Barriers to Access to Healthcare for Migrant Women

Background

Men and women migrate at a similar rate, although they are affected differently by migration. One of the reasons for the migration of people from their home countries is the human rights issues within their home countries (King & Dudina, 2019). The access to healthcare for migrant women should be studied from different perspectives, such as gender inequality, the traditionally-allocated gender roles, and a highly gendered labour market has resulted in a situation whereby widespread feminized poverty is experienced (King & Dudina, 2019). All of the negative situations that migrant women face directly impact their health outcomes since the negative outcomes will result in negative physical, mental, and emotional health. The situation is even worse for undocumented migrant women since the fear of legal implications of their migrant status becomes a great challenge to their access to healthcare, resulting in negative health outcomes in both the short and long runs (King& Dudina, 2019). Undocumented migrants have limited rights, and healthcare access since some countries do not allow free access to primary care, while others only allow access to emergency services that they might have to pay for.

In some cases, primary and emergency care are reserved for special categories of migrant women, such as pregnant undocumented women and children or women with some communicable diseases such as HIV/AIDS (King & Dudina, 2019). Some practical barriers could be experienced, such as the complicated administrative processes, the costs associated with access to healthcare, the risks associated with the law, or the possibility of being denounced to the authorities by the healthcare providers (King & Dudina, 2019). The reduced access to healthcare as experienced by migrant women has resulted in negative outcomes such as delays in the screening, treatment, and management of the different health issues experienced by the migrant women (King & Dudina, 2019). The migrant women are also at risk of not accessing contraception and other legal pregnancy-terminating methods. The legal status of migrant women could also expose them to gender-based violence and sexual abuse, resulting in negative health outcomes (King & Dudina, 2019). Their mental health is also affected due to the negative conditions that they may be exposed to, hence exposing them to even worse predicaments that may lead to challenging outcomes.

Identifying the Health Needs of Migrant Women

The first health need for migrant women is reproductive health. Women between ages 15 and 44 face issues associated with reproductive health. The major issue for this category of health needs is the practice of unsafe sex that exposes them to negative reproductive health outcomes (Schmidt et al., 2018). Secondly, cancer is another significant health issue that migrant women face. Two major types of cancers are experienced by migrant women, breast and cervical cancer. Given the barriers associated with the inability to access healthcare, early cancer detection is not achieved (Schmidt et al., 2018). Therefore, migrant women are likelier to experience cancer and its negative outcomes due to the late detection and the extent to which the disease will spread.

Maternal health is another important health need that migrant women face. Pregnant women require critical care during pregnancy and childbirth. Given the barriers that migrant women face when seeking primary care, pregnant migrant women are also likely to experience complications during pregnancy and childbirth. HIV/AIDS is another health need that migrant women might face (Schmidt et al., 2018). Unsafe sexual activities and violence against migrant women put them at great risk of contracting HIV/AIDS. Their illegal status in the countries they are in means that they may not receive the medications required to either protect themselves against HIV/AIDS or to manage the condition if they are already infected (Schmidt et al., 2018). Apart from HIV/AIDS, migrant women are also at the risk of contracting other sexually transmitted diseases such as HPV, gonorrhoea, chlamydia, or syphilis.

Gender violence is another health need that results in physical and mental health issues in migrant women. Violence against women could either be physical or sexual. The majority of the perpetrators are violent against women due to the assurance that they will not report them to the authorities since they are afraid of being deported from the countries (Belfast Health Development Unit, 2020). Mental health is another health need that migrant women experience. Women are generally more likely to experience mental health issues due to their vulnerability and the challenges that they experience due to being in a country illegally (Belfast Health Development Unit, 2020). Therefore, migrant women are likely to experience negative outcomes in their lives due to the mental health issues that they experience, such as poor health outcomes and suicide as a last resort.

The Gantt Chart


Health persuasion activities

 

advocacy for the policy changes will result in a situation whereby the health needs of the society will be effectively addressed

 

Underpinning theory:

 

Maslow’s Health Needs

Maslow’s hierarchy of needs theory views human beings as complete persons made up of physical, social, mental, and emotional aspects inseparable from their psychology and feelings. According to Maslow, all the stages of treatment need to account for the physical needs of the patients in question by the healthcare professionals involved

 

 

 

 

Legislative action activities

 

The policymakers, therefore, need to craft policies that will effectively address the different determinants of health or the lack of it

Underpinning theory:

Bradshaw’s Theory

Bradshaw discusses the different types of needs that directly or indirectly affect public health. Needs are an important aspect of public health since they help one identify the areas that require improvements so that positive outcomes can be achieved

Personal counselling activities:

Educating the migrant women on the importance of getting healthcare services

 

Underpinning theory:

Seedhouse Theory and Health Needs

Seedhouse argues that health is a foundation of achievement, not an achievement as previously believed. He further posits that health needs resulting from the human need for autonomy and self-determination. When one is healthy, they are likely to produce positive outcomes from the different endeavours they are invested in

Community development activities:

raising awareness of the health needs and effectively overcoming the challenges that could be experienced

 

 

 

 

 

Underpinning theory:

 

Doyal and Gough Theories of Health Needs

This theory attempts to differentiate between the basic health needs and the cognitive and more autonomous needs that human beings experience. The physical needs are required to stay alive and survive the different physical challenges they experience

 

 

 

Qualitative and Quantitative Research on the Barriers to Healthcare by Migrant Women

Qualitative Research

Out of the migrant women researched, most of them explained that they were not aware of what menstruation periods were when they first got them. They were, therefore, fearful, shameful, and afraid to express themselves to their parents on their needs at that time (Marques et al., 2020). They also mentioned that they did not receive any advice from their parents on their sexual health, putting them at the risk of experimentation that could result in negative health outcomes in the long run. The migrant women also mentioned that one of the biggest challenges that they experience is sexually related (Kang et al., 2019). Given the population’s vulnerability, migrant women face an array of situations that could expose them to various negative health outcomes. Some of the issues could be the unprotected sex that migrant women are exposed to (Kang et al., 2019). Furthermore, the migrant women also mentioned that they were highly exposed to physical and sexual violence, resulting in negative mental and physical health outcomes.

Quantitative Research

The first quantitative research included a single strategy and approach in establishing the barriers to health that migrant women experience. While other research efforts had used a combination of quantitative methods, this particular research used a single strategy to analyze better the data collected (Baalam et al., 2021). The combinations involved were the cultural awareness that the people have towards migrant women and how well they treat them. The intervention methods that the society will undertake concerning the barriers to health that migrant women experience were also investigated, leading to the positive outcomes that will be achieved from the research undertaken (Jayaweera, 2018). Qualitative evaluations were also undertaken so that the expected outcomes can be effectively understood on the challenges that migrant women experience in seeking medical attention (Jayaweera, 2018). The results of the qualitative research will also be analyzed by the quantitative research methods, resulting in a complete understanding of the challenges that migrant women experience when seeking medical services.

In the second quantitative study, Pérez-Urdiales (2021) explains that for immigrants, accessing healthcare services in their new country can be complicated by many impediments. Undocumented immigrants, in particular, face more severe restrictions on their legal rights and a higher likelihood of experiencing health problems. In the same way, women are far more likely than males to seek medical attention, and they encounter additional barriers to care because of their gender. In the Basque Country, this study looked at how easy it is for illegal immigrants and minority women to access free public healthcare. The thesis has three sub-studies, each of which was conducted using both qualitative and quantitative approaches (Pérez-Urdiales, 2021). While utilizing a negative binomial regression analysis (n = 9,272), researchers examined the change in the number of illegal immigrants visiting a free clinic before and after implementing a new law. Immigrant women and healthcare workers from free clinics were interviewed for 25 in-depth interviews using qualitative content analysis.

According to a new study, newcomers to Europe have been steadily increasing over time. There was 10.7 percent of the population in Spain that was registered immigrants as of January 2019. Spain’s autonomous Basque Country has 7.4 percent of its total population of foreign-born citizens, with a roughly equal split between males and women (Pérez-Urdiales, 2021). As a result, it is difficult for healthcare practitioners and politicians to know exactly how many illegal immigrants live in Spain and its regions.

Based on the quantitative study findings, the new Basque Decree 114/2012 imposed additional restrictive requirements on immigrants’ access to public healthcare services in 2013. Pérez-Urdiales (2021) explains that this mostly affected undocumented immigrants when its implementation was in 2013. A segmented time-series technique was utilized to examine the trends in the frequency of consultations of illegal immigrants in a basic medical health center before and after the law’s launch. When the Basque Decree 114/2012 was put into effect in January 2013, it was deemed the beginning of the intervention period. From January 2007 to December 2012, this was done from January 2013 to June 2017 to determine the pre-and post-intervention phases. Before moving on to Stata 13.0 software for analysis, the researchers first counted the number of appointments manually from the registration forms completed at the health consultations (Pérez-Urdiales, 2021). The free clinic registry was queried for descriptive purposes for data on overall and incoming patient sessions, country of origin, and prognosis for men and women.

An adjustment was made for seasonality and unemployment in the Biscay province and a percentage of the registered immigrant population. The rate of joblessness was used as a proxy for the impact of the economic downturn on the number of people seeking health care at the clinic. The fluctuation in the province’s immigrant population was reflected in the percentage of the registered population (Pérez-Urdiales, 2021). For the third quarter of each year, the frequency of appointment days fell, recorded by seasonality.

The below equation shows how the data was presented in the quantitative study:

where Y stood in the position of the result variable (percentage of medical consultations), ß0 was the reference tier at the start of the interval; ß1 estimated the underlying structural trajectory in the result before the therapy; ß2 assessed the immediate effect of the therapy through the change in the outcome and ß3 represented the change in the outcome trend following intervention (Pérez-Urdiales, 2021). Rate ratios (RR) and 95% confidence intervals (CI) were derived from the data using negative binomial regression analysis, then stratified by gender.

Interestingly, the data demonstrated that the trend of illegal immigrants attending a free clinic was unrelated to adopting increasingly restrictive legal restrictions for immigrants to obtain the necessary medical care. Barriers to access to healthcare for illegal immigrants and minority women were based on their features, medical system operating, legal requirements, and a stereotypical and poor social perception of immigrants held by health workers. Individual legal professionals, social groups, and personal networks were the primary facilitators for accessing legal information and help (Pérez-Urdiales, 2021). In conclusion, it was clear that structural and individual impediments based on the social vulnerability of unregistered immigrants and minority women had been discovered. Gender-based violence and being undocumented hindered women’s access to healthcare and made them fearful of being rejected at health centers. Immigrants’ legal rights must be ensured, but it is also necessary to promote rights-based attention to achieve more equitable health systems.

Discussion of Health Needs Theories

Maslow’s Health Needs

Maslow’s hierarchy of needs theory views human beings as complete persons made up of physical, social, mental, and emotional aspects inseparable from their psychology and feelings. According to Maslow, all the stages of treatment need to account for the physical needs of the patients in question by the healthcare professionals involved (Adawi, 2018). Higher levels of human needs are also responsible for the productivity and wellbeing experienced in the people concerned. Therefore, Maslow’s theory encourages healthcare professionals to look and operate beyond their areas of expertise (Adawi, 2018). Therefore, they should evaluate their patients based on their physical health, families, and career situations. The treatment efforts undertaken should then address the basic aspects of the patients’ health before addressing their secondary health needs. Without looking at the patient as a whole being, it will be impossible to provide all-rounded care that will be more effective in the long run.

Seedhouse Theory and Health Needs

Seedhouse argues that health is a foundation of achievement, not an achievement as previously believed. He further posits that health needs resulting from the human need for autonomy and self-determination. When one is healthy, they are likely to produce positive outcomes from the different endeavours they are invested in (Seedhouse, 2004). According to this theory, health is broken down into four aspects: basic needs, access to information, the education required to analyze the collected information, and responsibility for others in society (Seedhouse, 2004). By addressing the issues effectively, it will be easier to address the health challenges experienced in society.

Doyal and Gough Theories of Health Needs

This theory attempts to differentiate between the basic health needs and the cognitive and more autonomous needs that human beings experience. The physical needs are required to stay alive and survive the different physical challenges they experience (Gough, 2020). Apart from food, the physical needs also involve the inability of the person concerned to catch diseases. Therefore, the physical needs involve avoiding the harmful situations they may be exposed to (Gough, 2020). The autonomous needs involve the mental, cognitive, and different opportunities to participate in the social activities around them. The autonomous needs have a direct role in the physical health outcomes that they express.

The Application of Bradshaw’s Theory to the Prioritization of Health Needs

Bradshaw discusses the different types of needs that directly or indirectly affect public health. Needs are an important aspect of public health since they help one identify the areas that require improvements so that positive outcomes can be achieved (Guzys, 2020). Needs are also used in planning, management, and determining the types of health outcomes that could be achieved in the process (Guzys, 2020). By understanding needs, it is also possible to come up with important aspects in the improvement of health, the allocation of resources, and determining how equity can be achieved in healthcare.

Bradshaw suggests four types of needs. The first type of need, according to Bradshaw, is the normative need. Different professionals define the normative needs, and therefore, the professionals are responsible for laying down the standards affecting the needs under this category (Guzys, 2020). Secondly, the felt needs are defined by Bradshaw as the needs felt by the individual in question. The felt needs are limited to the individual in question, meaning that the individual perceptions of the knowledge in question are responsible for the perceptions that one has of their health needs. Expressed needs are the needs that are demanded by an individual (Guzys, 2020). The expressed needs are the actions that come up after the felt needs are undertaken. Therefore, the expressed needs are involved in seeking help for the different challenges that they experience. Finally, the comparative needs are the needs that have been identified by comparing the services that are received by one group of people.

There is a clear distinction between the need for healthcare and the health need. The health need is a broader subject since it involves the detection, prevention, management, and treatment measures undertaken (Guzys, 2020). The need for health does not have any known treatments since the broad category cannot be fully addressed. On the other hand, healthcare is concerned with the immediate search for a reprieve when they experience negative health outcomes (Guzys, 2020). The need for healthcare has a known solution, and treatment path since the medical conditions experienced have known intervention methods.

Table of Findings and Mapping Theories

Resource Hyperlink Methodology Findings
Kang, C., Tomkow, L., & Farrington, R. (2019). Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK. British Journal of General Practice69(685), e537-e545. https://bjgp.org/content/69/685/e537 Qualitative Migrant women and asylum seekers generally find it difficult to access healthcare and therefore they suffer negative health outcomes.

Seedhouse theory of health needs was used

Jayaweera, H. (2018). Access to healthcare for vulnerable migrant women in England: A human security approach. Current Sociology66(2), 273-285. https://journals.sagepub.com/doi/abs/10.1177/0011392117736307?journalCode=csia& Qualitative The article looks at the challenges that migrant women have in accessing healthcare services in England. The challenges experienced have resulted in insecurity in their quest for the access to health services.

Maslow’s theory of health needs was used

Belfast Health Development Unit. (2020). Barriers to Health Migrant Health and Wellbeing in Belfast. https://hscbusiness.hscni.net/pdf/Migrant_Health_Strategy_Belfast.pdf Qualitative and quantitative The resource looks at the different challenges that migrant women experience in their quest to access health services.

Bradshaw’s theory of health prioritization was used to check the effectiveness or failure of the health system in providing health services to the migrants in the United Kingdom

Pérez-Urdiales, I. (2021). Undocumented immigrants and immigrant women access healthcare services in the Basque Country (Spain). Global Health Action14(1), 1896659. https://doi.org/10.1080/16549716.2021.1896659 Quantitative This study examines and explains the healthcare in relation to women immigrants into the UK. It explains that access to healthcare services in the host nations might be difficult for immigrant communities due to a variety of factors. Immigrants without legal status are more likely to suffer from bad health than those with legal status. In the same way, women are more likely than males to seek medical attention, and they encounter additional barriers to care because of their gender.

 

 

The Gantt Chart

 

Strategies for Addressing the Health Needs

There are different ways through which health needs can be addressed. The first strategy is raising awareness of the health needs and effectively overcoming the challenges that could be experienced (Subica & Brown, 2020). The awareness will be addressed to both the general public and the healthcare professionals so that positive outcomes can be achieved. The healthcare professionals will be more prepared for the challenges that will be experienced when they are aware of the challenges that they are bound to experience in addressing the healthcare needs to be experienced (Subica & Brown, 2020). When the general public is aware of the health needs, they will be more involved in improving their personal, family, and health needs. This way, it will be easier to overcome the challenges experienced in healthcare since both professionals and society will be involved in improving the health issues experienced.

Secondly, health needs in society will be addressed by considering the short and long-term effects of the health issues experienced in society. The policymakers, therefore, need to craft policies that will effectively address the different determinants of health or the lack of it (Subica & Brown, 2020). By thinking about the immediate and long-term effects of the conditions exposed to, it will be easier for the stakeholders to prepare effectively for both the short and long-term outcomes that could be experienced (Subica & Brown, 2020). Finally, advocacy for the policy changes will result in a situation whereby the health needs of the society will be effectively addressed. The policy changes will ensure that the changes needed will be applied at the institution, local, state, regional, national, and international levels (Subica & Brown, 2020). The policy changes will also lead to positive changes that will eliminate the social determinants of health. Some of the most pressing needs for changes to be effectively applied include promoting education among members of society, whereby they will be educated on their health needs and how to overcome such challenges in both the short and long term. The policy changes will also help improve public attitudes towards public health, leading to better outcomes in the endeavours undertaken to improve public health.

Health Promotion Activities according to Beattie’s Health Promotion Model

Beattie’s model of health promotion is an approach that recognizes the fact that health is related to and affected by social and cultural aspects within the community that an individual is in. through Beattie’s health promotion model, it is possible to analyze the existing and previous health outcomes and also in pointing out the roles played by members of society in the outcomes achieved (Woodall & Freeman, 2020). The model also helps point out the resources that can be used to improve the current medical and health-promoting practices so that new strategies can be developed and positive outcomes can be achieved in both the short and long runs.

The model is made up of four quadrants that are arranged into two axes. The four quadrants represent the different methods through which different stakeholders can help in health promotion (Woodall & Freeman, 2020). This being the case, healthcare professionals, the government, and members of society have a role to play in persuasion, legislation development, individual counselling, and the development of communities. The two axes within the model represent the different modes of intervention that can be either authoritative or negotiated (Woodall & Freeman, 2020). There is also a critical focus on interventions, whereby individual or collective responses can be developed in seeking solutions for the different health issues experienced in society.

The government, through legislative action, undertakes a top-down approach that enables it to produce the expected health outcomes in both the short and long runs. The government is responsible for mass counselling and offering recommendations to help members of society overcome the challenges they experience (Woodall & Freeman, 2020). The government’s role in health promotion is to ensure that individuals and communities are protected from unwanted health outcomes through the different roles. Furthermore, community development in health promotion is achieved through the empowerment of the members of society (Woodall & Freeman, 2020). The empowerment is concerned with enhancing the knowledge, skills, and understanding that they avail to the members of society so that they can overcome the previous, current, and expected health challenges and help in the growth and development of the society.

The Resources and Communication Skills Required

The most important resources needed in health promotion are finances used to run the different health promotion endeavours. Without finances, any given project’s good intentions will not be brought to life since financial resources are required to actualize the plans that a project’s stakeholders have in mind (Kavanagh et al., 2020). All health promotion activities rely on the availability of finances since they are either directly or indirectly propelled by the finances available for the different activities that contribute to health promotion. Secondly, personnel is also required for the achievement of the desired health outcomes in society, there is a need for professionals who can help in the improvement of society to be readily available (Kavanagh et al., 2020). The professionals have to apply their knowledge in health promotion to the different situations they find themselves in and produce the desired outcomes. They are also responsible for resource allocation to the different areas of the projects they are in charge of, resulting in positive outcomes. The knowledge of the need for health promotion and how to achieve it is another important resource required (Kavanagh et al., 2020). Knowledge will help the professionals understand the communities they have to impact and develop affordable interventions that will result in desirable outcomes.

Different communication skills will determine the success of the health promotion activities that will be undertaken. First, verbal communication will be used at an individual or communal level, ensuring that the messages on the processes to be undertaken or the attitudes develop in promoting healthy outcomes in society (Kavanagh et al., 2020). Furthermore, non-verbal communication skills such as the use of written materials for announcements or communication will help achieve the expected outcomes in both the short and long terms. The written communications need to be accompanied by the necessary presentation skills so that the people involved can effectively get the attention of their target audience and pass the information required to them (Kavanagh et al., 2020). The communication skills also involve the ability to educate the masses on health issues to change their attitudes or outlooks of life, thus improving the health outcomes in the communities concerned.

Evaluation of the Success of the Project

The most important aspect that will determine whether the process was successful or not is the number of people impacted by the project. The larger the number of people impacted by the project, the higher the possibility that the project has been successful (Kashfi et al., 2019). This being the case, the improvement of healthcare policies will be determined by the number of migrant women that will start benefitting from the measures put in place. When the number of migrant women who access healthcare increases, it will be evident that the health promotion measures and policies put in place have been successful. It is also possible to determine the success of a project by looking at the important statistics concerning the people it has impacted (Kashfi et al., 2019). For example, the number of migrant women whose medical issues are dealt with will determine whether or not the project has been successful. It is also possible to determine the success of a project by looking at the number of policy changes developed to ensure that positive health outcomes are developed in both the short and long runs.

The knowledge and skills acquired by the migrant women and health professionals after the project will also be used to measure the project’s success. When the participants have collected adequate knowledge, they are likely to make more changes than when they have not gained any knowledge (Kashfi et al., 2019). Therefore, it is expected that after the project, there will be a significant change of attitudes, whereby more migrant women will be willing to get medical attention. In contrast, more healthcare facilities will be willing to treat them. The reduction of the most prevalent diseases affecting migrant women will also be an indicator of the improvements achieved in the field (Kashfi et al., 2019). When there are reduced numbers of cases from migrant women about the negative health outcomes that they suffer from, it will be evident that positive steps have been made towards health promotion. Finally, adopting healthy behaviours will be another indicator of positive outcomes in health promotion (Kashfi et al., 2019). When the migrant women take up positive steps toward reducing the instances of ill-health experienced, it can be concluded that the measures put in place have been successful and will improve the health outcomes in the process.

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