Migrant and refugee women face a range of inequities when it comes to sexual and reproductive health. With lower rates of contraceptive use, a greater risk of contracting STIs, and a greater risk of experiencing poorer maternal and child health outcomes, understanding the reasons for these inequities is key to finding real solutions.
However, assumptions and stereotypes about why these inequities exist can get in the way of critical conversations. Too often, sexual health issues are framed as too ‘culturally taboo’ for migrant and refugee women to engage with. But taboos around sexual health exist in all cultures, including Australia’s dominant white, Anglo-Saxon, heterosexual culture.
World Sexual Health Day which occurs every year on September 4, is an opportunity for us to think about strategies that destigmatise and demystify sexual and reproductive health for everyone. Challenging stigma is an important part of advancing sexual and reproductive health rights and having meaningful and culturally appropriate conversations can be a starting point for further action. However, part of confronting stigma is also about challenging the stereotypes and misconceptions that mainstream organisations, service providers and the general public hold about migrant and refugee women and gender diverse people.
In our research exploring the sexual and reproductive health of migrant and refugee women, we found that health professionals often made assumptions about migrant and refugee women’s autonomy, interest in, and knowledge about sexual and reproductive health treatment and services. For example, assumptions and stereotypes about ‘culture’ and the perceived gendered dynamics in communities sometimes meant that migrant and refugee women were not being offered all forms of contraception. These cultural assumptions resulted in a tendency to treat migrant and refugee women as a homogenous group with the same beliefs, rather than as individual women, with knowledge and understanding of what works for them.
Our work with migrant and refugee women illustrates that they proactively seek out information about sexual and reproductive health and want the tools and resources to be able to advocate for their health and wellbeing. Overwhelmingly, we hear about the many structural barriers that often inhibits their ability to do so. These barriers include lack of access to in-language information about sexual and reproductive health or how to navigate Australia’s complex health system. Similarly, as we have written elsewhere, many government-funded programs for sexual and reproductive health services exclude migrant and refugee women based on their visa status, leading to prohibitively high out-of-pocket costs. For international students, the Overseas Student Health Cover Deed excludes access to pregnancy related health care for their first 12 months in Australia, preventing vital access to reproductive health services.
Like everyone, migrant and refugee women have different preferences for how they like to learn about sexual and reproductive health, and it is essential that migrant and refugee women themselves are leading conversations on what this looks like. This may be in the form of in-language health education, such as MCWH’s Health in My Language program, or it may be from their GP or other health professional. For this reason, it is important that all organisations invest in gendered cross-cultural training, led by expert migrant and refugee organisations in order to practice culturally responsive and sensitive care.
Access to in-language and culturally responsive education is only one part of the answer to addressing health inequity. Removing all barriers to access includes addressing structural barriers such as residency and visa restrictions. Working with and listening to migrant and refugee women is key to challenging taboos, breaking down stereotypes and ensuring that education, information and services are accessible and effective. Only then can we move forward, towards a fairer, more equitable health system.
This article was first published in edition #137 of The WRAP on September 2024.