Sexual and Reproductive Health Care for Irregular Migrant Women: A Meta-Synthesis of Qualitative Data
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Search Methods
2.3. Inclusion and Exclusion Criteria
2.4. Results of the Search
2.5. Quality Assessment
2.6. Data Extraction
Data Synthesis and Analysis
2.7. Rigor
3. Results
3.1. The Need to Focus Emergency Care on SRH
3.1.1. IMW: Victims of Trafficking and Sexual Exploitation
“They come and rape you for days, and when it suits them, they leave you there, bleeding... and you have to continue your journey as best as you can”[10]
3.1.2. The Need to Develop Suitable Safety Protocols
“Who is protecting my baby?” “Who is protecting my family?”[10]
3.2. Unsatisfactory Clinical Experiences
“When you have your parents with you, they are there to help because they feel responsible for you.” Consequently, I find it harder in Switzerland compared to Eritrea”[21]
“I think it is never the same doctor from one ultrasound to the other.” “That is difficult.”[21]
3.2.1. The Need for Interpreters
“I rang the bell several times, asking for help.” “I was worried that something was wrong with the baby, who was screaming and screaming.” “After a long time, the staff came in and said something incomprehensible in Swedish, then they left and did not come back.”[27]
“She (the physician) did not explain what the test would be like properly; I thought it was the one with the needle, so I said no.”[21]
3.2.2. Healthcare Providers’ Lack of Cultural Competence
“They claimed it was not amniotic fluid, but rather I had urinated on myself. I said I had already given birth to four children. I know the difference between urine and amniotic fluid. They never looked at the amniotic fluid and never performed a cardiotocography. The fluid and blood continued to leak out over the next week.”[21]
3.3. Forced Reproduction
3.3.1. Practices That Put the IMW’s Personal Health at Risk
“I asked my partner to use condoms, but he said maleness must be felt and left free. It should not be bound in an envelope (condom). I tried forcing him to use condoms, and he said he would go to his other sweethearts, and I would have to find another partner who uses condoms.”[14]
“I do not fuck behind; in my country, we do not talk about it … there is a man with a woman, a woman with a man, but not a woman with a woman, a man with a man, but it is never mentioned …”[26]
“My grandmother told me not to have sex before marriage because it is an immoral act. Contraception is only used by unclean women, such as beer girls and prostitutes, before marriage. Clean women only use contraception after marriage; otherwise, their uterus shrinks, making them barren before marriage.”[14]
3.3.2. Pregnancies Characterised by IMW’s Irregular Status
“With my two children, I always started going to the gynaecologist after 6 months of pregnancy. With the other one, I went at eight months, and I had no problems with my son. I said to myself, ‘I can have my daughter without anyone needing to care for me.’”[20]
“The doctor might check the baby and put the instruments inside the baby, which could accidentally damage it and cause a miscarriage.”[21]
“I got pregnant and was working at the time. I said: ... “The lady will fire me because she does not want me to work.” “Therefore, I did not say anything to the lady.”[21]
3.3.3. Unsafe Sex Life
“I asked my partner to use condoms, but he said that masculinity should be felt and left free, not tied to a condom. Additionally, he told me that he would leave with his other girlfriends and I should find another partner.”[14]
“No, I do not use protection with my boyfriend’ (sex worker). If it itches, you can use antibiotics or preventative gels...”[27]
3.4. Alternating between Formal and Informal Healthcare Services
3.4.1. Access to Information and Care
“They said they could not do anything because I do not have papers,’you are undocumented,’ after sitting there for 10 h.... We felt ignored and drove home.”[27]
“No one listened to my wishes. I was forced to have a vaginal delivery, regardless of my pre-existing risks.”[28]
“It was really challenging; I was in labour for two days. The doctors came, the interns came, the nurses came; they kept coming, but they did not treat me.”[28]
3.4.2. Unsafe Abortions
“If I ever notice I miss my period in the first month, I will start clenching and banging my stomach very hard. I will work hard physically; I will jump and massage myself. I will drink a lot of herbal water. If I start early, I will be able to deliver the baby easily.”[28]
4. Discussion
5. Conclusions
6. Implications for Practice
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Stage | Steps |
---|---|
STAGE 1 | The terms “illegal,” “irregular,” and “undocumented” were joined with the Boolean operator “OR.” This process was carried out with “migrant,” “immigrant,” “foreigners,” and “noncitizen,” as well as with “pregnancy,” “sexual health,” “maternal health,” “health care,” “reproductive health,” “qualitative research,” and “women.” |
STAGE 2 | After performing these searches separately, they were joined together using the Boolean operator “AND.” (((((((migrant) OR immigrant) OR foreigner)) AND (((((undocumented) OR illegal) OR irregular)) OR noncitizen)) AND ((((((pregnancy) OR sexual health) OR maternal health) OR health care) OR reproductive health) OR health services)) AND ((women) OR human female)) AND ((qualitative research) OR qualitative design). |
STAGE 3 | In addition to electronic searches, a manual search of grey literature was carried out. |
Article | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
---|---|---|---|---|---|---|---|---|---|---|
[14] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ✔ | ✔ | ✔ | ✔ |
[1] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
[26] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ↔ | ✔ | ✔ | ✔ |
[20] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ↔ | ✔ | ↔ | ✔ |
[21] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
[10] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ✔ | ✔ | ✔ | ✔ |
[27] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ↔ | ✔ | ✔ | ✔ |
[28] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ✔ | ✔ | ✔ | ✔ |
[29] | ✔ | ✔ | ✔ | ✔ | ✔ | ↔ | ✔ | ✔ | ✔ | ✔ |
Stage | Description | Steps |
---|---|---|
STAGE 1 | Text coding | Recall review question Read/re-read the findings of the studies Line-by-line inductive coding Review of codes in relation to the text |
STAGE 2 | Development of descriptive themes | Search for similarities/differences between codes Inductive generation of new codes Write preliminary and final report |
STAGE 3 | Development of analytical themes | Inductive analysis of sub-themes Individual/independent analysis Pooling and group review |
Author and Year | Country | Sample (IMW) | Age (Years) | Interview Duration | Data Collection | Data Analysis | Main Theme |
---|---|---|---|---|---|---|---|
[14] | Cambodia | 15 | 18–28 | Not interviewed | IDI | Manual analysis of coded data | Attitudes toward or practise of unsafe abortions |
[26] | Spain | 8 | 23–40 | 30 min | IDI | Content analysis | Risk of STIs and HIV in sex workers |
[20] | Spain | 26 | 20–35 | 3 h | FGs | Thematic analysis | IMW’s experiences of maternity care |
[21] | Switzerland | 33 | 21–40 | Not interviewed | FGs | Analysis of themes and subthemes | Experiences of maternal health services |
[10] | Spain | 13 | 18–35 | 18 min | IDI | Valerie Fleming stages | IMW’s health needs |
[27] | Sweden | 13 | 18–36 | 45 min | IDI | Qualitative analysis of content | Clinical experiences of birth/pregnancy |
[28] | Lebanon | 35 | Not provided | 1 h | IDI | Ethnographic analysis of themes | Unequal access to care for IMW |
[29] | United States | 8 | 20–45 | Not interviewed | Life story | Analysis of statements | Cultural needs and access restrictions |
[1] | Belgium Netherlands | 14 | 15–49 | Not interviewed | IDI | Inductive analysis | Sexual health determinants |
Themes | Subthemes |
---|---|
3.1. The need to focus emergency care on SRH | 3.1.1. IMW: victims of trafficking and sexual exploitation. |
3.1.2. The need to develop suitable safety protocols | |
3.2. Unsatisfactory clinical experiences | 3.2.1. The need for interpreters. |
3.2.2. Healthcare providers’ lack of cultural competence | |
3.3. Forced reproduction | 3.3.1. Practices that put the IMW’s personal health at risk |
3.3.2. Pregnancies characterised by the IMW’s irregular status | |
3.3.3. Unsafe sex life | |
3.4. Alternating between formal and informal healthcare services. | 3.4.1. Access to information and care |
3.4.2. Unsafe abortions |
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Share and Cite
Granero-Molina, J.; Gómez-Vinuesa, A.S.; Granero-Heredia, G.; Fernández-Férez, A.; Ruiz-Fernández, M.D.; Fernández-Medina, I.M.; Jiménez-Lasserrotte, M.d.M. Sexual and Reproductive Health Care for Irregular Migrant Women: A Meta-Synthesis of Qualitative Data. Healthcare 2023, 11, 1659. https://doi.org/10.3390/healthcare11111659
Granero-Molina J, Gómez-Vinuesa AS, Granero-Heredia G, Fernández-Férez A, Ruiz-Fernández MD, Fernández-Medina IM, Jiménez-Lasserrotte MdM. Sexual and Reproductive Health Care for Irregular Migrant Women: A Meta-Synthesis of Qualitative Data. Healthcare. 2023; 11(11):1659. https://doi.org/10.3390/healthcare11111659
Chicago/Turabian StyleGranero-Molina, José, Ariadna Sara Gómez-Vinuesa, Gonzalo Granero-Heredia, Alba Fernández-Férez, María Dolores Ruiz-Fernández, Isabel María Fernández-Medina, and María del Mar Jiménez-Lasserrotte. 2023. "Sexual and Reproductive Health Care for Irregular Migrant Women: A Meta-Synthesis of Qualitative Data" Healthcare 11, no. 11: 1659. https://doi.org/10.3390/healthcare11111659