Sub-Saharan African immigrant women's experiences of (lack of) access to appropriate healthcare in the public health system in the Basque Country, Spain

Abstract

Background Immigrant populations face diverse barriers to accessing appropriate healthcare services on several levels. In the Basque Country, Sub-Saharan African women were identified as facing the largest barriers to access them. The aim of the study is to analyse Sub-Saharan African immigrant women's perceptions and experiences of access to appropriate healthcare in the public health system in the Basque Country, Spain. Methods Fourteen women from eight Sub-Saharan African countries who have used the Basque public healthcare services were interviewed. A qualitative content analysis was applied: meaning that units were identified, coded and the resulting codes were then organized into three categories. Results The first category, Fearing to enter a health system perceived as not friendly for immigrants, included factors, mainly those related to legal conditions for accessing healthcare services and lack of lawful documentation, that made women avoid or discontinue seeking out healthcare. The second category, Being attended on professionals' own communication terms, comprised how the lack of effective communication compromised not only the access of the immigrant women to healthcare services, but also their health. Lastly, the third category, Is mistreatment based on racism or merely on bad luck? described how being an immigrant and black influenced the way they were (mis)treated in the health system. Conclusion For Sub-Saharan African immigrant women, accessing appropriate healthcare in the Basque Country was perceived to be subject to institutional barriers. At the legal level, barriers included lack of entitlement, difficulties in fulfilling legal access conditions and lack of documentation. The lack of communication with health centre staff and their attitudes, guided by a stereotyped social image of immigrants and black people, also hindered their possibilities of receiving appropriate healthcare. Facilitators for accessing healthcare included strategies from individual professionals, personal networks and social actors to help them to cope with the barriers. There is a need of reinforcing inclusion values and rights-based approach to attention among staff at the health centres to have more non-discriminatory and culturally appropriate health systems.

Hospitalization Experience of Muslim Migrants in Hospitals in Southern Spain—Communication, Relationship with Nurses and Culture. A Focused Ethnography

“…The MPs' positive views of the public health system and its professionals, despite experiencing discrimination [33], differs from the findings of other studies [42,43]. The patients tended to minimize and justify unprofessional behaviors, even blaming themselves for nurses' inappropriate behaviorstoward them.…”

“…MPs are aware of the importance of adequate communication with the nurses who care for them and the language barrier highlighted by this study has also been widely described in the literature as one of the main challenges to effective access to health care for migrants [33,[35][36][37][38]. Communication between nurses and patients is a challenge not only in terms of language but also in the way in which culture can affect the way patients express themselves [35].…”

“…The purpose of this study was to describe and understand the experience of MPs hospitalized in public hospitals in southern Spain. We identified several important issues, such as communication problems, the relationship with nurses and experiences with their habits and traditions in the hospital context; these issues present barriers to accessing quality health care [33,34].…”

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

“…Migrants face barriers to healthcare access because of their migration status, sociocultural influence, financial constraints, and stigma [5,10]. Limited access to healthcare for migrants has been highlighted in many European countries, including Spain, Portugal, and Ireland, with the need to consider equity and equality [11,12]. In Asia, migrant workers had limited access to HIV testing, especially when undocumented [13].…”

A Qualitative Study of Systemic Barriers Encountered by HIV-Positive Immigrants in Spain

“…Being an undocumented immigrant has also been identi ed as a risk factor for facing more barriers while accessing healthcare services. 33,34 The 2012 RDL and RD abolished previously practiced universal healthcare access in Spain, 35 and the requirement of being registered in an AC was a barrier stemming from the new law. Therefore, regardless of whether participants were aware of the 2012 RDL and RD, the commonly cited systemic barrier to accessing a public health insurance card was the direct effect of 2012 RDL and RD.…”