Department of Global Public Health, Global and Sexual Health, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
BMC Public Health. 2024 Sep 20;24(1):2569. doi: 10.1186/s12889-024-19778-y.
Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia.
The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care.
A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling.
There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.
移民女性在目的地国家往往难以获得医疗保健服务，并经历着不平等的性健康和生殖健康结果。这些健康不平等现象包括避孕方法的可及性和使用情况。为了更好地了解哪些因素影响着移民女性的避孕方法的可及性和使用情况，本范围综述旨在综合有关高收入国家（HICs）中具有移民经历的女性的避孕方法的可及性和使用情况以及相关干预措施的证据，这些 HICs 位于欧洲、北美和澳大拉西亚。
本研究检索了 2000 年 1 月至 2023 年 6 月期间发表的同行评审的定量、定性和混合方法文章，使用了 PubMed、Web of Science 和 CINAHL 科学数据库。如果文章报告了有关研究，这些研究探索了具有移民经历的育龄女性在 HICs 中使用避孕方法来预防怀孕，则将其纳入研究。两名研究人员独立筛选并从文章中提取数据。根据 Levesque 等人的医疗保健可及性框架，根据患者和卫生系统层面的因素对研究结果进行了分类。
共纳入 68 篇文章，其中约有一半（n=32）来自北美。这些文章侧重于个体层面，而不是卫生系统层面，包括女性避孕知识、文化和宗教对获取和使用避孕方法的影响、伴侣参与以及不同的健康保险覆盖范围等方面。在卫生系统层面，文章强调了缺乏关于避孕服务的信息、服务和沟通方面的文化（不足）适应性、避孕方法的副作用，以及服务的地理可及性和成本。本综述还确定了三篇报告与避孕咨询相关的干预措施的文章。
关于卫生系统如何在组织层面上对具有移民经历的女性的避孕服务造成障碍，相关知识匮乏，因为研究主要集中在个体层面。本综述的研究结果可以作为进一步研究和政策与实践发展的基础，具体建议包括早期提供与卫生系统相关的信息和避孕教育、让男性伴侣参与避孕讨论、对医疗保健专业人员进行文化能力培训以及加强避孕咨询的口译服务。
