A socio-ecological approach for examining factors related to contraceptive use among recent Latina immigrants in an emerging Latino state

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review

BACKGROUND

Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia.

METHODS

The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care.

RESULTS

A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling.

CONCLUSIONS

There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students

BACKGROUND

Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia.

METHODS

Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels.

RESULTS

Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information.

CONCLUSIONS

Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach

OBJECTIVES

The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.

DESIGN

A qualitative exploratory design with the key informant approach.

SETTING AND PARTICIPANTS

The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women.

RESULTS

Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women.

CONCLUSIONS

A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

BACKGROUND

Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective.

METHODS

We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460.

RESULTS

We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances.

CONCLUSION

To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.

Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

Crisis at the intersection of four countries: healthcare access for displaced persons in the Lake Chad Basin region

For a decade, the Lake Chad Basin (LCB) region, which is at the intersection of four countries and home to ethnic groups in Cameroon, Chad, Niger and Nigeria, has been occupied by Boko Haram. The lax borders and deprivation in the region contributed to the emergence and expansion of Boko Haram's insurgency. While much is known about the human casualties of the invasion, little is known about the accessibility of healthcare for the displaced persons. This qualitative study adopted Penchansky and Thomas' ([1981]. "The Concept of Access: Definition and Relationship to Consumer Satisfaction." Medical Care 19 (2): 127-140) theory of access as its conceptual framework (with the following components: geographical accessibility, availability, financial accessibility, acceptability and accommodation) to explore the experiences of the displaced persons in the LCB with respect to access to healthcare. One-on-one interviews (n = 51) and two focus group discussions (n = 16) were conducted with 67 refugees and internally displaced persons recruited from nine host communities in Nigeria and Cameroon, who shared their perceptions of their healthcare access. The displaced persons faced barriers to their access to the healthcare in the LCB. It was found that for each of the components of the theory of access, the study participants encountered barriers to healthcare access. For example, with regard to financial accessibility (affordability), poverty was identified as the main personal barrier to the displaced persons' healthcare access, and with regard to acceptability, it was communication that was reported to be a barrier. The limitations of the study, the recommendations for future research and the implications of the findings are discussed in detail.

Socially Connected Neighborhoods and the Spread of Sexually Transmitted Infections

Sexually transmitted infections (STIs) in the United States have been increasing at record levels and exhibit unequal spatial patterning across urban populations and neighborhoods. Research on the effects of residential and nearby neighborhoods on STI proliferation has largely ignored the role of socially connected contexts, even though neighborhoods are routinely linked by individuals' movements across space for work and other social activities. We showcase how commuting and public transit networks contribute to the social spillover of STIs in Chicago. Examining data on all employee-employer location links recorded yearly by the Census Bureau for more than a decade, we assess network spillover effects of local community STI rates on interconnected communities. Spatial and network autoregressive models show that exposure to STIs in geographically proximate and socially proximate communities contributes to increases in local STI levels, even net of socioeconomic and demographic factors and prior STIs. These findings suggest that geographically proximate and socially connected communities influence one another's infection rates through social spillover effects.

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

Background

About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia.

Methods

We conducted a scoping review of the literature published from 1^st January 1970 to 30^th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model.

Results

A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations.

Conclusions

People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13256-z.

Women's post-abortion contraceptive use: Are predictors the same for immediate and future uptake of contraception? Evidence from Ghana

This study seeks to identify the socio-demographic, reproductive, partner-related, and facility-level characteristics associated with women’s immediate and subsequent use of post-abortion contraception in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were utilized in this study. The weighted data comprised 1,880 women who had ever had an abortion within the five years preceding the survey. Binary logistic regression analyses were performed to examine the associations between the predictor and outcome variables. Health provider and women’s socio-demographic characteristics were significantly associated with women’s use of post-abortion contraception. Health provider’s counselling on family planning prior to or after abortion and place of residence were associated with both immediate and subsequent post-abortion uptake of contraception. Among subsequent post-abortion contraceptive users, older women (35–49), women in a union, and women who had used contraception prior to becoming pregnant were strong predictors. Partner-related and reproductive variables did not predict immediate and subsequent use of contraception following abortion. Individual and structural/institutional level characteristics are important in increasing women’s acceptance and use of contraception post abortion. Improving and intensifying family planning counselling services at the health facility is critical in increasing contraceptive prevalence among abortion seekers.

Latinx Immigrant Mothers' Perceived Self-Efficacy and Intentions Regarding Human Papillomavirus Vaccination of Their Daughters

OBJECTIVE

Racial and ethnic disparities persist in cervical cancer cases, 90% of which are caused by the human papillomavirus (HPV). Suboptimal vaccine uptake is problematic, particularly among Latinx women, who have the highest cervical cancer incidence compared with other racial/ethnic groups. We examined the association of self-efficacy and HPV vaccination intention among Latinx immigrant mothers of unvaccinated 9- to 12-year-old girls.

METHODS

An interview-administered survey assessed baseline sociodemographic information, knowledge and perceived risk of cervical cancer and HPV, self-efficacy, and intention to vaccinate among 313 Latinx immigrant mothers in Alabama from 2013 to 2017 before the implementation of an intervention to promote HPV vaccination.

RESULTS

Participants were, on average, 35 years old, with 9 years of education, and had lived in the United States for 12 years. Mothers who perceived their daughters were at risk of HPV infection were more likely to be vaccine intent than their hesitant counterparts (p < .001). Vaccine hesitancy was more common in those with lower education, low HPV and cervical cancer knowledge, and lower perceived self-efficacy scores (p < .001). Self-efficacy was associated with vaccine intention when controlling for other variables (p < .001). The only variable associated with self-efficacy was HPV awareness (p = .001).

CONCLUSIONS

Programs promoting HPV vaccination among Latinx immigrants should include educational components regarding risks of HPV infection and cervical cancers in addition to information regarding access to vaccination services. Knowledge of risks and access may heighten perceptions of self-efficacy and improve vaccine uptake among this population.

Managing Precarity: Understanding Latinas' Sexual and Reproductive Care-Seeking in a Midwest Emergent Latino Community

In this qualitative interview study, we took a two-pronged approach to understand the complexities of sexual and reproductive health (SRH) care access for Latinas in an emerging Latino community (ELC). Phase 1 assessed the SRH resources available for uninsured Latinas through provider interviews. In Phase 2, we interviewed 15 Latina-identified women about their considerations for SRH care-seeking. The scant options for SRH care are focused largely on contraception and pregnancy. Providers viewed themselves as prevention-oriented and perceived Latinas did not prioritize preventive care. Women described compounding challenges and precarious conditions. Annual checkups, accessing contraception, and treating vaginal infections were identified as needs. Barriers to SRH care were enhanced in an ELC. Participants described too much paperwork and limited time as organizational barriers which aggravated others, such as language limitations and feeling embarrassed to ask questions. Further research on SRH care using a reproductive justice approach is needed in ELCs.

Factors influencing contraceptive use or non-use among Aboriginal and Torres Strait Islander people: a systematic review and narrative synthesis

Background

The Australian population has an unmet need for contraception. However, evidence suggests contraceptive patterns of Aboriginal and Torres Strait Islander populations are unique. To tailor contraceptive services and meet the contraceptive needs of Aboriginal and Torres Strait Islander people, it is important to understand the contributing factors to contraceptive use and non-use.

Methods

This study aimed to systematically review and narratively synthesise the evidence exploring the factors influencing contraceptive use among Aboriginal and Torres Strait Islander people. A systematic literature search was initially run in September 2016 and was updated again in April and August of 2018. A qualitative narrative synthesis was conducted from 2018 to 2019. Factors influencing contraceptive use or non-use were explored using a Social Ecological Model.

Results

The review identified 17 studies meeting the inclusion criteria published between 1972 and 2018. Most of the included studies were qualitative (n = 11), with the remaining studies being mixed methods (n = 3) or quantitative (n = 3). The majority focused on either a localised geographic area or specific Aboriginal or Torres Strait Islander community (n = 11). One study specifically focused on factors influencing contraceptive use, albeit among postpartum women. The remaining studies discussed factors influencing contraceptive use within the context of risky behaviour, sexual transmitted infections, or contraceptive practices more generally. Factors unique to individual communities included community attitudes (e.g. importance of not being too young to have a baby), specific cultural norms (e.g. subincising the penis as part of transition to manhood), and access to culturally appropriate health services. Other factors, including contraceptive characteristics (e.g. discomfort of condoms) and reproductive coercion (e.g. partner wants a baby), were similar to those found in the broader population of Australia and internationally. Most studies were lacking in quality, warranting more methodologically sound studies in the future to further assess the factors contributing to contraceptive use or non-use among Aboriginal and Torres Strait Islander people.

Conclusions

Identifying community specific facilitators, as well as understanding the more broadly applicable factors contributing to contraceptive use or non-use, is essential if wanting to offer appropriate contraceptive services within an Aboriginal or Torres Strait Islander community.

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar

BACKGROUND

Humanitarian migrants from Myanmar represent a significant refugee group in Australia; however, knowledge of their health needs and priorities is limited. This study aims to explore the meaning and influencers of health from the perspectives of refugees from Myanmar.

METHOD

Using a community-based participatory research (CBPR) design, a partnership was formed between the researchers, Myanmar community leaders and other service providers to inform study design. A total of 27 participants were recruited from a government-funded English language program. Data were collected using a short demographic survey and four focus groups, and were analysed using descriptive statistics and thematic analysis methods.

RESULTS

Key themes identified included: (1) health according to the perspectives of Australian settled refugees from Myanmar, (2) social connections and what it means to be part of community, (3) work as a key influence on health, and (4) education and its links with work and health.

CONCLUSIONS

This study outlined the inter-relationships between health, social connections, work and education from the perspectives of refugees from Myanmar. It also outlined how people from Myanmar who are of a refugee background possess strengths that can be used to manage the various health challenges they face in their new environment.

Muslim Women's use of contraception in the United States

Background

American Muslim women are an understudied population; thus, significant knowledge gaps exist related to their most basic health behaviors and indicators. Considering this, we examined American Muslim women’s contraception utilization patterns.

Methods

Self-reported data collected in late 2015 were analyzed. Women who identified as Muslim, were at least 18 years old, sexually active, and current residents of the United States (n = 224) met the inclusion criteria. Convenience sampling was employed. Multivariate logistic regression models estimated associations between demographics, marital status, ethnicity, nativity, health insurance, religious practice, and contraception use.

Results

Identifying as Muslim, in general, was significantly associated with greater odds of using contraception in general and condoms compared to American Muslim women who identify as Sunni. Identifying as Shia was associated with greater odds of using oral contraceptive pills relative to Sunni respondents. South Asian ethnicity was associated with higher odds of using oral contraceptive pills compared to those of Middle Eastern or North African ethnicity.

Conclusions

Findings suggest American Muslim women’s contraception utilization patterns share certain similarities with both American women in general and disadvantaged racial and ethnic minority groups in the United States, implying that factors that influence American Muslim women’s use of contraceptives are possibly countervailing and likely multifaceted. More research is needed to accurately identify associates of contraceptive use in this population. This work serves as a starting point for researchers and practitioners seeking to better understand reproductive health decision in this understudied population.

Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

BACKGROUND

In Australia only 2.2% of published health research has focused on multi-cultural health despite the increase of culturally and linguistically diverse populations. Research on the perceptions and experiences of health care professionals (HCPs) in engaging with refugee and migrant women is also lacking. Given the integral role of HCPs in providing sexual and reproductive health (SRH) care for these populations, an understanding of the challenges they experience is required. Therefore, this study sought to examine the perspectives and practices of Australian HCPs with regard to the provision of SRH care for refugee and migrant women.

METHODS

Employing qualitative methods, twenty-one semi-structured interviews were conducted with HCPs representing various professions, work experiences, cultural backgrounds, age and healthcare sectors. The interviews were analysed using thematic analysis and the socio-ecological model was utilised to interpret the data.

RESULTS

The complexities of HCP's engagement with refugee and migrant women were identified in three major themes: Being a Migrant; Gender Roles and SRH Decision-making; and Women in the Healthcare System. HCPs discussed the impact of accessing SRH care in women's country of origin and the influence of re-settlement contexts on their SRH knowledge, engagement with care and care provision. Perception of gender roles was integral to SRH decision-making with the need to involve male partners having an impact on the provision of women-centred care. Barriers within the healthcare system included the lack of services to address sexual functioning and relationship issues, as well as lack of resources, time constraints, cost of services, and funding.

CONCLUSION

Australian HCPs interviewed reported that migrant and refugee women do not have appropriate access to SRH care due to multifaceted challenges. These challenges are present across the entire socio-ecological arena, from individual to systemic levels. Multiple and multidimensional interventions are required to increase SRH utilisation and improve outcomes for refugee and migrant women.

Outcomes of Elective Outpatient Hysteroscopic Sterilization in Undocumented Women: A Retrospective Analysis

OBJECTIVE

To determine the feasibility of hysteroscopic sterilization in low-income and unauthorized immigrant women when financial barriers to care are removed.

METHODS

Outpatient hysteroscopic sterilization for low-income women at an urban clinic was made possible by grant funding. All procedures were performed by obstetrician/gynecologist attending physicians or supervised trainees. Electronic records were reviewed for cases performed from June 2010 to December 11, 2013. Outcome incidences and complications were determined. Subgroup analyses using demographic and clinical factors were performed.

RESULTS

Hysteroscopic sterilization was attempted in 197 patients. Most were Hispanic (93%) and undocumented immigrants (83%). Bilateral placement was achieved on first attempt in 92% (181/197). Successful placement was ultimately achieved in 96% (190/197), and 88% (168/190) returned for hysterosalpingogram (HSG). Appropriate tubal occlusion was documented on 96% (161/168) of HSGs with mean time of 3.5 ± 1.3 months. Repeat HSG at 6 months showed 100% occlusion (7/7). Of the initial cohort, 85% (168/197) could ultimately rely on Essure for contraception. One pregnancy was self-reported 9 months after the procedure; the patient had not followed up for HSG. There were no pregnancies among those who completed follow-up. There were no cases of procedural complications. Successful Essure placement was not associated with age, parity, immigration status, or clinical characteristics (analgesics administered, history of cesarean section, vaginal delivery, cervical surgery, ectopic, fibroids, or pelvic inflammatory disease). The only factor positively associated with HSG follow-up was age 35 years or younger (53% vs. 47%; p = .03).

CONCLUSIONS

Successful hysteroscopic sterilization can be achieved in an undocumented, low-income population. Rates of confirmatory HSG follow-up were found to be higher than in the general population. Public funding of programs could decrease unintended pregnancies and pregnancy-related costs.