GLOBAL – Improving the reproductive health of undocumented women migrants & refugees

Interventions to improve the reproductive health of undocumented female migrants and refugees in protracted situations: a systematic review

by S Larrea-Schiavon, LM Vázquez-Quesada, LR Bartlett, N Lam-Cervantes, P Sripad, I Vieitez, L Coutiño-Escamilla

Global Health: Science and Practice 10(6):e2100418, 21 December 2022

Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations.

We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied two search strategies across six databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality.

Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs.

Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.

Key findings
Providing free or low-cost services to migrant women and female refugees in protracted situations is a critical strategy in successfully ensuring access to the continuum of sexual and reproductive, maternal, and newborn care services. Staffing health care units with culturally competent and trained personnel influences the prevalence of contraception use and can reduce maternal and neonatal complications and adverse outcomes. Educational interventions can potentially have a greater impact if implemented after or concurrently with the improvement of health system capacities.

Key implications
Implementing organizations should consider the importance of cultural sensitivity and security when designing and implementing the intervention and should support, as much as possible, a health system culture of de-identified electronic record keeping—particularly in conflict areas, as records can get lost during violent attacks. Implementing organizations, research partners, and target communities should be involved from the start in the design of the intervention and evaluation so that both components are responsive to community needs and have strong monitoring and evaluation methodologies to report on best practices and lessons learned.

SHARED by RAISE/IAWG Literature Review, Columbia University Mailman School of Public Health, E-mail: 31 January 2023