The problem with sexual and reproductive healthcare for migrant and refugee women in Australia

All women have the right to sexual and reproductive health care. Unfortunately, women from migrant and refugee backgrounds living in Australia face barriers to accessing support that can mean they have poorer health outcomes than Australian-born women.

Migrant and refugee women are:

• at a greater risk of suffering poorer maternal and child health outcomes;
• less likely than Australian-born women to have adequate information and familiarity with modern contraceptive methods;
• at greater risk of contracting a sexually transmitted condition such as HIV and hepatitis B, especially women who are from countries where the condition has a high prevalence;
• less likely to use health and social/support services; and
• less likely to have access to evidence-based and culturally relevant information which will enable them to make decisions about their health.

Barriers to adequate health care

The experience of migrating and settling in Australia, and the conditions sometimes attached to visas, often places constraints and stresses on migrant and refugee women that make it more difficult to access support. Particularly when it comes to making decisions about their sexual and reproductive health, migrant and refugee women must negotiate a complex, and often costly, health system that does not always adequately support their specific needs. In addition, stereotypes about migrant women because of their cultural background can ignore the diversity of women’s experiences and circumstances that lead to miscommunication and negative experiences with service providers.

Women’s health services such as the MCWH know first-hand that migrant and refugee women need advice and want to talk about their sexual and reproductive health – whether it is about fertility, contraception or abortion – in the language of their choice.

While women want to seek out sexual and reproductive health services, often the type of access available is not appropriate:

Sometimes information isn’t suited to our needs and isn’t culturally appropriate …  Information should be clear, because sometimes people don’t understand. I want someone to explain these things to me in my language. If I don’t understand, the information isn’t useful and I won’t go back.

– focus group participant, from the MCWH’s Common Threads Report

A gendered, culturally appropriate approach

In order to empower migrant and refugee women to be decision-makers over their own sexual and reproductive health, we need to take a gendered and culturally appropriate approach to health care.

But what would this look like?

Linh’s story

The following case study describes Linh’s experience as a newly arrived migrant.

Linh is a newly arrived young Vietnamese woman. She has a job working night shift at the chicken processing plant.

She has lower abdominal pain every time she gets her period, but does not know why. Due to the nature and hours of her work, she cannot find the time to access mainstream services. She is also worried that she will lose her job if she takes time off work.

As the pain grows worse, she finally makes an appointment with a local GP, as she doesn’t know where to find a Vietnamese-speaking doctor. The GP she sees is male, and she is embarrassed that she has to talk to him about these sensitive issues. Although she has requested an interpreter and one is provided, the interpreter is also male.

The GP ascertains that Linh has a very basic level of knowledge about women’s health and her body, and senses that she is very uncomfortable and distressed to be there. He provides her with the name of some medicine to take for her lower abdominal pain but also looks up other clinics in her area with Vietnamese-speaking female GPs.

Linh indicates via the interpreter that she wants to know about contraception options and the menstrual cycle. The GP understands the difficulties with Linh’s work hours so he contacts a women’s health organisation on her behalf and arranges for a Vietnamese Health Educator to visit her at home, at a time of her convenience. He also asks the organisation to send Linh information in Vietnamese.

The GP assures Linh that it is a free service.

How did the GP do?

While the GP was limited in the care he could provide Linh in a clinical setting, he was able to refer her to an organisation that provides bilingual health education at any time. The GP also provided Linh with greater access to culturally appropriate health information by giving her the names of Vietnamese speaking GPs in the local area.

Centring migrant women’s voices

So, what would a gendered, culturally appropriate approach to health care involve?

As a start:

• Flexibility and responsiveness
• Clinical health providers and community organisations working together with women for best health outcomes
• Information being delivered in a culturally appropriate way using bicultural and bilingual workers

Community workers are the best because they speak our language. They have the knowledge of both medical and cultural expectations and experiences. If they feel we need more, they can refer us to other services.

– Chinese focus group participant

Health care that takes into account women’s specific health and cultural needs is the first step to improving access to sexual and reproductive health services and in turn to improving migrant and refugee women’s poorer health outcomes.

About MCWH & its services

The Multicultural Centre for Women’s Health (MCWH) is a national organisation run by immigrant and refugee women and dedicated to immigrant and refugee women’s health.

MCWH works together with immigrant and refugee women, community organisations, health practitioners, employers, communities and governments to build and share knowledge, achieve equity and improve health and wellbeing for immigrant and refugee women through health education, research, advocacy and capacity building.

MCWH has a free women’s health library in Collingwood. We can also send you free multilingual health information in over 70 languages. Call 1800 656 421 for more information. To find out more about our training programs or book for a bilingual health educator to come to your area and run a free health education session, contact us on (03) 9418 0999 or visit the website.