Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation

Abstract

BackgroundForced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.MethodsThe study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.ResultsThe accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.ConclusionsThe standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3502-2) contains supplementary material, which is available to authorized users.

Health Care for Refugees in Europe: A Scoping Review

“…In the countries of arrival and transit, the high number of asylum seekers, short-term stays, and uncoordinated health care can negatively impact access to, and quality of, care. A lack of patient records and information on the health status of patients during flight and in reception countries [14,28,29], as well as the involvement of different actors and organisations [4,14], lead to a lack of equity of need, duplication of treatment, and overlaps in care. In the destination countries, asylum seekers face a multitude of legal, financial, and administrative barriers to access [4].…”

Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters

“…Depending on their residence status, migrants access healthcare services in different ways: permanent foreign residents must fend for themselves while refugees are supported—to a lesser or greater extent—by local authorities (Origlia Ikhilor et al, ). A study on how Swiss asylum centres organize healthcare provision showed that sexual and reproductive healthcare needs of women asylum seekers are not sufficiently addressed and there is a lack of translation and gender sensitive approach of women (Cignacco et al, ). There is an urgent need to better target health care at allophone women's needs and women need guidance through the Swiss maternity healthcare system to be able to make informed decisions.…”

“…Factors such as poor living conditions, unemployment, and poverty adversely influence migrant maternal health. The health inequality of pregnant migrants and their newborns does however seem to be primarily related to difficultly accessing perinatal care services in the host country (Bundesamt für Gesundheit, ; Cignacco et al, ; Keygnaert et al, ; Merten & Gari, ). It has also been shown that there is a direct link between language barriers and adverse birth outcomes (Sentell, Chang, Ahn, & Miyamura, ).…”

Refugee women's experiences with contraceptive care after resettlement in high-income countries: A critical interpretive synthesis

“…Some women were concerned about the personal risks of excessive bleeding, such as losing the ability to be intimate with their partner [33] . Methods associated with dysmenorrhea, such as copper IUDs, were reported to exacerbate the severe menstrual cramps experienced by some women with female genital cutting (FGC) [50] .…”