances, the decision to leave is usually cast by the family, and the life of CYAs is suddenly disrupted by external circumstances.

STUDY DESIGN

An anonymous survey.

METHODS

The same survey instrument, provided by the National Child Traumatic Stress Network (NCTSN), was used to survey self-reported health needs among CYAs during the aftermath of Hurricane Katrina (Health Survey for Children and Adolescents After Katrina) in October 2005-February 2006 and again during the peak of refugee arrivals in Berlin between October 2015 and March 2016. A weighted index to measure cumulative exposure to traumatic stresses during migration was developed along with an unweighted psychological impact score based on the 22-item NCTS psychological impact questionnaire. Spearman's correlation coefficient (rho) was used to assess the correlation between age and the two psychological impact indices. The two-tailed t-test was used to investigate differences in trauma experienced and psychological impact by gender. Logistic regression was used to investigate differences in types of traumatic stress experienced and psychological impact among CYAs displaced because of Hurricane Katrina and those seeking asylum in Berlin.

RESULTS

The Katrina cohort included a total of 1133 CYAs, the Berlin cohort, a total of 405 CYAs. The median age in the Katrina cohort was 6.73 years (standard deviation [SD] 5.67, range 0-24; 50.13% males) compared with 17.64 years (SD, range 0-24; 83% males) in the Berlin cohort. Comparative analyses were adjusted to age and gender and revealed significant differences between the two cohorts, both with regards to the amount of trauma experienced and the psychological impact. A statistically significant and moderate positive correlation was observed between trauma experienced and psychological impact of migration in the refugee population (rho = 0.4955, P < 0.001); the correlation was less pronounced but still significant in the Katrina cohort (rho = 0.0942, P = 0.0015). Free-text responses revealed that in addition to common concerns about health, housing and safety, refugees were also pre-occupied with language acquisition and the adaptation to a new culture.

CONCLUSIONS

The observed differences in the experience and the consequences of trauma in displaced CYAs warrant additional investigation. It was replicated that human-made disaster seems to show more traumatising potential than natural disaster. Stakeholders need to be aware of the potential medium and long-term consequences of migration/evacuation and allocate resources accordingly.

Programme potential for the prevention of and response to sexual violence among female refugees: a literature review

Continuing international conflict has resulted in several million people seeking asylum in other countries each year, over half of whom are women. Their reception and security in overburdened camps, combined with limited information and protection, increases their risk and exposure to sexual violence (SV). This literature review explores the opportunities to address SV against female refugees, with a particular focus on low-resource settings. A systematic literature review of articles published between 2000 and 2016 was conducted following PRISMA guidelines. Databases including Medline (Ovid), PubMed, Scopus, PsychINFO, CINAHL and the Cochrane Library. Grey literature from key refugee websites were searched. Studies were reviewed for quality and analysed according to the framework outlined in the UNHCR Guidelines on Prevention and Response of Sexual Violence against Refugees. Twenty-nine studies met the inclusion criteria, of which 7 studies addressed prevention, 14 studies response and 8 addressed both. There are limited numbers of rigorously evaluated SV prevention and response interventions available, especially in the context of displacement. However, emerging evidence shows that placing a stronger emphasis on programmes in the category of engagement/participation and training/education has the potential to target underlying causes of SV. SV against female refugees is caused by factors including lack of information and gender inequality. This review suggests that SV interventions that engage community members in their design and delivery, address harmful gender norms through education and advocacy, and facilitate strong cooperation between stakeholders, could maximise the efficient use of limited resources.

Prevalence and circumstances of forced sex and post-migration HIV acquisition in sub-Saharan African migrant women in France: an analysis of the ANRS-PARCOURS retrospective population-based study

BACKGROUND

Sub-Saharan African migrant women are a key population at risk of HIV infection in Europe. Using data from the ANRS-PARCOURS study, we aimed to assess the prevalence of forced sex after migration and its association with post-migration acquisition of HIV as well as the circumstances of forced sex after migration, including housing and administrative insecurity, among sub-Saharan African migrant women living in the Paris Region, France.

METHODS

The ANRS-PARCOURS study was a retrospective life-event survey done between February, 2012, and May, 2013, in health-care facilities in the Paris region of France. Women were eligible if they were born in sub-Saharan Africa, aged between 18 and 59 years, and had been diagnosed with HIV infection at least 3 months earlier for women receiving HIV care or not diagnosed with HIV. In this analysis, we used ANRS-PARCOURS study data to compare the incidence of forced sex after migration in three groups of sub-Saharan African migrant women: those who acquired HIV after migrating, those who acquired HIV before migrating, and those without HIV. We assessed the associations between forced sex, sexual partnerships, and living conditions after migration with mixed-effects logistic regression and generalised structural equation models. The study is registered with ClinicalTrials.gov, number NCT02566148.

FINDINGS

We obtained data from 980 eligible individuals who participated in the ANRS-PARCOURS study (407 without HIV and 573 HIV-positive) from 54 randomly selected health-care facilities. We excluded 20 women whose HIV infection could not be dated and eight women with missing data from the analyses, for a total of 405 women in the reference group (without HIV) and 547 women in the HIV group (156 with post-migration HIV acquisition, 391 with pre-migration HIV). Women who acquired HIV after migration experienced forced sex after migration more frequently than women without HIV (24 [15%] vs 18 [4%]; p=0·001). Forced sex after migration was associated with being hosted by family or friends (β=0·95, 95% CI 0·19-1·72) and lack of stable housing (β=1·10, 0·17-2·03). Lack of a residence permit was also associated with forced sex after migration.

INTERPRETATION

The social hardships faced by sub-Saharan African migrant women after migration, especially a lack of housing or lack of a residence permit, increases their exposure to sexual violence and to HIV infection.

FUNDING

The French National Agency for Research on AIDS and Viral Hepatitis, Santé publique France, the national public health agency.

Traveling through the perineum(s): to the discovery of an old world

INTRODUCTION

The migration of large numbers of people and refugees induces various fears in their receiving countries; the arrival of potential terrorists, and, among others, the negative impact that their need for health care can have on the sustainability of health services. In this sense, migrants are considered by many a threat.

METHOD

In this brief "letter narrative", based on the experience gained in the treatment of various diseases of the perineum, I mean to suggest that the perineal disorders, especially in women, is common event, shared by women of different ethnicity, culture, and religion. Moreover, they do not threaten the sustainability of health services.

DICUSSION AND CONCLUSION

For the scientific community, there is a need for greater attention and conscious analysis of pathologies and fundamental human rights that accompany these populations to better understand the scope and value also in terms of scientific research in this epochal event.

International organizations and migrant health in Europe

International organizations have defined and managed different aspects of migrant health issues for decades, yet we lack a systematic understanding of how they reach decisions and what they do on the ground. The present article seeks to clarify the state of knowledge on the relationship between international organizations and migrant health in Europe. To do so, we review the operations of six organizations widely recognized as key actors in the field of migrant health: the European Commission, the Regional Office for Europe of the World Health Organization, the International Organization on Migration, Médecins du Monde, Médecins Sans Frontières, and the Open Society Foundation. We find that international organizations operate in a complementary fashion, with each taking on a unique role in migrant health provision. States often rely on international organizations as policy advisors or sub-contractors for interventions, especially in the case of emergencies. These linkages yield a complex web of relationships, which can vary depending on the country under consideration or the health policy issue in question.

Sexual and gender-based violence against refugee women: a hidden aspect of the refugee "crisis"

The current refugee "crisis" in Europe has created multiple forms of vulnerability and insecurity for refugee women including various forms of sexual and gender-based violence. Increasing numbers of women, either alone or with family, are attempting to reach Europe to seek protection from conflict and violence in their countries, but these women are subject to violence during their journey and/or on arrival in a destination country. The lack of adequate accommodation or reception facilities for refugees and migrants in Europe, as well as the closure of borders which has increased the need for smugglers to help them reach Europe, acts to exacerbate the violence and insecurity.