Barriers to Sexual and Reproductive Health and Rights of Migrant and Refugee Youth: An Exploratory Socioecological Qualitative Analysis

Abstract

(1) Background: Migrant and refugee youth’s (MRY’s) sexual and reproductive health and rights (SRHRs) are a global health issue. MRY encounter adverse SRH experiences due to limited access to and knowledge of SRHRs services. Using a socioecological framework, this study examined the barriers affecting MRY’s SRHRs. (2) Methods: A cross-sectional study utilising a participatory action research design was used. A total of 87 MRY (ages 16–26, from 20 cultural groups within Greater Western Sydney, Australia) completed seventeen focus group discussions on their SRHRs experiences. The focus groups were co-facilitated by youth project liaisons to ensure their authenticity and validity. The data were analysed thematically and interpreted using socioecological theory. (3) Results: The findings identified socioecological barriers, a lack of awareness about and access to services, and sociocultural dissonance as leading to the under-implementation of SRHRs services. These barriers included cultural disconnects, language barriers, remote service locations, intergenerational cultural conflicts, and ineffective SRHRs services. The key themes identified included traditional and institutional stigma, lack of SRH education, reliance on social media for SRH information, and privacy concerns. (4) Conclusions: There is a limited consideration of MRY’s SRHRs and the impact of intergenerational discordance and stigma on MRY’s rights. The findings suggest the necessity for a collaborative SRHRs strategy and policy design that empowers MRY’s agency across multicultural contexts.

1. Introduction

Sexual and reproductive health and rights (SRHRs) play a crucial role in the overall health and well-being of youth, particularly for those in migrant and refugee populations. A comprehensive understanding and provision of these rights are essential for a successful transition from adolescence to adulthood and positive long-term outcomes for mental health, relationships, and quality of life [1,2]. These rights, established within an international human rights framework, encompass several key dimensions. They include the right to accurate and comprehensive sexual and reproductive health education, the right to access appropriate healthcare services without discrimination, and the right to make autonomous decisions about one’s sexual and reproductive health [3]. Additionally, SRHRs include the right to privacy and confidentiality regarding sexual and reproductive health matters, the right to be free from sexual violence and coercion, and the right to access family planning services and information [4]. For migrant and refugee youth, the realisation of these rights can be particularly challenging due to various socioecological barriers. Research has shown that migrants and refugee youth (MRY) may not know where, how, or when to access sexual and reproductive health (SRH) services, or have the economic capacity to do so [5]. Studies have indicated that MRY encounter barriers to contemplating and accessing SRH support and services, which significantly impact their well-being. The barriers also extend to service providers, who are not knowledgeable about the needs of MRY and, thus, lack the capacity to support them. For instance, Family Planning Services reported that of the low number of youth who accessed their services in 2012, 46% reported learning about them through word of mouth [6]. This suggests that cultural stigma and misconceptions surrounding SRH may limit service accessibility, reinforcing reliance on informal networks for information about SRH [6]. Further complicating these challenges are interpersonal factors, such as language barriers, discrimination from non-migrant peers, and services lacking cultural awareness and safety. This contributes to an environment where MRY may feel uncomfortable discussing SRH issues [7,8].

Australia is one of the most multicultural countries in the world [9]. Therefore, it is important to examine migrant and refugee youth’s experiences of SRH in diverse areas of Australia. In examining these experiences, we view culture as a dynamic system of shared beliefs, values, and practices that shapes health understanding and behaviours. For MRY, this encompasses both traditional heritage and engagement with new cultural contexts, which can both challenge and facilitate SRHRs engagement. In the Australian context, Mpofu et al. [10] argued that while SRH education is included in schools’ curricula, it varies in its breadth and depth across regions. Such educational inconsistency and the social pressures exerted by peers, family, or the broader community may inhibit MRY from seeking SRH information and support. Moreover, existing educational resources are often developed without substantial input from young people, despite evidence suggesting that resources tailored to a service’s users are more effective and accessible [5,7]. This study explores these challenges further and proposes strategies to improve MRY youth’s SRH service access by drawing on the experiences and perspectives of MRY.

Although SRHRs are crucial to SRH and are recognised as a key element of youth’s well-being, little is known about Australian MRY’s understanding of and experiences with SRHRs. This study seeks to contribute to this research gap by focusing on the perspectives of MRY and examining the role of sociodemographic variables for the SRHRs of MRY in Greater Western Sydney, one of the fastest-growing regions in Sydney, with a migrant population of 50% [11,12]. No previous research has specifically mapped the socioecology of this demographic with regard to SRHRs. Such research findings could inform policies and practices to improve youth sexual and reproductive health and well-being and, by extension, improve national health outcomes. Therefore, this is the first study that aims to answer the following research question: what are the socioecological barriers that impact MRY’s agency, decision making, and well-being with respect to their SRHRs?

1.1. Theoretical Framework

The Socioecology of MRY’s Sexual and Reproductive Health and Rights

MRY face complex barriers to accessing, understanding, and implementing SRHRs information. These barriers are interconnected at multiple levels, including the individual, interpersonal, institutional, and societal. Bronfenbrenner’s socioecological theory (1979) provides a practical framework (Figure 1) for understanding these barriers, as it considers the five interconnected layers of the environment surrounding an individual: the individual, microsystem (interpersonal), mesosystem (relationships between microsystems), exosystem (institutional), and macrosystem (societal) [13].

Factors, such as age, gender, sexual orientation, education, personality, length of time in the host country, and acculturation strategy, can affect MRY’s SRHRs access and implementation [14,15,16]. These factors, along with socioeconomic status, language barriers, and traumatic experiences, can influence the interpersonal, organisational, and societal expectations placed on MRY, which affect their engagement with SRHRs [17,18,19,20].

From the mesosystem and exosystem perspectives, MRY may have limited knowledge of what, where, how, and when to access SRHRs services [5,17,21,22]. Botfield et al.’s [5,7] studies have shown that the SRH education provided to young people is often developed without input from that demographic, which may result in limited accessibility and utilisation of services.

At the macrosystem level, MRY navigate the cultural influences of their culture of origin and the host country, leading to intergenerational conflicts, fear, and structural social misunderstandings around SRHRs [23,24,25,26]. This can result in disengagement from SRHRs and negative physical and psychological consequences, such as exposure to sexually transmitted infections, unplanned pregnancies, and poor mental health [27,28]. Institutional and societal contexts also impact MRY’s ability to access SRHRs information and services. According to the research, in Australia, migrant and refugee populations often experience SRHRs services as culturally inappropriate or insensitive, leading to limited engagement and poor outcomes [18,29,30,31]. Factors, such as limited access to interpreters, a lack of continuity of care, and perceptions of unhelpful or uncaring staff, contribute to this problem [5,32,33].

When categorised using a socioecological model, the factors that emerge at the microsystem level include immediate family, school, and friends, while the mesosystem level examines the interactions between these factors [31]. At the exosystem level, healthcare systems, extended family, and government policies play a role in shaping MRY’s approach to SRHRs, while the macrosystem level encompasses attitudes, ideologies, culture, and religion, all of which influence MRY’s reproductive health decisions in Australia [31]. Mpofu [34] and Amroussia et al. [35] agreed on the significant impact that religion can have on MRY’s SRHRs beliefs and behaviours. The cultural concentration, which refers to migrants maintaining a connection to their culture while adapting to that of the host country, can bring both opportunities and challenges for MRY in renegotiating relationships and family structures in a new cultural context [17,19,36,37]. Therefore, by exploring these various factors within a socioecological framework, we can comprehensively understand the complex interplay of factors that influence MRY’s approach to SRHRs.

2. Methods

2.1. Study Design

This paper reports on the findings from a qualitative data collection with MRY aimed at capturing the depth, nuances, and complexities of MRY’s SRHRs experiences and perspectives, which are often lost in quantitative approaches. The findings presented in this paper are from a larger mixed methods study funded by the Australian Research Council (DP200103716), entitled Migrant and Refugee Youths Sexual and Reproductive Health and Rights, which sought to examine MRY’s access, decision making, and utilisation of SRHRs services, and to develop a model for service implementation. The broader study used a participatory action research (PAR) design to engage and empower MRY, enabling them to identify research questions, participate in data collection, and provide useful information to facilitate change. PAR is a research methodology that prioritises the active involvement and collaboration of the communities under study in research, and has been applied in health research to address complex social problems that require transformation [38,39]. Applying the PAR methodology to SRHRs research ensures that researchers, youth project liaisons (YPLs), advisory committee members (ACMs), and MRY come together as partners to define issues, co-design solutions, and implement changes. Liamputtong [40] noted that this approach is critical for sensitive SRHRs issues requiring confidentiality and respect for diversity.

2.2. Recruitment and Sample

The recruitment process for this study was executed in multiple stages to involve the youth participants in developing the research. Recruitment commenced on 1 June 2020 and ended on 12 June 2021. The three groups of participants (ACMs, YPLs, and MRY) were drawn from a diverse range of racial, ethnic, religious, socioeconomic, educational, sexual, and geographical backgrounds. A total of 87 young people participated in this study (YPLs, n = 8; MRY, n = 79). Demographic information was obtained for the 75 youth participants, with 56 (65.12%) identifying as females and 19 (22.09%) as males. The youth participants were between 15 and 29 years old (Appendix A shows the detailed demographic profile).

2.2.1. Advisory Committee Members (ACMs)

The ACMs included individuals from key stakeholder groups (such as community-managed organisations, community leaders, influencers, and workers) and health professionals with pertinent careers and experiences. Their contributions were integral to implementing the PAR framework of this project. They also assisted with convenience sampling and recruiting the YPLs, who had active involvement with the migrant and refugee communities in Greater Western Sydney.

2.2.2. Youth Project Liaisons (YPLs)

The YPLs served as relatable liaising peers to the other MRY who participated in this study. The YPLs also helped to mitigate any perceived power differentials between the researchers and the youth, given that the YPLs were in the same age demographic as the MRY. Hence, the YPLs, taking an active part in the PAR process, helped to mitigate the MRY’s perception of the researchers as outsiders.

2.2.3. Migrant and Refugee Youth (MRY)

As the focus of this study, the MRY offered invaluable qualitative data on their experiences and understanding of SRHRs, which were necessary for this project to meet its aims. Subject to the inclusion criteria (

Table 1. Participants’ eligibility criteria.

Participant Groups	Inclusion Criteria
Migrants and refugee youth	Aged 15 to 26 years.
	Self-identified as migrant or refugee.
	Residents of Greater Western Sydney for at least 12 months.
Youth project liaisons	Aged 15 to 26 years.
	Self-identified as migrant or refugee. Residents of Greater Western Sydney for at least 12 months.
Advisory committee members	From key stakeholder groups.
	From support service providers.
	Researchers and/or policymakers.

), the MRY were recruited via a range of sources, including ACMs; YPLs; social media advertisements (Facebook, Instagram, and Snapchat); community organisation newsletters; printed materials posted at Western Sydney University campuses; and notice boards in shopping malls, churches, and community organisations in Western Sydney. A diverse sample of young people were recruited across different racial, ethnic, religious, socioeconomic, educational, sexual, and location groups.

2.3. Data Collection

Seventeen focus groups were co-facilitated by the first author, each ranging from 60 to 90 min, with an average time of 60 min. The focus groups were held during the COVID-19 pandemic, which resulted in the focus groups mostly being convened online via Zoom^® between November 2020 and June 2021, with the participants located in their preferred spaces. Three of the focus group sessions were conducted face-to-face, two of which were held simultaneously in two different spaces at a local community-managed organisation in Greater Western Sydney. The sessions were audio-recorded and professionally transcribed verbatim using Trint^® software (version 2021), followed by an extended manuscript verification by the research team.

2.4. Procedures

The participants were recruited, organised, and facilitated through the YPLs, who recruited their peers via convenience sampling, and from the research team’s networks (17 FGs, ranging from 2 to 10 participants per focus group, n = 79 youth). The focus group questions (Appendix B) were developed during a collaborative workshop involving the ACMs, YPLs, and the research team. This workshop format ensured the questions were appropriate, relatable, and culturally safe for the target population. The questions were tested and refined with input from the YPLs to enhance their reliability and validity from a youth perspective, while the ACMs provided guidance on cultural appropriateness and sensitivity. This collaborative development process aligned with our PAR methodology and helped ensure the questions would effectively capture MRY’s SRHRs experiences. The focus groups (which were conducted in the English language) explored MRY’s understandings and experiences of, and the barriers and facilitators related to SRHRs.

While this methodology effectively captured many aspects of the MRY’s SRHRs experiences, it is important to note certain methodological considerations. Some sensitive topics—particularly experiences of sexual violence during migration—may have been underrepresented in our data. The group setting, despite its benefits for general discussion, may not have provided the optimal environment for disclosing traumatic experiences. Additionally, while our YPLs enhanced cultural safety and rapport, their peer status may have inadvertently discouraged participants from sharing deeply personal trauma narratives. These limitations inform our recommendations for future research, particularly regarding sensitive topics that may benefit from alternative methodological approaches, such as individual interviews or trauma-informed research designs.

Central to the PAR methodology, the YPLs engaged with the project at various key phases and were trained to recruit and engage the MRY and co-facilitate focus groups at the data collection stage. The YPLs also participated in an annual focus group (60 min) for three years to gain insight into their experiences of engaging in a PAR project, and their perspectives on the project’s alignment with human rights principles. The annual focus groups were audio-recorded, transcribed, and analysed using the existing data analysis protocol.

2.5. Ethical Considerations

The Western Sydney University Human Research and Ethics Committee approved the ethics framework (H13798) before this study commenced. The initial plan was to conduct the focus group through in-person sessions; however, due to COVID-19 restrictions, the Zoom^® platform was employed as an alternative.

2.6. Consent

A participant information sheet (PIS), consent information, and inclusion criteria were distributed to the participating MRY to ensure their understanding and consent before participating in this study. Completed consent forms and consent by assent were also accepted for convenience and to minimise paperwork, particularly for some disadvantaged youth. At the start of each workshop or group session, the facilitator sought additional verbal consent to confirm the participants’ willingness to participate in the focus group.

2.7. Data Analysis

The data from the focus group sessions were thematically analysed [41] by the first, second, and last authors. The thematic analysis was performed by identifying the topics and substantive categories within the participants’ accounts in relation to this study’s objectives. Pseudonyms were used to protect the participants’ confidentiality. Quirkos^® is an intuitive qualitative data management software that assists researchers in coding and analysing qualitative data [42]. Quirkos^® (version 2.5.3) was used to ascertain the topical responses and emergent substantive categories, coding for word repetition, direct and emotional statements, and discourse markers, including intensifiers, connectives, and evaluative clauses [40,41]. The YPLs also attended a workshop where they were taught basic qualitative analysis principles, and then worked in groups of two to analyse 2 of the 17 focus group transcripts. The resulting codes were added to the thematic analysis of the qualitative data.

3. Results

This study examined the various socioecological barriers (see Figure 2) that impact MRY’s SRHRs using Bronfenbrenner’s socioecological systems framework. A key focus was understanding how MRY navigate their SRHRs against these identified factors. The thematic analysis of the collected data revealed themes that provided insights into the MRY’s understanding and experiences of SRHRs, in line with the following socioecological levels: micro-, meso-, exo-, and macrosystem.

3.1. Microsystem Level

Various barriers affecting the MRY’s SRHRs were identified at the microsystem level, including lack of awareness, lack of education, fear, blame, guilt, shame, and lack of knowledge and access to services. These barriers were often exacerbated by challenges relating to their migratory status, and played a crucial role in how the MRY navigated their SRHRs. These factors emphasise the complexity of SRHRs issues at the individual level, indicating how different personal experiences, feelings, and the influence of education and awareness can shape an individual’s understanding and behaviour regarding SRHRs.

3.1.1. Lack of Awareness and Access to Services

MRY often come from cultural backgrounds where open discussions about SRHRs are discouraged or non-existent [43]. Some participants’ comments reflected a lack of awareness regarding SRHRs, particularly due to cultural or societal norms. For instance, as one participant noted, “I come from a country where... you weren’t taught about reproductive health a lot... there were young, 16, 17-year-olds who didn’t know that sex led to falling pregnant.” (Sarah, F, Sri Lankan), revealing how a lack of awareness can lead to basic misconceptions about reproduction. Such a lack of awareness may contribute to risky sexual behaviours and prevent MRY from seeking necessary reproductive health services. An absence of knowledge was also seen regarding the understanding of concepts such as consent, with another participant stating, “A lot of people don’t really know what consent is still... maybe it’s just where they’re from or how they were raised that they don’t truly grasp the concept of consent” (Lupita, F, Fijian).

Furthermore, the participants expressed concerns about not only their lack of knowledge about SRHRs, but also their lack of access to services. One participant acknowledged, “Just the lack of knowledge [about services] is what stops me... possibly not me, but maybe incorrect knowledge... that could be something that would stop someone from being able to protect their sexual reproductive health” (Loretta, F, Indian). The participants’ experiences underscored the impact that this lack of knowledge and unfamiliarity with and lack of access to the healthcare system had on individuals’ abilities to protect their sexual and reproductive health. A participant expressed that “it would definitely be helpful if these [SRH] centres were located closer or more around the western Sydney area, and they’re more easily accessible if they had proper funding” (Johnny, M, Indian).

3.1.2. Lack of SRHRs Education

The lack of adequate SRHRs education was a recurring theme in the data across all the focus group sessions. The participants unanimously reflected on the ineffectiveness of the SRHRs education in the various schools they had attended. One participant stated, “There’s a disparity between how much about sexual health and consent and stuff is taught in high school compared to... my friends from other areas in Sydney” (Jas, F, Indian). The participants emphasised a disparity in the amount of sexual health education received in school, adding, “Some of my friends [like] didn’t even know [like] stuff about consent until we were in like year 11 or year 12, and we had to [like] find that ourselves. [Like], no one really sits you down and explains to you [what] anything about sexual health. [Like] in PE, it was [like] a topic on it (SRH) or a couple [of] topics on it, but they don’t spend a lot of time on it” (Ethan, M, Chinese). The lack of school-led instruction about SRHRs resulted in the individuals feeling unprepared and unsafe, as indicated by another participant, who said “I don’t think it’s appropriate for anyone under 18 to have sex when they don’t when like, school doesn’t really even teach you how to do it safely” (Jas, F, Indian). This implies that a lack of education can leave MRY ill equipped to make safe and informed decisions about sexual health.

3.1.3. Fear of Fatal Consequences

Fear, often stemming from inadequate or fear-based sexual education, can have detrimental effects on MRY’s approach to SRHRs. A fear of the consequences of sexual activity was evident in the participants’ accounts. They emphasised being taught to avoid sex due to the risk of contracting diseases, such as HIV, rather than being educated on safe practices. One participant put it quite starkly: “Yeah, the point of the AIDS presentation is to, ‘don’t have sex because you will get AIDS... just don’t have sex because you will die’” (Angelene, F, South Indian).

3.1.4. Blame, Guilt, and Shame

MRY have highlighted the potential culturally or socially instigated feelings of shame, guilt, and blame regarding SRHRs that make it difficult to access the necessary services or communicate about these issues [44,45]. This was mirrored in the participants’ reflections, where societal judgement, internalised shame, and feelings of personal blame hindered their willingness to seek help. For instance, as one participant mentioned, “Like, you know, women not going to get these checkups …marital rape, you know this could be happening. But they’re like, ‘I don’t want to bring this up’ because [like] the women end up being shamed’” (Lupita, F, Fijian). Another participant stated, “I’d prefer to distance myself from someone from [like] a similar cultural background just because I think I’d always feel somewhat like judged or I’d always feel like the taboo of, like my cultural upbringing in the commentary of that doctor” (Zantla, F, Bangladesh). Another highlighted the blame-laden guilt where an MRY is expected to know better, stating, “I have the knowledge I learned about it in school, but… it’s always preventative but it’s never kind of like, ‘OK, now, say you do have it (STI), what are your options? How do you go about this?’ It’s always preventative and therefore, if you get it, it almost implies that it’s your fault ‘…that’s your responsibility, that’s on you’” (Angelene, F, South Indian).

3.1.5. Alcohol and Other Drugs (AODs)

The participants highlighted that using alcohol and other drugs impacted their decision making regarding SRHRs. One participant described how being under the influence of alcohol made it harder to think clearly, stating, “When I drink, it’s like you, I don’t think of everything. You’re kind of just in the moment, so you forget certain things, ” (Moana, F, Fijian), thus increasing the likelihood of unsafe sexual behaviour, resulting in unplanned pregnancy, psychological harm, and STIs. Another participant highlighted the effect of AODs on the reproductive system, stating, “If you took drugs, alcohol or certain things, they can affect your reproductive organs, which is a very complicated system” (Evelyn, F, Indian).

3.2. Mesosystem Level

At the mesosystem level, the interactions between the various microsystems, such as family and school, peer groups, and healthcare professionals, greatly impact the SRHRs of MRY [46,47]. The various factors indicated by our data are as follows.

3.2.1. Family Conflict

Conflicts within families often arise due to the complex interplay between generational differences and cultural transitions in understanding sexual health. While some tensions reflect universal parent–child dynamics, others emerge specifically from navigating multiple cultural contexts. A participant noted, “Even though I’m growing up, they may still see me as a child so they don’t really—it’s hard for them to catch up, really, in their mind like, ‘oh its time, and she’s old enough, and she’s mature enough’” (Leticia, F, Nigerian). This reflection demonstrates how generational perspectives on maturity and independence can affect SRHRs discussions, regardless of cultural background. As the family is often the primary source of information about health and personal development for young people, conflict can prevent MRY from accessing critical information, leading to misunderstandings and potentially harmful misconceptions about SRHRs. For example, one participant stated, “If, maybe if your parents found out you were researching about sexual health… they’re like’, what’s going on?” (Leticia, F, Nigerian). While another added, “Yeah, even though I’m [legally an adult], yeah, they’ll still punish me, because in my family, they still look at me as a little child” (Moana, F, Fijian). This illustrates how parents often struggle to reconcile their child’s evolving maturity and independence, which can hinder an open dialogue about SRHRs within families. In addition, the absence of support from family members can pose a significant challenge in managing SRHRs. One participant described her struggle to maintain secrecy about using contraceptives at home: “I had to keep everything very secretive if I was using a pill, if I was using contraception” (Angelene, F, South Indian). Without support from their families, MRY may face difficulties in accessing SRHRs services or in understanding their rights. Further, another stated, “I always felt like, protecting my health or maintaining my health in a household […] that never really talks about it, is me being in trouble. It’s just weird sort of like association, where I went out of my way to make sure I was safe or I’m doing the best for my body, but if I get caught, I’m in trouble” (Angelene, F, South Indian). Secrecy due to the lack of family support may further contribute to unsafe SRH behaviours and poor health outcomes.

3.2.2. Social Isolation and Stigma

The data showed that stigma around sexual experiences can exacerbate social isolation, limiting access to peer education and support around sexual health issues, which means fewer opportunities for MRY to share and learn from their peers’ experiences. A participant noted, “There’s a lot of social stigmas around sex in general, [like] there’s a stigma around having a lot of sexual partners, there’s a stigma if you haven’t had any” (Marley, F, Chinese). Reflecting on their experiences, a participant talked about another student who was “… really socially awkward or isolated or [like] just feel alone or feel like they can’t trust anyone; I think it would be an even more challenge for those kids” (Zainab, F, Pakistani). This lack of interaction can restrict MRY’s understanding of SRHRs, which may lead to unsafe SRH practices and negative health outcomes.

3.2.3. Gender Knowledge Gap

This refers to the disparity in the understanding and knowledge of sexual health between the genders, which could lead to misconceptions about SRHRs, potentially contributing to unsafe practices and reinforcing gender inequalities. This gap can be widened by the influence of pornography and the media, which often portray unrealistic and harmful views of sexual health and relationships. Referring to the masculine gender, one participant emphasised their perceptual limitations: “I’m so surprised, I’m like, ‘by your old age, like 20, 30 years old, how do you not know? I can’t start my period on command’. Or they think your vagina is supposed to smell like flowers” (Dipthi, F, Pakistani). Another participant added, “And that really bothers me because a lot of young girls get like insecure, and dirty men with their fingers, they’re touching it. And I’m just saying, like, you can get a yeast infection. It’s not okay. Like they think you’re supposed to smell pretty, but they don‘t do the same thing about their situation down there. Like it has to be both ways; [participating]in sex health classes where they show that it‘s not a bad thing, like you‘re supposed to smell like that. It‘s a vagina. It‘s moist down there. (Monique, F, Bosnian). Another participant expressed a slightly different take, “I think taboo regarding sexual health that exists within cultural communities is, in my opinion, I think it‘s a result of misogyny most of the time… I think sexual health is targeted towards women more than men” (Darlene, F, Ghanaian).

3.2.4. Sexual Violence

Experiences of or exposure to sexual violence can severely impact SRHRs, which are often traumatising and influence future sexual behaviour and health. As one participant stated, “Like if you have to pester someone, where you have to like try and push them or influence them into doing something that they’re not willing. For example, like even if you’re like under the influence of alcohol and you and the other party can’t consent because they’re not in like a sober state of mind, like that’s still coercion, you know, like you’re forcing someone to do something that they don’t want” (Moana, F, Fijian). In agreement, another participant reiterated, “Yeah, that can put a lot of pressure on you, like mentally if you haven’t consented to something” (Rita, F, Liberian). And another stated, “They make you think you want to. Yeah, they asked repeatedly. They don’t drop it. They keep asking and asking, and eventually you say ‘yes’ because you’re tired of saying ‘no’ because saying no isn’t working. So you say ‘yes’ and then give in. So that isn’t consent” (Natalie, F). Exposure to sexual violence can have devastating effects on the SRHRs of MRY, increasing the risks for STIs, unwanted pregnancy, and long-term psychological harm. Another instance of sexual violence was highlighted around honest conversations about the use of protection or contraception. A participant reported, “I heard about [like] how some guys [like] they would say, ‘yes, [like] I’m using the condom,’ and then even the girl would say, ‘OK, you’re using it,’ and then they would just not use it; [like] they would manipulate the other partner” (Aileen, F, Pakistani).

3.2.5. Lack of Confidentiality and Trust

At the mesosystem level, a lack of confidentiality and trust significantly influences MRY’s experiences and perceptions of SRHRs. A lack of trusted guidance can foster feelings of isolation and anxiety, as illustrated by one participant who admitted, “I was just like, paranoid about it at one point, and then obviously I couldn’t talk to my parents and that’s about it” (Johnny, M, Indian). Another participant expressed frustration over the scarcity of reliable resources or authoritative figures to guide them through the complex maze of SRHRs, stating, “There’s no sort of representation of how to do that...there’s really nothing you can -, and your own friends or people around in your school and we’re all trying to navigate this, but there’s no sort of guiding person who can talk to you about these sorts of things” (Leila, F, Lebanese).

Additionally, the intersection of personal and cultural spaces can further complicate these experiences, causing MRY to avoid seeking help because of cultural stigma or fear of judgement. A poignant example of this came from a participant who recounted their uncomfortable experience with a family acquainted doctor. She stated, “I was going to a doctor, and this was so awkward. As soon as I stepped into that room, she asked me, ‘oh, how’s your family? and all of that’. That just alienated me from the whole medical purpose that I wanted to come in there for because I don’t want that kind of, you know, I don’t want a family friend or anyone from my specific communal ethnic group knowing about my medical concerns and needs” (Zantla, F, Bangladeshi). These experiences underline the critical need for the increased representation and confidential services of SRHRs specifically catering to MRY.

3.2.6. Insensitivity

Insensitivity towards SRHRs, especially from educators, service providers, or familial adults, can further perpetuate the stigma and fear associated with SRH, discouraging MRY’s help-seeking behaviours. Insensitivity can lead to feelings of shame and guilt, furthering the harm caused by a lack of education and support. Reflecting on a personal experience, a participant recalled, “They don’t even acknowledge that it’s like a personal and sensitive topic; …you don’t really get that one-on-one contact or even just make it feel like a personal experience” (Rollah, F, Lebanese). Another participant added, “I think it’s upsetting because it’s an upsetting situation… and then you’re just left to be like, ‘you know, it is what it is’” (Ayelen, F, Nigerian). This lack of sensitivity can deter MRY from seeking the necessary information and support for their SRH.

3.3. Exosystem Level

At the exosystem level, the environment surrounding MRY often indirectly impacts their attitude towards SRHRs through several broader societal factors, including the absence of professional support, language barriers, policy impacts, inadequate SRHRs education in school curriculum, and lack of access to services [5,17,48,49]. The following themes emerged when considering the exosystem level.

3.3.1. Lack of Professional Support

There is an overlap between the meso- and exosystem regarding the lack of professional support, which often means that MRY lack the necessary guidance for navigating SRHRs services. This hinders MRY in making informed decisions about SRH. A male participant reflected on a similar situation, stating, “There’s no sort of representation of how to do that, like, I can’t really think of, other than pornography, there’s really nothing you can [do], and your own friends or people around in your school, and we’re all trying to navigate this, but there’s no sort of guiding person who can talk to you about these sort of things” (Lee, M, Chinese). Rollah (F, Lebanese) added, “No one really has the follow-up conversation. I think that’s a massive gap in sexual health and reproductive health, education”.

3.3.2. Language Barriers

Language barriers further complicate the situation, limiting MRY’s ability to understand and engage with SRHRs services in their new home countries. Language barriers affect the accessibility and understanding of SRHRs [14,50]. MRY often find it challenging to explain complex concepts like consent or contraception when delivered in a language they are not familiar with. Nasrat (M, Indian) stated, “Things that are easy for us to talk about in English, you can’t explain that to like maybe older people or recent migrants or refugees”, pointing out that discussing SRH topics is already challenging, and becomes more challenging when a third party is required to interpret it or when one is required to find the right words to express their meaning in a different language.

3.3.3. Policy Impact

Policies that are not designed with the unique needs of MRY in mind can contribute to these challenges. An example is the taxation of menstrual health products, which disproportionately affects financially disadvantaged MRY [14]. Some MRY acknowledged this challenge, summed up by one who stated, “… not everyone has access to, you know, menstrual hygiene products or anything like that” (Sila, F, Lebanese). This implies that policies do not adequately address the needs of MRY in terms of SRHRs. Another participant stressed the difficulty in navigating the settlement process as a new arrival, with challenges to SRHRs coming from old perspectives and complicated by the trauma of the migratory process. She stated, “if you come from another country, there’s a different culture there. …When your parents are from somewhere else and then migrated to a new place, it’s a bit full on” (Jael, F).

3.3.4. Lack of SRHRs Education in the Curriculum

The lack of comprehensive SRHRs education in school curriculum, which typically does not include direct input from young people or MRY, leads to misunderstandings and misinformation about MRY’s SRHRs. The lack of SRHRs education in the curriculum has led to misconceptions and ignorance. An MRY commented, “You shouldn’t get hurt as a kid. You should get taught this information because it is important to your health. You don’t get taught” (Darlene, F, Ghanian). Another added, “I think a lot of young people, like, unfortunately, because of the lack of education, they sometimes, um, detriment the sexual reproductive health without even realising it” (Jas, F, Indian); and another said, “Teaching abstinence only is unsafe” (Monique, F, Bosnian). These statements imply the need for an overhaul of the educational curriculum with SRHRs content that is beneficial to MRY, taking their needs into consideration.

3.3.5. Lack of Access to Services

MRY often find it difficult to access SRHRs services due to various factors, including limited knowledge about service availability, stigma, and logistical issues, such as scheduling conflicts with school. For instance, one participant noted, “Around access to clinics, [like] when I think about when I was first exploring, [kind of] sexual relationships, it was in high school, and it was a lot of pressure, and I didn’t have access; [like] you’re at school for most of your week and then…, you have a curfew, or you have families [like] you get picked up from school. So there’s never really a chance to go to a clinic. I didn’t have access to go out of my current routine because my parents or family weren’t supportive, that wasn’t a thing. I can’t skip school, obviously. So that was never really accessible to me in high school” (Angelene, F, South Indian). The data also show that the relative invisibility of SRH services, such as abortion clinics, further amplifies SRHRs barriers. As one MRY noted, “No one really [like] advertises about it. [Like] you never see it when you walk down the street. You see [like] Cancer Council clinics [like] you can get your skin checked. Those clinics have labels, right? Have you ever seen [like] one for abortion?” (Marley, F, Chinese).

3.4. Macrosystem Level

At the macrosystem level, numerous cultural factors often intersect to influence the SRHRs of MRY. Cultural norms and beliefs, from both their country of origin and Australia, shape their experiences. These experiences are further shaped by societal attitudes toward migrants, which can affect service access, healthcare interactions, and overall SRHRs engagement across all system levels. This dual influence can result in internal conflicts, especially if the two cultures have different attitudes towards SRHRs. In many cases, the cultural norms of their country of origin, which often discourage discussions about SRHRs, may conflict with the more open attitudes seen in Australian culture [7,17,19].

3.4.1. Cultural and Societal Norms

The data show that cultural beliefs and societal norms can sometimes foster an environment where discussions about sex and reproductive health are stigmatised, consequently limiting young people’s access to essential information and resources. For example, an MRY expressed, “I remember, as a kid, whenever we watched TV, and anyone was kissing, and your parents are there, you have to act like you’re embarrassed like you hate [it], and it’s disgusting” (Moana, F, Fijian). Another participant summarised the pervasive influence of these norms, stating, “I think, in the cultural perspective… if you’re raised, um, surrounded by people who are the same culture as you, you don’t need to question anything, you just go with the flow and you go with the social status because everyone around you has the same culture, the same upbringing so you don’t question anything outside of that little box...” (Darlene, F, Ghanian). Within this context, another participant commented that societal judgement and the legal age for accessing certain SRHRs services may not be congruent with the cultural norms within MRY communities, causing conflict and confusion. She stated, “The legal age is 16, but can a 16-year-old walk into a Priceline pharmacy and buy plan B without people [like] judging or questioning or [like] giving a double take...?” (Jas, F, Indian).

3.4.2. Religious Beliefs

Religious beliefs are often intertwined with cultural beliefs and can also influence attitudes towards SRHRs. For example, a participant reflected, “I also think it transcends into conversations about reproductive health... And what are the options?? Is contraception an option? Like, am I having kind of healthy amounts of pain, or is it debilitating? Can I go to a doctor? Like, I think the whole kind of sexual and reproductive health is a taboo in, well, like, I’m South Indian, so in my culture and I was raised Christian, so that also, religiously, abortion is never on the table” (Angelene, F, South Indian). Another added, “But going to a Catholic school, when they touched on sex, it was all about just abstinence” (Taylor, F, Filippino). Subsequently, they noted that “It was very hush-hush growing up. Abstinence is the best solution to this, and that’s basically what we were taught in primary school” (Lupita, F, Fijian). Reflecting on her religion, another MRY remarked, “If someone was raped or something like that, … she’d still be seen as dirty or impure. Yeah, because... her virginity has been taken before marriage” (Darlene, F, Ghanian). For MRY from a religious background, these teachings discourage premarital sex, contraception, and abortion, without proffering support for SRH incidences, thus affecting their experiences and understanding of SRHRs.

3.4.3. Moral Boundaries

The data also highlight that moral boundaries within families and communities can affect how MRY perceive and navigate SRHRs. A participant rebutted her family’s presumption that the use of contraception would encourage sexual practices: “They think being on the pill will encourage me to have sex instead of making my own decisions, so they would take any alternative route besides the pill..” (Lepa, F, Fijian). Another participant reflected on the advice she received, “The safest way for you to not get a sexual disease is to just don’t have it (sex), rather than use a condom or take the pill, etcetera” (Monique, F, Bosnian). This presumptive approach tends to rob MRY of their agency and decision-making capacity, instilling fear and promoting punitive consequences.

3.4.4. Media and Culture

The portrayal of sex, sexuality, and reproductive health in the media and popular culture shapes attitudes and beliefs about SRHRs. According to our findings, exposure to pornography can lead to skewed perceptions of sexual relationships, particularly if it is the primary source of sexual education, as highlighted by an MRY as follows: “Yeah, they’re just aggressive. They’re just like hitting them. And they think that that’s what women like” (Monique, F, Bosnian). If the media and popular culture perpetuate harmful stereotypes or misinformation about SRHRs, this can influence MRY’s understanding of and engagement with their SRHRs.

4. Discussion

Throughout the focus group discussions, the participants were encouraged to articulate their understanding of sexual and reproductive health and explore their perceptions of their rights pertaining to SRH. Additionally, they were asked to identify and discuss barriers they had personally encountered in relation to their SRH, and to propose potential strategies to address these gaps. Significantly, most of the participants were unfamiliar with or had not previously considered their rights associated with their SRH. Many expressed difficulties in distinguishing between sexual health and reproductive health, leading to many often-inconclusive understandings. Despite this, there was considerable alignment in the participants’ responses across the different focus groups about the individual barriers they faced in relation to SRHRs.

Furthermore, the participants mostly agreed that discussions about sex are frequently stigmatised, to the extent that they overshadow its associated components, such as health and well-being. This consensus underscores the pervasive impact of stigma across various spheres of influence, including familial relationships, cultural norms, education, and religious institutions. In separate studies, Asnong et al. [51] and Logie et al. [52] corroborated findings suggesting that negative community attitudes towards sexual activity and access to reproductive services can deter youth from accessing information about sexual health services, including HIV testing. They also found that traditional views and stigmas surrounding SRH issues contribute to a knowledge gap about contraception and life skills necessary for MRY to make informed choices.

Using the Bronfenbrenner socioecological framework, this study identified the barriers that influence intergenerational exchanges as they relate to MRY. The following is an interpretation of the results in line with Brofrenbrenner’s socioecological framework, in relation to the existing evidence. The following sections include recommendations for practice, research, policy, and theory.

4.1. Microsystem Level

At the microsystem level of Bronfenbrenner’s socioecological theory [13], which focuses on individuals and their immediate surroundings, this study uncovered numerous barriers that significantly impact the SRHRs of MRY. A central issue identified is the lack of awareness and education regarding SRHRs. Many MRY come from different cultural backgrounds where open discussions about SRHRs are discouraged or non-existent [53]. This lack of dialogue can lead to misunderstandings and misconceptions about SRHRs. For instance, we have noted that the participants had an unclear understanding of critical concepts, such as consent. Ussher et al. [20], Pound et al. [54], and Khan et al. [53] attributed a misunderstanding of such fundamental concepts to a lack of sex education, which is concerning because it exposes MRY to potential SRHRs violations. In their qualitative synthesis of young people’s views on school-based sex and relationship education (SRE), Pound et al. [54] found that schools often approach SRE in the same way as other subjects, without acknowledging the sensitive nature of the topic. This lack of acknowledgment and appropriate education can contribute to MRY’s misconceptions about SRHRs. Our findings, therefore, align with the existing research that emphasises the role of comprehensive education for enhancing SRHRs outcomes [20,53].

The fear associated with the likely consequences of sexual activity is another crucial barrier that we identified. Such fear is often rooted in inadequate or fear-based sexual education, and tends to discourage MRY from engaging in safe sexual practices. This finding is consistent with Haas et al. [55] and Mittal et al.’s [56] studies, which showed that fear-based education can be counterproductive to promoting safe sexual practices.

Similarly, we also identified culturally or socially instigated feelings of shame, guilt, and blame regarding SRHRs as significant deterrents to MRY accessing the necessary services or openly discussing SRHRs issues. Baigry et al.’s [44] recent findings identified social stigma, fear, and shame as barriers to young people accessing SRH services in various countries, including Kenya, Nigeria, Malaysia, Nepal, and Iran—a similar demographic as that represented in our study. We also found that socio-cultural norms hinder youth’s access to contraceptives and STI treatments. Similarly, the study by James et al. [45] highlighted the association between stigma and healthcare utilisation, emphasising how stigma can lead to experiences of shame, guilt, and blame, ultimately deterring MRY from seeking adequate healthcare services. Thus, our findings resonate with those of global research, pointing to the pervasive influence of cultural and societal norms in shaping MRY’s SRHRs outcomes [57].

While the MRY in this study expressed concerns about their lack of knowledge about SRHRs resulting in the inaccessibility of relevant services, Josefsson et al.’s [58] study explored a separate challenge. Their study in Sweden revealed that students and professionals in various fields, including healthcare and social work, reported inadequate training and a lack of competence in SRHRs. The lack of knowledge amongst professionals could intersect with the lack of knowledge amongst MRY and lead to dire consequences for MRY’s SRH. MRY’s unfamiliarity with the healthcare system and the geographically disadvantaged position of SRH centres, especially in Greater Western Sydney, add to the challenges. Such challenges highlight the crucial role of easily accessible and well-funded health services in promoting SRHRs.

In addition, the influence of AODs on decision making concerning SRHRs emerged here as a critical concern. Among other research, Horyniak et al.’s [59] work has shown that forced migrants, including refugees, may be at risk for substance use as a coping mechanism for traumatic experiences, mental health disorders, acculturation challenges, and social and economic inequality. However, substance use can impair clear thinking and lead to unsafe sexual practices, such as inconsistent condom use and having multiple high-risk partners among MRY, echoing broader research linking substance use to poor SRHRs outcomes [32,59,60,61].

Thus, these microsystem-level barriers emphasise the complexity and multifaceted nature of the SRHRs issues faced by MRY [62,63]. They underline the need for interventions to be person-centred, considering individual experiences, feelings, and immediate contexts. They corroborate Bronfenbrenner’s assertion of the microsystem’s significant role in shaping an individual’s experiences. This insight is essential for designing effective SRHRs interventions for MRY, underscoring the need for comprehensive education, fear reduction, de-stigmatisation, adequate service accessibility, and AODs harm reduction strategies [14,32,64].

Recommendations for Practice

MRY’s SRHRs are subject to many socioecological influences within the context of Bronfenbrenner’s socioecological framework across system levels [13]. To address these multilevel challenges, an evidence-based approach incorporating recommendations from MRY is essential.

At the microsystem level, their interpersonal relationships and immediate surroundings considerably affect MRY’s understanding of their SRHRs. The absence of support from friends, parents, and teachers due to the stigmatisation of these topics often leads to misinformation or a lack of information [32]. This underscores the necessity of professional support and the creation of strong support networks, such as peer groups, school-based groups, and culturally appropriate networks, where comprehensive sex education programs are available [32]. To tackle this issue, the SRHRs of MRY must be established and promoted through a blend of system improvements and targeted services [20]. Service providers should create culturally safe health promotion strategies that are sensitive to the unique challenges faced by MRY, and integrate sexual health promotion into the early resettlement process [62,65]. Such strategies should encompass clear information regarding consent and other SRHRs concepts. By offering comprehensive sex education and encouraging open discussions about consent, service providers can empower MRY to navigate their SRHRs safely and with understanding [65].

To implement these strategies, professionals who interact with MRY should be trained in cultural safety and competency to adequately understand and support MRY’s unique SRHRs needs [7,66]. Furthermore, comprehensive and culturally safe sex education programs should be developed to address the misinformation or lack of information MRY face [67].

4.2. Mesosystem Level

The mesosystem-level factors illustrate the complex web of socio-environmental barriers influencing MRY’s SRHRs, highlighting the importance of comprehensive, culturally safe, and MRY-oriented interventions [13]. At the mesosystem level, the interplay between various microsystems, such as family, school, peer groups, and healthcare professionals, plays a significant role in shaping the SRHRs of MRY [68]. These findings suggest the presence of numerous socioecological factors that affect MRY’s SRH outcomes.

One example is family conflict, due to generational beliefs and cultural differences in SRH perspectives, which can present a significant hurdle. This conflict can hinder open discussions, which are crucial for imparting accurate and comprehensive SRHRs information. This lack of open dialogue within families may lead to potentially harmful misconceptions about SRHRs, with repercussions for MRY’s health and well-being [69]. Huang et al.’s [69] work suggested that a negative experience due to sexual stigma promotes secrecy, hindering help-seeking among minority groups; this aligns with our findings. Equally, Schaaf and Khosla [70] examined the effectiveness of a culturally sensitive parent–adolescent communication intervention for promoting sexual health communication and reducing sexual risk behaviours in youth from low- and middle-income countries. Their study found that the intervention significantly increased parent–adolescent communication about SRH topics and improved adolescents’ agency and knowledge of SRH. Miller et al.’s [71] research had similar sexual health outcomes, including increased condom use and decreased risky sexual behaviours among African American adolescents. Effectively, culturally sensitive and psychologically safe parent–adolescent communication initiatives are needed to address this barrier and promote accurate and comprehensive SRHRs information and agency among MRY [69,70].

Another critical mesosystem-level barrier is the stigma surrounding sexual experiences, which can exacerbate social isolation among MRY. This finding aligns with Adinew et al. [72] and Logie et al.’s [51] works, which found that negative community attitudes towards sexual activity and access to reproductive services can deter youth from accessing information about SRH services, including HIV testing. Additionally, Napier-Raman et al.’s [31] systematic review conducted in Australia found that MRY face similar barriers to accessing services and care for their SRH. This indicates that stigma and other factors can contribute to social isolation and limited access to support for SRHRs and peer education [31,51]. Peer interactions are essential as sharing and learning experiences, particularly regarding sexual health. Our findings highlight the importance of creating safe spaces for these discussions, emphasising the importance of age, gender, and culturally tailored programs to engage MRY in SRHRs conversations (combating social stigmas), research, and programming [51].

The gender knowledge gap, or the disparity in understanding and knowledge about sexual health between genders, has emerged in our study as a potential contributor to unsafe sexual practices and reinforced gender inequality [50,73,74,75]. This gap is exacerbated by the portrayal of unrealistic and harmful views of sexual health and relationships in the media and pornography [71]. Miller et al.’s [71] study showed that frequent pornography use is associated with sexual dissatisfaction and a greater preference for porn-like sex [76,77]. Our findings align with Miller et al.’s [69], among other studies, that the use of pornography is linked to poor sex practices, violence, and relationship dissatisfaction among MRY [76,77].

In tandem, experiences of or exposure to sexual violence, a grave concern at the mesosystem level, can profoundly impact SRHRs by inducing trauma and impacting future sexual behaviour. Of particular significance is the impact of sexual violence during migration on the barriers to and engagement with SRHRs services. While our focus groups did not yield extensive data on this topic, previous research by Kalra and Bhugra [78] has established that migrants and refugees, particularly women, adolescents, and children, often experience physical and/or sexual violence along the migratory route. These experiences continue to have a psychological impact that affects their engagement with SRHRs services [14,78]. Our findings reveal that the significant people in MRY’s lives may further amplify these traumatic experiences and deepen the social and psychological impact. This is supported by Keygnaert et al.’s [79] research (on sexual violence among refugees, people seeking asylum, and undocumented migrants in various countries), which demonstrated the frequent co-occurrence of sexual violence with physical, psychological, and socioeconomic forms of violence. Consequently, MRY victims disproportionately experience mental health challenges, including depression shaped by trauma, poverty, and elevated exposure to sexual and gender-based violence [51]. Substance use and depression often co-occur among forced migrants, further exacerbating their mental health disparities [51].

Based on our findings, the lack of confidentiality and trust at the mesosystem level can also foster feelings of isolation and anxiety among MRY. This claim has been supported by several studies [62,66,80,81,82]. The absence of trusted guidance or representation can complicate MRY’s navigation of SRHRs, particularly considering cultural safety and fear of judgement. Tirado et al. [62] explored a parallel concern for MRY where an interpreter is required, highlighting the interpreter’s judgment and confidentiality when discussing sensitive SRHRs subjects with the MRY. A reliance on untrained interpreters for discussing SRHRs may result in language discordance and the difficulty of clients in gaining comprehensive and accurate health-related information. The need for confidential services in SRHRs is underscored, particularly those specifically designed for MRY [81].

Furthermore, insensitivity towards SRHRs from educators, service providers, or familial adults can exacerbate the stigma and fear associated with SRH, thereby depleting MRY’s agency and help-seeking capacity [62,83]. Several studies have highlighted the positive impact of safe and sensitive SRHRs education and services on young people’s well-being and SRH attitudes. For example, a study conducted by Tirado et al. [62] in Sweden found that there are deficits SRH services for young migrants, including a lack of knowledge about SRHRs among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. Similarly, a study by Cohodes et al. [83] emphasised the importance of providing youth-friendly SRH services that are respectful, confidential, and non-discriminatory. In their Inuit youth research conducted in Canada, Corosky and Blystad [62] found that youth face significant barriers to receiving SRHRs care and support, including a lack of trust in support workers, stigma and taboos surrounding SRHRs topics, and feelings of powerlessness. These barriers particularly affect female youth, making it even more crucial to create an environment where MRY feel comfortable seeking help [62,84]. The need for sensitivity in these areas is paramount to ensure that MRY feel comfortable and empowered to seek adequate SRH support.

4.2.1. Recommendations for Practice

At the mesosystem level, a lack of interconnectedness between microsystem entities (such as family, school, and community) leads to gaps in knowledge, understanding, and access to services for SRHRs [5,63,84]. Youth services could liaise with other community-managed organisations and the department of education (through the school system) to facilitate MRY groups and workshops. Introducing MRY groups and workshops could serve as bridging points between these entities. This could foster a more comprehensive understanding among MRY, and enable them to navigate SRHRs services more effectively. These MRY groups should incorporate trauma-informed approaches that recognise the potential impact of migration-related violence and trauma on SRHRs engagement. These groups could serve as platforms where the importance of SRHRs awareness, knowledge, and value clarification are discussed at the individual and community levels to promote a supportive attitude towards SRHRs.

4.2.2. Recommendations for Research

Research has indicated that early formative environments, such as schools and communities, profoundly influence the attitudes and behaviours of youth regarding SRHRs [21,85,86]. Collaboration between these entities could foster a nurturing environment, instilling respectful and inclusive SRHRs attitudes from an early age. Thus, future research should aim to develop and evaluate collaborative programs involving the various stakeholders in SRHRs education and to understand their impact on the well-being of MRY. In addition, future research should investigate the effectiveness of peer-led education strategies in promoting healthy SRHRs behaviours and determine the factors contributing to their success. Based on the insights from this study, peer groups are often a significant source of information and influence among youth. Therefore, understanding peers’ roles in shaping SRHRs behaviours and beliefs can inform the development of peer-led interventions.

4.3. Exosystem Level

The barriers presented at the exosystem level, such as a lack of appropriate professional support, language barriers, policy impacts, the absence of comprehensive SRHRs education in the curriculum, and lack of access to services, reflect the complexity and interconnectedness of the factors emphasised by Bronfenbrenner’s socioecological model [14,32,50,62,63,83]. These barriers hinder the SRHRs of MRY and are influenced by various structural and systemic factors [14].

The absence of professionals (such as culturally safe SRHRs counsellors, GPs, teachers, and social workers) to guide MRY through SRHRs issues has significant implications. The research conducted by Tirado et al. [62] regarding the barriers faced by migrant youth in accessing SRH services in Sweden supports our findings. Their study highlighted the importance of improving healthcare providers’ awareness and culturally safe SRHRs services for migrant youth. In line with our findings, Tirado et al. [62] and Aibangbee et al. [87] noted that navigating SRHRs within new societies can be particularly challenging for MRY without professional support that understands the unique needs and complex issues MRY navigate daily.

Language barriers, a well-documented issue among migrant and refugee populations, further intensify the challenge, inhibiting MRY’s ability to understand and engage with SRHRs services [5,32,87,88]. This communication difficulty complicates MRY’s chosen acculturation strategy, and most likely results in their social isolation and misunderstanding of crucial information about SRHRs, exacerbating their health risks [87].

The impact of policies on MRY’s SRHRs is another factor at the exosystem level [14]. Policies that do not acknowledge the cultural implications or are not inclusive of the unique needs of MRY can create additional barriers to their access to SRHRs [14]. For example, taxing menstrual health products can further emphasise socioeconomic inequities and impact MRY’s SRHRs [62]. Similarly, migration-related trauma complicates MRY’s responses to a system. For example, Cohodes et al.’s [83] study examined the effects of migration-related trauma on the mental health of young migrants emigrating from Mexico and Central America to the United States. This buttresses our findings about the impact of structural factors on the well-being of MRY and their responsiveness to SRHRs.

The lack of comprehensive SRHRs education in school curriculum, reiterated at the microsystem level, is a systemic educational barrier that negatively impacts MRY’s understanding of and access to SRHRs information and services [31,36,88]. Various research, including Villa-Torres and Svanemyr’s [36] work, has consistently demonstrated the significant impact of SRH education on promoting safer sexual practices and mitigating health risks, as evidenced by our findings. This outcome underscores the importance of educational reforms including comprehensive SRHRs education, considering the unique needs and practical implications for MRY.

Furthermore, limited access to services, compounded by issues such as stigma, lack of knowledge about service availability, and logistical challenges, suggests significant environmental barriers at the exosystem level [89]. These barriers align with Bronfenbrenner’s model, which identifies the systems and structures within the broader environment as significant influences on an individual’s development and behaviour [13].

These findings highlight the critical need to address the various barriers at the exosystem level that affect MRY’s SRHRs. They underline the importance of integrated and multilevel approaches that address systemic issues in education, policy, and service provisioning, in line with Bronfenbrenner’s socioecological theory [63]. Our findings reveal the complex role of culture in shaping SRHRs experiences. While the participants identified cultural tensions, their experiences also suggested opportunities for leveraging cultural strengths in service delivery. This understanding informs our emphasis on culturally safe programs, which can help bridge traditional and contemporary approaches to sexual health. Furthermore, they point to the necessity of cultural safety and inclusive practices that consider the unique needs and experiences of MRY [14].

4.3.1. Recommendations for Practice

Our study observed that existing SRH services may not fully resonate with the distinct needs and experiences encountered by MRY in various regions, including Greater Western Sydney. This gap signifies a pressing need to restructure and realign these services to be more inclusive and responsive [89].

Several strategies could be initiated to bridge this gap. First, healthcare providers should receive comprehensive training in both cultural safety and trauma-informed care approaches, recognising that many MRY may have experienced sexual violence during their migration journey. This dual focus would ensure that services are both culturally appropriate and sensitive to trauma-related barriers to care. Additionally, language-accessible resources and multilingual staff in healthcare services could provide more personalised assistance, fostering a sense of safety and understanding among MRY during their health visits [62]. Developing MRY-friendly platforms (including on prevailing social media platforms) where they could provide direct feedback and present ideas in a safe and collaborative space could foster an inclusive healthcare environment.

Another crucial step in addressing MRY’s needs is implementing community advertising initiatives. This could be operationalised through collaboration with community leaders (including influencers and gatekeepers) and organisations to develop campaigns that resonate with MRY. These campaigns could be designed to increase awareness about available SRHRs services, encourage community dialogue on these topics, and foster a supportive environment for MRY [43,86].

These recommendations are not without challenges. In agreement with Tirado et al.’s [62] and VanderWielen et al.’s [90] works, our findings reiterate concerns about privacy, accuracy, and confidentiality when utilising interpreters. These concerns further emphasise the need to train interpreters and multilingual workers to have a broader understanding of SRHRs topics to ensure the effectiveness and long-term success of these strategies [62,90].

4.3.2. Recommendations for Research

The insights from this study identify the importance of intergenerational dialogues for destigmatising and normalising SRHRs conversations. To examine this further, future research could focus on designing and evaluating interventions to test and promote SRHRs dialogues within MRY communities. Given the small representation of male participants in this study, future research could also consider MRY gender-specific SRHRs exploration. This aligns with the findings of Ruane-Mcateer et al. [91], who emphasised the importance of gender-transformative programming to engage men and boys in SRHRs decision making and improve SRHRs outcomes.

Furthermore, addressing the unique needs of MRY with disabilities is crucial for ensuring inclusive SRHRs policies and programs. In line with the study by Hameed et al. [92], future studies should focus on developing evidence-based policies and interventions to support MRY with disabilities, including identifying their specific barriers to accessing SRHRs and effective strategies for overcoming them. Also, the study by Scherer et al. [93] emphasised the importance of coordination, efficiency, and accountability in disability-inclusive programs, which can also be applied to SRHRs interventions for MRY with disabilities.

4.3.3. Recommendations for Policy

Policies could be formulated to develop culturally safe and inclusive healthcare systems that address the unique needs and barriers MRY face. Policies should include implementing cultural safety training as a mandatory component of continuous professional development for healthcare providers. In their work, Curtis et al. [94] highlighted that cultural safety training helps healthcare providers understand and address the cultural, social, and historical factors that influence the health outcomes of MRY. It promotes self-reflection, awareness of power dynamics, and the provision of care that is respectful, safe, and responsive to the needs of diverse populations [94,95,96].

Policies should prioritise the allocation of resources for future research and development to better understand the specific SRHRs needs and prevailing challenges faced by MRY. This research should adopt a bottom-up and collaborative demography-led approach, involving the active participation of MRY and their communities, similar to the methodology applied in our research [66,97]. Evidence-based policies and programs could then be formulated based on the findings of this research, ensuring that they are tailored to the unique needs and experiences of MRY [97,98].

Policies should promote inter-agency collaboration between local health districts and community-managed organisations to ensure that services and programs addressing the SRHRs of MRY are coordinated, comprehensive, and effective. Roseby et al. [99] opined that collaboration which begins at the local level and involves the active participation of MRY and their communities is most effective. Therefore, through collaborative efforts, different stakeholders could pool their resources, expertise, and knowledge to develop and implement holistic approaches to SRHRs that address the social determinants of health and promote health equity [99,100].

By implementing these recommendations, policymakers could contribute to the development of culturally safe and inclusive healthcare systems that address the unique needs and barriers faced by MRY in accessing SRHRs services. These policies could help reduce health disparities, promote health equity, and ensure MRY’s agency.

4.4. Macrosystem Level

At the macrosystem level, several cultural and societal factors play a role in shaping MRY’s SRHRs. These factors reflect Bronfenbrenner’s socioecological theory’s outermost layer, which includes the overarching patterns of a given culture or subculture [13]. The influence of these larger social systems on MRY’s SRHRs can manifest in nuanced and complex ways.

This research’s findings reveal the strong influence of cultural and societal norms on MRY’s SRHRs. These norms can stigmatise discussions about SRHRs, leading to limited access to vital information and resources [17,19,101]. This cultural influence aligns with Bronfenbrenner’s emphasis on the macrosystem’s role in shaping behaviours and experiences, indicating a need for interventions that challenge harmful norms and promote SRHRs-friendly cultural shifts [13,21].

Religious beliefs, which are often intertwined with cultural norms, can significantly influence SRHRs attitudes. Mpofu’s [34] research on health and well-being among religious adherents in Zimbabwe found that religious beliefs potentially expose women and children to health risks. They potentially pose barriers to services, such as contraception and abortion, and limit discussions about SRH [10,34,35]. Our study underscores the need for culturally safe and religiously sensitive health education and services that respect religious beliefs and ensure comprehensive access to SRHRs [10].

Our study also highlights how moral boundaries within families and communities complicate MRY’s SRHRs. These moral boundaries can inadvertently perpetuate fear and limit MRY’s agency in decision making about their SRHRs. This observation aligns with Bronfenbrenner’s macrosystem model, which identifies societal norms as significantly influencing individual behaviours [13,102].

Moreover, our findings reveal that the portrayal of sex, sexuality, and reproductive health in the media and popular culture plays a significant role in shaping young people’s attitudes towards SRHRs. Aylward and Halford’s [103] research, which reiterated the United Nations’ stance on the rights of children to access SRH services and evidence-based education about human sexuality, tended to agree with Kwankye and Augustt’s [104] research hypothesis. They hypothesised that exposure to media influences young people to adopt positive SRH behaviours. While partly true, Kwankye and Augustt’s overall findings do not consistently show statistically significant associations between media exposure and reproductive health behaviour [103]. In alignment with our findings, they indicate that negative or unrealistic representations can lead to misunderstandings of sexual relationships and contribute to inaccurate and misinformative portrayals in the media [104]. According to our findings, these portrayals can also inadvertently result in a trado-cultural insistence on shielding young people from over-sexualised Western society.

Conversely, legal and political structures significantly impact MRY’s access to SRHRs services, as supported by Gazard et al. [105]. For instance, restrictive immigration policies can limit healthcare access for MRY, emphasising how migration status intersects with SRHRs access. They note that a range of other factors, such as ethnicity and socioeconomic status, further complicate this intersectionality. Discriminatory experiences arising from these intersecting identities can increase the need for SRHRs services and create disparities in their utilisation [106]. Our findings stress the importance of considering these multi-layered discrimination factors and advocating for an intersectional approach in research on health service use. The conflict between the legal age and cultural norms is another example that further illustrates the intricate interplay between macrosystem factors and MRY’s experiences with SRHRs services [105]. Thus, these findings reveal that the barriers identified at the macrosystem level emphasise the critical need for comprehensive, culturally safe, and accessible SRHRs services and education. Furthermore, they highlight the need for larger societal changes, including legal and policy reforms, and shifts in cultural and societal norms in line with Bronfenbrenner’s socioecological theory.

4.4.1. Recommendations for Practice

At the macrosystem level, the societal norms, values, and laws facilitating MRY’s SRHRs cannot be realised without effective intergenerational and intercultural dialogue [107]. Our findings reveal that MRY often navigate multiple cultural contexts and norms, which can present both challenges and opportunities for SRHRs engagement. Therefore, intergenerational and intercultural dialogues will be crucial for addressing stigmas and building upon cultural strengths and resources. These dialogues will facilitate the exchange of knowledge and experiences between different generations and cultural perspectives, leading to more nuanced and effective approaches to SRHRs issues [108,109,110]. Drawing from Schmitt et al.’s [108] analysis of SRHRs in post-Soviet society, intergenerational dialogue contributes to a more effective use of older people’s potential for generativity. Such a strategy would provide an opportunity for joint agenda setting and policy framing, and advocate the prioritising of purposive SRHRs issues [109].

Implementing intergenerational dialogues to address MRY’s SRHRs challenges at the macrosystem level would necessitate a multifaceted approach. An initial step could include organising community-based forums or workshops (‘town hall meetings’) where different generations could come together to discuss SRHRs issues. These gatherings could provide a platform for the older migrant and refugee generation to share historical perspectives on SRHRs and for MRY to voice their current concerns and experiences. Incorporating MRY’s recommendations into practice could help ensure that they have the knowledge, resources, and support they need to make informed decisions about their SRHRs.

Secondly, schools and universities could incorporate SRHRs dialogues into their curricula or extracurricular programs, perhaps as part of a larger public health education initiative [5]. This could include guest lectures from older community members or SRHRs health providers.

Also, media platforms could be used to normalise and destigmatise conversations around SRHRs. This could include interviews, podcasts, or social media campaigns featuring intergenerational dialogues on SRHRs topics. Furthermore, engagement with religious leaders and institutions could be particularly influential in shifting cultural norms. This could involve educating religious leaders about the importance of SRHRs and equipping them to facilitate dialogues within their communities. Mpofu et al. [10] stressed that harmonising the religious and cultural aspects of SRHRs policies is essential. This could be facilitated through interfaith dialogues to cultivate understanding and collaboration with cultural leaders, thereby promoting a more receptive environment.

Equally, older individuals could be trained to serve as SRHRs advocates, drawing upon their life experiences to enrich the dialogue. Similarly, youth could be trained in effective communication and advocacy skills to better express their SRHRs needs and perspectives.

4.4.2. Recommendations for Theory

This research project has used Bronfenbrenner’s socioecological theoretical framework [13,68] as a lens to investigate and understand the barriers MRY encounter in relation to their SRHRs. While this study has revealed how each socioecological system is interlinked, it does not incorporate one significant system—the chronosystem—initially omitted from Bronfenbrenner’s model (1979), but later included to account for environmental changes over time [111].

The chronosystem considers significant life transitions, socio-historical events, and environmental changes over time, which can significantly affect an individual’s development. The inclusion of this perspective is particularly relevant when examining MRY’s experiences. Migration itself is a significant life event, and the time since migration, the age at migration, and the historical and sociopolitical context of the migration period can all significantly impact MRY’s SRHRs. Therefore, understanding how MRY’s SRHRs evolve over time in response to changing personal circumstances and broader sociocultural environments can provide important insights into the long-term impacts of current interventions and identify areas where additional support may be needed.

While the socioecological model offers invaluable insights into the realities of individuals and communities, it is essential to guard against assumptions and biases that could emerge inadvertently. For instance, not all MRY encounter poor SRHRs conditions or lack safe microsystems for open discussions of SRHRs. Thus, the socioecological model should be viewed as a tool for understanding the complexities within individual experiences and communities, rather than a mechanism for making extensive generalisations.

Moreover, a more comprehensive theoretical approach requires the inclusion of other vulnerable MRY demographics. This could span from the LGBTQI+ community to MRY living with disabilities. Their unique experiences could illuminate different dimensions of the challenges faced and opportunities that could be harnessed, thereby deepening and enriching the existing theoretical framework [112,113].

Adopting an intersectional lens within the socioecological model could further illuminate how various social identities, such as race, gender, and sexual orientation, intersect at the micro-, meso-, exo-, and macrolevels. Such intersections shape the SRHRs experiences of MRY in profound ways, and acknowledging them could ensure the development of strategies that would be more responsive to these intersectional experiences.

4.5. Strengths and Limitations

This research project was designed to examine the SRHRs experiences and challenges of MRY in Australia’s Greater Western Sydney, and it succeeded in gathering rich and nuanced data. A key strength of this study is its utilisation of the socioecological model, which provided a robust theoretical framework for examining SRHRs experiences from a multidimensional perspective. This framework allowed for a comprehensive understanding of MRY’s experiences across different environmental systems and the interplay between these systems.

In addition, applying the PAR methodology provided a platform for participants to actively engage in the research process and contribute to an understanding their individual experiences. This enhanced the authenticity and depth of this study, capturing the lived experiences of MRY from their perspective. The diversity in the participants’ cultural backgrounds and experiences further enhanced the richness of the data and the insights drawn.

However, despite these strengths, this study has some limitations. The sample had an overrepresentation of female participants among those who submitted their demographic information, comprising approximately 70%, which might limit the applicability of the findings to the broader population of MRY in Australia. The COVID-19 pandemic significantly influenced the design and execution of this study, which led to most of the focus group sessions being conducted online. This change might have affected the depth of interaction, even though it provided a safe platform for the MRY to participate in this study. Technical issues such as internet connectivity hindered full participation by a small number of participants, but did not significantly impact the data. Furthermore, the pandemic situation meant that participants’ attendance was lower than initially envisaged at each focus group, resulting in an increase in completed focus groups by 80% to achieve data saturation. These changes potentially affected the generalisability of the findings to non-pandemic times.

Thus, future research should seek to address these limitations, possibly by aiming for a more balanced gender representation and accounting for the influence of exceptional circumstances, such as a global pandemic, on this study’s outcomes. Despite these limitations, the findings offer valuable insights into the SRHRs experiences of MRY and provide a solid foundation for further research in this field.

5. Conclusions

In conclusion, this study illuminated the complex and multidimensional experiences of MRY’s SRHRs in Australia. Employing Bronfenbrenner’s socioecological model afforded an understanding of the nuanced influences of various environmental systems on MRY’s SRHRs. These influences ranged from microsystem factors, such as family dynamics, to broader macrosystem influences, such as national health policies, with each level integral to shaping MRY’s SRHRs experiences.

Empathy and analytical rigour formed the basis for understanding the myriad barriers MRY face in relation to their SRHRs. These barriers are often deeply rooted in socio-cultural nuances, economic disparities, and sometimes, policy inadequacies that create a complex web of challenges that MRY face in accessing adequate SRH services and resources. It became critical, therefore, to dissect the underpinnings of these barriers—to understand why they exist or do not exist—in a bid to formulate evidence-based strategies to address them. Recognising the depth and breadth of the findings of this study, we acknowledge that this work is preliminary, considering the intricate dynamics at play. Recognising the depth of work required, we anticipate delving further into this vital study area. A forthcoming paper will be dedicated to articulating the facilitators and solutions proposed directly by the MRY, harnessing their firsthand insights and experiences to pave the way for more grounded, inclusive, and effective interventions in this space. This progressive step aims not only to illuminate the intricacies of these barriers, but also to actively engage in a dialogue that fosters solutions, resilience, and empowerment among the MRY community in Australia.

Valuable insights were obtained from the participants using the PAR methodology. This approach emphasised the importance of engaging directly with the communities involved and accurately capturing their lived experiences. The recommendations provided for practice, research, policy, and theory offer a path forward for enhancing the SRHRs experience of MRY. However, the limitations of this study, such as the gender imbalance in the sample and the potential impacts of the COVID-19 pandemic on the research execution and outcomes, warrant an acknowledgement. Future research must strive to address these limitations to ensure wider applicability of the findings.

Overall, this study signifies that addressing the SRHRs challenges confronting MRY is a multilevel and complex task. Collective action across multiple levels of society, from individual families to broader socio-political contexts, is required. The findings from this study provide a crucial stepping stone towards expanding knowledge, policymaking, and practice to support MRY’s agency and decision making regarding SRHRs in Australia.