The cultural context of sexual and reproductive health support: an exploration of sexual and reproductive health literacy among female Asylum Seekers and Refugees in Glasgow

• DOI: https://doi.org/10.1108/IJMHSC-01-2019-0002
• Pages: 46-64
• Date: 23 December 2019
• Published date: 23 December 2019
• Author: Mari Kaneoka,William Spence
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements

The cultural context of sexual and

reproductive health support: an

exploration of sexual and reproductive

health literacy among female Asylum

Seekers and Refugees in Glasgow

Mari Kaneoka and William Spence

Abstract

Purpose –Sexual and reproductive health (SRH) incorporates prevention of unplanned pregnancies,

unsafe abortions, and sexually transmitted infections (STIs). The sourcing, understanding and

application of related information are important for health and this defines sexual and reproductive

health literacy (SRHL). Health care utilization rates among Asylum Seekers and Refugees (ASRs) may

not be high and they are unlikely to seek sufficient SRH information and care in their host countries,

leaving some needs unmet. No SRHL research related to Scotland’s Asylum Seeking and Refugee

Women (ASRW) exists. In this qualitative study, the purpose of this paper is to explore the SRHL-

related views and experiences of adult ASRW living in Glasgow and their views on assistancer equired

to improve their SRHL.

Design/methodology/approach –In total, 14 semi-structured interviews were audio-recorded and

transcribedand qualitative thematic analysisemployed.

Findings –Five themes and 13 sub-themes with four key findings highlighted: experience of unmet

SRHL needs, similarities and differences in the source of SRH information, SRH views and behaviours

influenced by cultural and religious factors, barriers and facilitators to accessing SRH information/

care and developing SRHL.

Research limitations/implications –This was a small scale qualitative study affording limited

transferability. The work addressed a highly sensitive topic among women from conservative home

country cultures.

Practical implications –Routine collection of sexual and reproductive health databy the NHS should

be explored for this group. NHS staff should be aware of the rightsof asylum seekers, Refugees and

failed asylum seekers, to NHS healthcare free at the point of delivery in Scotland (National Health

Service, 2019; Scottish Government, 2018), and be well trained in the likely religious and cultural

norms of these groups. Host communities should consider improving access to SRH information and

care in ASRWs first languages.

Social implications –The study identified weaknesses in the opportunities for social integration

affordedthis group and the coordination of existingsocial opportunities. The stigmatizationof immigrants

in the UK is well understood and has repercussions for many individuals and societal organizations

implicatedin the promotion of this.

Originality/value –This paper addresses a very sensitive topic with women from conservative

cultures. With few publications in this area, and none pertaining to Scotland, the paper makes a small

but original contribution that might be considered a starting point for researchers and relevant

services in Scotland.

Keywords Scotland, Health

Paper type Research paper

Mari Kaneoka is based at

the Department of Public

Health, University of

Glasgow, Glasgow, UK.

William Spence is based at

the University of Dundee,

Dundee, UK.

Received 5 January 2019

Revised 30 August 2019

Accepted 24 November 2019

This paper was written between

October and November 2018.

PAGE 46 jINTERNATIONAL JOURNALOF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 16 NO. 1 2020, pp. 46-64, ©Emerald Publishing Limited, ISSN 1747-9894 DOI 10.1108/IJMHSC-01-2019-0002

Introduction

Scotland’s response to the refugee crisis

The UK has hosted the sixth highest number of refugees across all European countries

(Eurostat, 2018) and its Government plans to receive 20,000 Syrian refugeesby 2020 (Refugee

Council, 2015). More than 32,000 people have applied for asylum in the UK each year between

the start of the Arab Spring and 2015 (Refugee Council, 2016). Scotland has hosted asylum

seekers and refugee (ASRs) since the latter part of the twentieth century and Glasgow has

hosted the second largest number of ASRs in the UK (Home office, 2016). There were

approximately 10,000 ASRs in Scotland in 201 6 (Home office, 2016) and by 2018, Scotland

had received 2000 Syrian refugees (UNHCR, 2017). The majority of ASRs live in Glasgow as it

is currently the main Scottish city designated by the UK government for dispersal of asylum

seekers although new dispersal areas have recently been established across Scotland

(Scottish Government, 2018). There is little routinely collected data to determine the heath

needs of UK ASR, let alone the SRH needs of Asylum Seeking and Refugee Women (ASRW)

despite members of this group being more likely to have faced domestic violence, rape, sexual

violence, forced marriage and female genital mutilation (National Health Service, 2019).

The vulnerability of female Asylum Seekers and Refugees

The UN Refugee Convention definition of a “refugee” was accepted in this study (UNHCR,

1951) and an asylum seeker is seen to be an individual who has applied for protection

under the Convention –or Article 3 of the European Convention of Human Rights –pending

a decision from the UK government on whether refugee status is granted or not (Scottish

Government, 2018). Refugees may have had difficult experiences of fear, danger and

poverty in their evacuation processes. The UK RefugeeCouncil’s (2012) study of 54 female

refugees revealed that more than 70 per centhad suffered violence either in their country of

origin or UK, and 44 per cent had been sexually abused before arriving in the UK. ASRW

risk sexual abuse in refugee campsand transactional sex with smugglers (Refugee Council,

2012). Asylum seeking women have also reported transactional sex with government

employees where they were promised priority treatment and speedier release if they

acceded to sexual demands of male guards (Freedman, 2016). Although 97 per cent of

female asylum seekers reported feeling safe in Scotland, over half reported deterioration in

their health after arrival (ScottishRefugee Council, 2009). This survey found that ASRs might

face many challenges, such as financial difficulties, cultural maladjustment and language

barriers after arriving in host countries. The low level of UK welfare payments to ASR has

been seen to be part of the government’s attempts to create a hostile environment for these

individuals (Allsopp et al.,2014). In 2017, it was estimated 15,000 ASR found themselves

destitute –inadequate nutrition, no fixed home, could not afford essential items and/or

experiencing worsening health–in the UK and distribution of Red Cross food parcels to this

group increased by 20 per cent on the previousyear (British Red Cross, 2019).

Sexual and reproductive health for ASR women

WHO defines health literacy (HL) as, “The cognitive and social skills which determine the

motivation and ability of individuals to gain access to, understand and use information in

ways which promote and maintain good health”. (WHO, 1998, p. 10). HL involves cognitive

skills, behavioural skills, advocacy skills, and existential skills (WHCA, 2011) and adequate

HL skills can help women access necessary SRH information and care (WHO, 2016). HL is

an important tool in enabling women’s empowerment by developing individual capacity,

which can reduce gender inequality in health (WHO, 2016). Fortenberry et al. (2001)

showed that the rate of gonorrhoea testing was 10 per cent higher in those with high HL.

Strengthening the empowerment of ASRW can reduce gender and health inequalities that

are common across SRH issues.

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