Women’s Health in women from refugee and asylum seeker background
Even in 2018, women and girls around the world continue to face great inequalities in health and psychosocial wellbeing. The notion of “women’s health” encompasses many elements that include and extend beyond the physical and mental health of women. The health and wellbeing of women in society is influenced by their understanding of, and access to health services; which is in turn influenced by structural as well as social determinants of health. 1 Major health related issues include cervical and breast cancers, sexual and reproductive issues, gender-based violence, and mental illness.2
For women from refugee and asylum seeker background, health issues may stem from and be compounded by: pre-migration experiences of trauma and violence, poverty, and culturally-based gender stereotypes which limit their rights and opportunities3,4. These women often feel disempowered and isolated within their new home country; where language barriers, different laws and limited family and social networks shape their daily lives.5 This increases their vulnerability to mental health issues, which in turn, decreases their capacity for participation in health promoting activities (such as exercise) and reduces their capacity to become productive members of society.4,5
The Australian healthcare system differs markedly from the systems that exist in the lower and middle income countries from which refugees and asylum seekers flee. For example, the Australian healthcare model focuses on the patient, encourages “shared decision making” and has both acute and preventative health services.6 Women from refugee and asylum seeker backgrounds are often unfamiliar with the preventative health resources which are available to them, as prior experiences with healthcare delivery may have been limited only to seeking assistance during an emergency.7
Over the last decade, 40% of persons resettled under Australia’s Humanitarian Programmes were women of child-bearing age.8 This highlights an important area of disparity: sexual and reproductive health. Poor sexual health literacy can lead to risky sexual behaviours, late diagnoses of sexually transmitted infections and some cancers; as well as lack of access to effective contraception leading to unwanted pregnancies and abortion.9-11 A lack of knowledge around sexual practices can lead to pain and negative sexual experiences, affecting a woman’s psycho-sexual well-being and quality of life.12
Barriers to accessing meaningful sexual and reproductive healthcare for women from refugee and asylum seeker background include language difficulties (written and oral), a lack of understanding of cultural norms by healthcare providers, issues with access including difficulty navigating the healthcare system and the cost of healthcare.13 Enabling factors for these women include access to a female healthcare professional, the effective use of interpreters, provision of multilingual resources and having their questions and concerns sensitively addressed by a healthcare professional. 6,14
In 2017, The Water Well Project facilitated twelve health education sessions on women’s health topics. These were delivered to over 150 women from diverse ethnic and cultural backgrounds. Topics included sexually transmitted infections, contraception and pregnancy. In our small interactive group sessions, women were able to ask questions of healthcare professionals in an informal, culturally sensitive environment, and to receive relevant information on accessing preventative health resources within the Australian healthcare system. One of the participants in these sessions told us that they had “learnt …new things about pap smears and thrush”- and another reported having learnt “ more about women’s health and breast screen”. After one community session, a mother confided to her community representative that "I want to know how to stop having babies", whilst another mother shared that she had never really discussed her own health with anyone other than when she had been pregnant.
In 2018, we will endeavour to broaden our reach across Victoria, New South Wales and Tasmania. We hope to reach many more women from refugee and asylum seeker background, and enable them to attain and maintain health, such that they are able to also improve the health and well-being of their families and wider communities.
You can donate to help us empower more women here: https://www.thewaterwellproject.org/donate-today/
1 Women’s health priorities and interventions. Temmerman, M., Khosla, R., Laski, L., Mathews, Z., & Say, L. 2015, BMJ, p. 351
2 World Health Organization. Ten top issues for women's health. [Online] 2015.
3 Foundation House. Towards a health strategy for refugees and asylum seekers in Victoria. s.l. : http://refugeehealthnetwork.org.au/wp-content/uploads/Towards-a-health-strategy.pdf, 2014.
4 Health and socio-cultural experiences of refugee women: an integrative review. . Shishehgar, S., Gholizadeh, L., DiGiacomo, M., Green, A., & Davidson, P. M. 2017, Journal of immigrant and minority health,, pp. 19(4), 959-973.
5 Department of Health. Development of a new Nationals Women’s Health Policy Consultation Discussion paper. s.l. : http://www.health.gov.au/internet/publications/publishing.nsf/Content/whdp-09~whdp-09-ch5~whdp-09-ch5-2~whdp-09-ch5-2-2~whdp-09-ch5-2-2-2, 2009.
6 Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives. Mengesha ZB, Perz J, Dune T, Ussher J. 2017, PLoS ONE, p. 12(7): .
7 Hach M. Common Threads: The sexual and reproductive health experiences of immigrant and refugee women in Australia. . s.l. : MCHW, 2012.
8 Factors affecting implementation of perinatal mental health screening in women of refugee background. Nithianandan, N., Gibson-Helm, M., McBride, J., Binny, A., Gray, K. M., East, C., & Boyle, J. A. 11(1), 150. : Implementation Science, , 2016, Implementation Science, p. 11: 150.
9 Ussher, J. M., Metusela, C., Hawkey, A. J., & Perz, J. M. Sexual and Reproductive Health of Migrant and Refugee Women: Research Report and Recommendations for Healthcare Providers and Community Workers. s.l. : . https://www.westernsydney.edu.au/__data/asse, 2017.
10 Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and non-humanitarian source countries: a retrospective, observational cohort study. Gibson‐Helm, M. E., Teede, H. J., Cheng, I. H., Block, A. A., Knight, M., East, C. E., ... & Boyle, J. A. 2015, pp. 42(2), 116-124.
11 Australian Medical Association. Sexual and reproductive health. s.l. : https://ama.com.au/position-statement/ sexual-and-reproductive-health-2014, 2014.
12 Purity, privacy and procreation: constructions and experiences of sexual and reproductive health in Assyrian and Karen women living in Australia. . Ussher JM, Rhyder-Obid M, Perz J, Rae M, Wong TWK, Newman P. 2012, Sex Culture, pp. 16(4):467–85.
13 Culturally and linguistically diverse women’s views and experiences of accessing sexual and reproductive health care in Australia: a systematic review. . Mengesha, Z. B., Dune, T., & Perz, J. 2016, Sexual Health, , pp. 13(4), 299-310.
14 Yelland, J., Riggs, E., Fouladi, F., Wahidi, S., Chesters, D., Casey, S., & Brown, S. Having a baby in a new county: the views and experiences of Afghan families and stakeholders. s.l. : Foundation House and Murdoch Children’s Research Instite, 2013.