Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways

Abstract

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)

“…We therefore echo others ‘recommendations that mobile populations may benefit from novel models of differentiated care that simplify and adapt HIV services across the cascade for PLHIV and to decongest the health system [ 33 , 54 ]. These models include patient-led community adherence groups, sexual networks [ 55 , 56 ], healthcare worker-managed groups, fast-track or multi-month drug scripting, mobile outreach, interventions optimized to seasonal migration patterns [ 57 ] and community drug distribution points (e.g., pharmacy-based refills). Importantly, these models can be facilitated by an acute awareness of the needs of mobile women and men living with HIV, holding the promise for engaging and retaining these populations who struggle to fit their needs to the requirements of community/clinic-based HIV care systems.…”

Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

“… 14 The healthcare system's response is therefore described as one of the essential elements of the intersection between migrants and health, more specifically, equal access to equal health care. 15 Even if health is an individual responsibility, there is a collective responsibility to develop health systems that are sensitive to migrants’ cultural and health characteristics. 15 …”

“… 15 Even if health is an individual responsibility, there is a collective responsibility to develop health systems that are sensitive to migrants’ cultural and health characteristics. 15 …”

“… 17 , 18 One reason for this is lower utilisation of SRH services, including family planning. 15 Lower levels of health literacy, language barriers, lack of awareness of rights, health professionals’ lack of awareness of access to rights and lack of acceptability of SRH services for socio-economic, political or cultural reasons are some of the barriers affecting many immigrant women’s reproductive health compared to native-born women. 19–24 Quality of health care that includes a healthcare system and healthcare personnel with regard for immigrant women's particular situation and the receiving country’s law and policies are factors to be recognised for making contraceptive counselling and access to contraceptives possible for all women, thereby increasing gender equality.…”

School-Based Education: An Opportunity to Promote Equitable Access to Sexual and Reproductive Health Knowledge

“…1 4 6 Those who experience socioeconomic disadvantage, including those living in poverty; people who are lesbian, gay, bisexual, transgender, intersex queer and other people of diverse sexuality, gender or bodily characteristics (LGBTIQ + ), culturally and linguistically diverse people; and women, girls, and adolescents tend to fare worst in terms of sexual and reproductive health. 6 7 8 9 These groups experience higher rates of maternal mortality and morbidity, unsafe abortions, teenage pregnancies, STIs, undiagnosed infertility, and limited access to health care. 6 9 10 Progress has been slow in addressing disparities in sexual and reproductive health with social, economic, and environmental determinants of health still requiring attention.…”