Act now to keep migrant and refugee women’s sexual and reproductive health on the national agenda

This week politicians, clinicians, nurses and health advocates will travel to Parliament House in Canberra to discuss women’s health. The RANZCOG women’s health summit is taking place as we mark two years into the ten year National Women’s Health Strategy. The theme of this year’s Summit is ‘Time to Act’.

The National Women’s Health Strategy frames migrant and refugee women as a ‘priority population’, and sexual and reproductive health as the first ‘priority area’. In July the Multicultural Centre for Women’s Health will be publishing a data report on the state of migrant and refugee women’s sexual and reproductive health in Australia, and the findings are clear. Migrant and refugee women’s health is still far from a priority, particularly in a pandemic.

Migrant and refugee women experience poorer sexual and reproductive health outcomes

Despite the lack of data on migrant and refugee women’s SRH, the available evidence shows that compared to Australian-born, non-Indigenous women, migrant and refugee women:

• Are less likely to have access to evidence-based and culturally relevant information which will enable them to manage their own fertility, contraceptive choices and menstrual health.
• Participate less in preventative health service access, for example, migrant and refugee women have lower screening rates for breast and cervical screening.
• Are at greater risk of contracting a sexually transmitted condition such as HIV or hepatitis B.
• Tend to access antenatal care later, and experience higher rates of stillbirth.
• Are at higher risk of experiencing pregnancy-related conditions such as preeclampsia and gestational diabetes.
• Are more likely to experience perinatal mental health conditions, often linked to social isolation and socioeconomic or financial insecurity, compounded by migration-related stressors.
• Are more likely to experience barriers to sexual and reproductive health care, including abortion care.

During the COVID-19 pandemic, Marie Stopes Australia clinics have witnessed additional barriers for migrant and refugee women in accessing urgent sexual and reproductive health services, such as abortion care. Shifting movement restrictions and lack of clear information about movement restrictions, exploited migrant and refugee patients’ concerns regarding over-policing, police discrimination and persecution for movement when accessing abortion care.

Communities continue to fill healthcare funding gaps

In Australia, international students are not entitled to Medicare and must have Overseas Student Health Cover (OSHC) for the duration of their stay in Australia. OSHC does not cover pregnancy-related conditions in the first 12 months of arrival in Australia unless the pregnancy is linked to an emergency situation. This means that if an international student, or the partner of an international student, experiences an unplanned pregnancy within the first 12 months of arrival in Australia, they may be faced with limited reproductive choices while simultaneously experiencing financial and settlement difficulties.

In the past two years, the Choice Fund has funded in excess of $850,000 worth of contraception and abortion services for patients experiencing financial hardship; many of those patients being migrant and refugee women. During the pandemic, the number of regular Choice Fund donors, philanthropists and the size of their donations has dramatically reduced. For the first time in many years, Marie Stopes Australia has had to turn away women experiencing financial hardship who cannot afford to access their choice of healthcare.

Reproductive coercion intersects with migration-related inequity and discrimination

Migrant and refugee women are at increased risk of family violence, including reproductive coercion. Reproductive coercion is both interpersonal and structural. The dynamics of power and control in intimate and interpersonal relationships can be directly shaped by discriminatory government policies related to migration and healthcare.

Immigration policy, temporary and dependent visa status, visa entitlements, along with social isolation and economic insecurity from the settlement process can increase migrant and refugee women’s vulnerability to coercive practices and/or violence. The violence they endure may be more severe and prolonged and they often experience structural and interpersonal barriers to accessing support services. Visa restrictions may limit migrant and refugee women’s capacity to exercise reproductive autonomy and prevent them from accessing government support services such as contraception, or maternal and abortion services.

Migrant and refugee women have the solutions

Migrant and refugee women are leading women’s health services, organisations, and companies throughout Australia. Migrant and refugee women are resourcing our health systems as clinicians, nurses, midwives, counsellors, community educators, and health advocates. Here are some of their solutions:

1. Policy: Health policy analysis and development is intersectional and addresses the specific issues faced by migrant and refugee women. Policies should aim to eliminate structural barriers to access such as cost, migration status, and visa category.

2. Resourcing: Specific and sustainable funding needs to be allocated for migrant and refugee women’s health programs, including healthcare provision and healthcare access.

3. Guidelines and standards: Guidelines and standards need to be tailored for the specific needs of migrant and refugee women in relation to maternal, perinatal and sexual and reproductive healthcare.

4. Workforce capacity building: Capacity building and professional development for health professionals and the interpreting workforce in gendered, cross-cultural awareness.

5. Intersectional data collection: Development of national conceptual information for sexual and reproductive health; more accessible data; comprehensive and cohesive coordination and analysis of collected data; data disaggregated by gender, sex, ability, ethnicity, disability, place of birth, and visa status.

6. Community-led research: More equitable research partnerships focusing on migrant and refugee women’s sexual and reproductive health. Research should be led by migrant and refugee women, or funding is allocated for the leadership and participation of migrant and refugee women.

7. Community education and information: Develop a national information infrastructure to deliver community-led, appropriate, in-language preventative women’s sexual and reproductive education and support programs across Australia, including in rural, regional, and remote areas.

8. Reframe antenatal care: Invest in innovative, tailored education and interventions run by migrant women’s organisations and delivered to migrant women by trained bilingual workers, in partnership with clinical care providers. Evaluate new initiatives and publish evidence on best practice antenatal care for migrant and refugee women.

For further information about these solutions, follow Multicultural Centre for Women’s Health on Facebook and Twitter — the Sexual and Reproductive Data Report and ‘Act Now’ report will be published in July 2021. If the National Women’s Health Strategy truly considers migrant and refugee women’s sexual and reproductive health to be a priority, it’s time to #ActNow.

Dr Adele Murdolo is the Executive Director of the Multicultural Centre for Women’s Health. She has a PhD in History and Women’s Studies and her research and publication areas include women’s health, violence against women and feminist history and activism in Australia. Adele is from an Italian migrant background. She is a passionate speaker and advocate for building the status of migrant and refugee women through research, practice and policy. For almost two decades as Executive Director of MCWH, Adele has provided strong leadership, expert advice and input into policy. You can follow Adele on Twitter.

Jamal Hakim is the Managing Director at Marie Stopes Australia. He holds two Bachelors in Commerce and Asian Studies from the ANU, and a Juris Doctor from RMIT. Jamal was born in Kuwait, and is of Lebanese heritage. He grew up in Ngunnawal country in a multi cultural community, with personal experience of the impacts of health bias against people of colour. Having worked in complex environments throughout his career, Jamal aims to balance culture, commercial sustainability and mission. He currently holds several board appointments, including with Democracy in Colour, MS Health Pty Ltd and Marie Stopes Papua New Guinea. In 2020, Jamal was elected as a Councillor for the City of Melbourne. You can follow Jamal on Twitter.