Evolving Approaches to Sexual and Reproductive Healthcare Access for Refugee Women 

By Aanya Ravichander

The world’s refugee population is increasing, thanks to climate change, political violence and war. There are currently more than 43.4 million refugees globally, the highest recorded level of displacement. Access to meaningful data on refugee health is minimal, rendering them practically invisible in conversations about public health. In these already marginalized refugee communities, refugee women face even greater vulnerability and struggle to access basic healthcare.  

A recent study of female refugees’ use of sexual and reproductive health services in the Southeastern U.S., published in PEC Innovation in December, examines this struggle. The use of these services, though necessary, is often taboo across the globe. The study finds that communication, costs, interpretation services, and cultural differences affect their access to treatment. Accessible clinic locations, transportation, and positive caregiver interactions served as facilitators to care, while language and financial hardships posed significant challenges. On the other hand, cultural differences and interpretation services had a multitude of effects.

Up to this point, there had been no studies on this population in Atlanta or the southeast, creating a “big gap in the literature,” says Milkie Vu, PhD, the co-principal investigator on the study and assistant professor at the Feinberg School of Medicine. She adds that this study represents the “first steps towards thinking about how to design not just culturally sensitive services, but also to get more funding, infrastructure, and resources to support clinics that serve refugee populations.”  

Researchers interviewed 26 female refugees living in Georgia, who had been forcibly displaced from Burma, Bhutan or Nepal, and the Democratic Republic of Congo. Researchers asked the participants about their access and utilization of sexual and reproductive services in their language of choice with female interpreters with similar cultural backgrounds and research method training. Participants were specifically asked about access to contraceptive care, HPV vaccination, cervical and breast cancer screenings, and prenatal care. The interviewees, in their responses, also discussed their resource use in relationship to modesty, comfort, birth control, fertility, transportation, and cultural influences. 

“We all know what the major obstacles are for refugee women,” says Dr. Stacia Crochet, an assistant professor in the Department of Gynecology and Obstetrics at Emory School of Medicine and faculty advisor of the Harriet Tubman Women’s Clinic, a free clinic for uninsured and underserved women in Clarkston, Georgia. “Language, transportation, cultural barriers, insurance, none of this is revolutionary. However, hearing it in the words of the patients is really helpful.” 

The interviewees related difficulties accessing multiple forms of care, but to the investigators, their criticisms of interpretation services stood out. Many of the participants felt that interpreters would omit certain parts of their communication, misinterpret what they were saying, or would add more than what the individual noted. Researchers working among refugees in New Zealand found similar effects, which they described in a 2023 article, highlighting that negative experiences with translation services was a significant stressor for refugee resettlement.  

“I can see everything that these patients are saying,” Dr. Crochet adds. “I can literally feel that. I can feel what it means to know that the translator is not saying exactly what you are trying to portray and when people are truly taking the time to listen to you.”  

A potential solution discussed in the paper is to have medically trained community ambassadors, in-person interpreters that are trained in both language as well as the cultural and medical contexts. Some organizations, such as the Amani Women Center and the Refugee Women’s Network, have community ambassadors that are medically trained to accompany women to their healthcare appointments, alleviating much of the stress.  

Given the women’s national origins, researchers anticipated that cultural influence would negatively impact their access to care. In a 2017 study, researchers on a related project found that taboos regarding menstrual and sexual health created knowledge gaps in understanding of sexual and reproductive health services across cultures in migrant and refugee populations. However, the current results paint a more nuanced picture.  

“People have their own agency, and the ability to decide for themselves in terms of services that they want to access or use,” Vu says. “So, the cultural influence is a little bit more complex. Rather than being sort of one sided or just having a uniformly homogeneous influence across these different groups.” 

Vu’s study adds more to our knowledge. The stereotype that cultural background affects sexual and reproductive health access solely in a negative way is incorrect. It is not the full picture. Some participants mention that sexual and reproductive health care access is respected in their culture because they just want everyone to be healthy. Other participants mention that choice to use the services is heavily emphasized in their communities, and sexually transmitted infections (STI’s) are discussed.  

For female refugee populations care needs to be provided in partnership with trusted, trained community-based organizations. Policy interventions can focus on more nuanced solutions, by recognizing the heterogeneous effects of cultural influences. Potential next steps include interviewing the health care professionals on their approaches to care for this patient population. Personalized care is a critical need. 

“It takes a clinician that wants to do it and wants to do it well and cares to have a good visit with a refugee woman. It just does,” Dr. Crochet says. “Why accept refugees if you are not going to provide for them?”