School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
Research Institute CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands.
BMC Public Health. 2024 Feb 19;24(1):520. doi: 10.1186/s12889-024-17916-0.
BACKGROUND: Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. METHODS: We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. RESULTS: We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. CONCLUSION: To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.
背景:移民和难民在发达国家和发展中国家获得性与生殖健康(SRH)服务方面面临前所未有的不平等。大多数注意力都集中在富裕国家的观点上,而实际上有大量的移民和难民正流向欠发达国家。本文综合了从中等收入和低收入国家的角度来看,获得适当的 SRH 护理所面临的障碍。
方法:我们对包含主要原始资料定性和定量研究以及详细定性描述的文章进行了系统综述。文章来自包括 PubMed、Science Direct、HINARI 和 Google Scholar 在内的各种数据库,发表时间在 2012 年至 2022 年之间。由于背景不同,我们排除了在高收入国家生活的来自中低收入国家的移民和难民的文章。为了选择文章,我们使用了系统评价和荟萃分析的首选报告项目(PRISMA)。使用标准的 QASP 检查表评估文章的质量。我们使用社会生态学模型来调查各个层面的障碍,并使用主题分析来确定模型各个层面的最强主题。本综述已在 PROSPERO 注册,注册号为 CRD42022341460。
结果:我们从总共 985 篇文章中选择了 15 篇进行最终分析。结果表明,尽管参与者的家乡和原籍国各不相同,但他们使用 SRH 服务的经历非常相似。大多数移民和难民女性声称受到服务提供者的歧视,语言和文化障碍在她们的经历中起着重要作用。在缺乏全民医疗保健覆盖的国家,医疗保健费用是使用 SRH 服务的障碍。使用 SRH 服务的其他主要障碍是对这些项目缺乏了解、对隐私的担忧、沟通不足、社区污名化以及与性别相关的权力不平衡。
结论:为了提高女性移民和难民对 SRH 的利用,提供以患者为中心的护理并让丈夫、父母、姻亲和社区参与 SRH 共同生产至关重要。必须为医疗保健人员提供关于文化能力、同情心和尊重的培训。增加移民和难民医疗保健的经济获取途径至关重要,满足他们的基本需求也是如此。
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