Women Of Refugee Background Research Articles

‘Resilient survivors’: narratives of violence against women of refugee background

ABSTRACT Scholarship on migrant deservingness explores how host society institutions require specific types of performances, particularly of vulnerability/ powerlessness and resilience/ self-sufficiency, sometimes in temporal succession. Such performances are also required of victim-survivors of violence against women, a category that overlaps considerably with refugees. This study brings together feminist literature related to violence against women with migrant deservingness literature, to observe how cultural factors interact with host society institutions. The article draws on an empirical study about narratives of violence in the lives of women of refugee background in Ireland, centring five in-depth interviews with self-identified victim-survivors, alongside six focus group discussions with women of refugee background. Using narrative analysis, I explore individual and collective identities in response to violence. Narrative identities of resilience are strongly present, while vulnerability is not. I conclude that, in line with scholarship on migrant deservingness, neoliberal institutional discourses of ‘resilient survivors’ support individual women to express agentic, albeit individualising and responsibilitising narratives, and I add that this simultaneously upholds patriarchal cultures of silence and inaction about violence. I offer conceptual thinking on ‘space for action’ as an alternative approach for scholars and practitioners to construct and consider the victim-survivor of violence against refugee women.

Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia.

Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), 'Structural inequities and the toll of the pandemic'; theme (2), 'Supportive infrastructure'; and theme (3), 'Cultural safety during the pandemic'. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies.

Exploring Trauma- and Violence-Informed Pregnancy Care for Karen Women of Refugee Background: A Community-Based Participatory Study.

Women of refugee background experience poorer perinatal outcomes when compared to their local-born counterparts. Women of refugee background have often experienced trauma and are likely to encounter barriers to accessing health services in host countries which can exacerbate their recovery from trauma and contribute to poor health outcomes. Trauma- and violence-informed approaches to care offer opportunities to address barriers to pregnancy care which may, in turn, improve these poor outcomes. Trauma- and violence-informed care is a framework that acknowledges a person's experiences of trauma, recognises its impact and symptoms, and works toward resisting re-traumatisation by integrating knowledge into practice. Despite this, trauma- and violence-informed care in maternity care settings has rarely been explored from the perspectives of women of refugee background. This study aimed to explore trauma- and violence-informed pregnancy care from the perspectives of Karen women of refugee background using Community-Based Participatory Research methods. The lead researcher is a Karen-Australian woman with lived refugee experience. A Community Advisory Group was formed to support the study. Semi-structured interviews were conducted with seven Karen women of refugee background who had recently had a baby in Western metropolitan Melbourne, Australia. The data were analysed using Reflexive Thematic Analysis. Karen women shared what they considered to be important elements of trauma- and violence-informed pregnancy care. Three major elements were identified: (1) care design and accessibility; (2) promoting choice and control; and (3) trauma-informed interpreting. The critical importance of the interpreter-mediated setting was highlighted as women reported that they may not experience trauma- and violence-informed maternity care if they cannot access an interpreter or their relationship with the interpreter is unsafe. This study offers critical insights regarding the elements of trauma- and violence-informed pregnancy care that are important to Karen women of refugee background.

Perinatal mental health screening for women of refugee background: Addressing a major gap in pregnancy care.

Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non-refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non-refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non-refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Similarly, high proportions of women of refugee and non-refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care.

Who is the Host? Interrogating Hosting from Refugee-Background Women’s Perspectives

ABSTRACT This paper explores refugee-background women’s concepts of hosts and hosting in resettlement. The refugee studies literature generally uses the term ‘host communities’ to describe a country’s citizens or established communities who interact with and may assist newcomers to build a new life. However, findings from our walking interviews project with a small group of refugee-background women in Sydney, Australia suggest that these women were actively contributing to hosting newly arrived families. They were in fact the hosts rather than the guests. They performed rituals of hosting for newcomers from similar backgrounds more so than the so-called host communities. The act of hosting involved an intra-group process that was integral to the women’s roles in their local communities. Conversely, inter-group relationships with so-called host communities were completely absent. We review how conceptualisations of hosting are used in forced migration studies. We outline how the findings on hosting challenged our own understanding of hosting in a resettlement context. Our discussion of refugee-background women’s agency as hosts for newcomers provides new understandings of an oft-forgotten aspect of women’s lived realities in resettlement, their strengths and resourcefulness, and the gendered nature of these rituals.

Intersections of immigration law and family violence: Exploring barriers for ethnic migrant and refugee background women

INTRODUCTION: Action on family violence1 remains a policy priority for the New Zealand government. Accordingly, this article explores the Immigration New Zealand’s Victims of Family Violence (VFV) visa. Specifically, it explores possible barriers preventing MELAA2 cultural groups from utilizing the VFV visa.APPROACH: The discussion is based on administrative immigration data, gathered by Immigration New Zealand (INZ), on applicants for VFV visas between July 2010 and March 2021.FINDINGS: Over the last 10 years, INZ received 1,947 applications for the VFV Visa. People of Asian (40%) and Pacific (38%) backgrounds made most of these applications, with India, Fiji, China, the Philippines, and Tonga making up the top five source countries. MELAA communities made only 11% of the total VFV visa applications. Applicants from South Africa, Brazil, Iran, Nigeria, and Argentina made up the top five source MELAA countries. Analyses showed that MELAA applications were mostly work-type visas.IMPLICATIONS: Data presented shows that the VFV visa is still underutilised within these communities. Possible reasons for these notable outcomes are explored in this article, with suggestions for remediating strategies for barriers preventing MELAA communities from utilising the VFV visa. This article concludes that more research is required to gain an in- depth understanding of the specific cultural contexts within which these women engage with this visa.

The Association between Intimate Partner Violence, Depression and Influenza-like Illness Experienced by Pregnant Women in Australia

Intimate Partner Violence (IPV) is a major public health issue, including during pregnancy where it poses a serious risk to the woman’s health. Influenza-Like Illness (ILI) also causes significant morbidity for women during pregnancy. It may be possible that ILI in pregnancy is associated with IPV, and that depression and trauma history play a role in the connection. 524 Australia-born women and 578 refugee-background women participated in the study. Baseline participants were randomly recruited and interviewed from antenatal clinics between January 2015 and March 2016, and they were reinterviewed six months post-partum. Bivariate and path analysis were used to assess links between IPV, depression and ILI. One in 10 women (10%; 111 out of 1102) reported ILI during their pregnancy period and this rate was significantly (p < 0.001) higher for women born in conflict-affected countries (13%; 76 out of 578) as compared to Australian-born women (7%; 35 out of 524). In both groups, Time 1 traumatic events, IPV and depression symptoms were significantly associated with ILI at Time 2. A significant association between IPV at Time 1 and ILI at Time 2 was fully mediated by depression symptoms at Time 1 (Beta = 0.36 p < 0.001). A significant direct path was shown from depression symptoms to ILI (Beta = 0.26, p < 0.001). Regardless of migration history, pregnant women who have experienced IPV and depression are more likely to report influenza-like symptoms in pregnancy. This may suggest that trauma and depression negatively affect immunity, although it could also indicate a connection between depressive symptoms and physical experiences of ILI.

A qualitative investigation of mental health in women of refugee background resettled in Tasmania, Australia

BackgroundWomen of Refugee Background (WoRB) are a highly vulnerable population with complex going mental health needs following resettlement. In Australia, there has been a substantial increase in WoRB being resettled in rural and regional locations. Despite this, no research to date has specifically focused on factors contributing to mental distress in WoRB in regional resettlement locations. The current study aimed to address this gap in literature.Methods21 semi-structured qualitative interviews were conducted with WoRB and service providers in regional locations of Tasmania, Australia. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed utilising Braun and Clarke (Qual Res Psychol 3(2):77–101, 2006) framework for conducting thematic analysis.ResultsThematic analysis revealed that WoRB conceptualised mental health as a pathogenic entity, which significantly influenced their mental health help-seeking behaviours. The findings also highlighted how resettlement to a rural and regional location of Australia may exacerbate many of the factors which contribute to ongoing mental distress in WoRB.ConclusionsThe findings of the current study build upon existing research which indicates the adverse impacts post-migrations stressors can have on the mental health of individuals of refugee background. Furthermore, this study suggests that the current services and supports available to WoRB resettled in regional locations of Australia are inadequate, and under-resources. These findings are discussed in regard to practical and policy implications which should be addressed to better support the mental health of WoRB resettled in rural and regional locations of Australia.

Exploring Resilience, Coping and Wellbeing in Women of Refugee Background Resettled in Regional Australia.

This study aimed to address a significant gap in the literature by investigating how Women of Refugee Background (WoRB) conceptualise resilience and identify factors that WoRB endorse as contributing to their wellbeing and coping during resettlement. Qualitative interviews were conducted with a group of 21 individuals (nine WoRB and 12 service providers). Thematic analysis identified that WoRB struggled to define resilience, with endorsed factors not fitting with current hegemonic Western understandings and theoretical understandings of resilience. The findings also highlighted how religious practice, finding a community and having a sense of meaning and contribution in their daily life were significant coping and wellbeing factors during resettlement, however, were difficult to access in regional resettlement locations. Results of the current study are discussed regarding theoretical and practical implications, taking into consideration the unique vulnerabilities experienced by WoRB resettled in regional locations of Australia.

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic.

Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.

Resettlement Stressors for Women of Refugee Background Resettled in Regional Australia.

Women of Refugee Background (WoRB) have been repeatedly identified as an extremely vulnerable population. Within an Australian context, WoRB are increasingly resettled to non-metropolitan locations, otherwise known as regional locations. Despite this, to date, no research has focused on the lived experience and challenges associated with the resettlement of WoRB to regional contexts. This study aimed to address this gap in the literature by investigating the resettlement experience of WoRB resettled in Tasmania—a state in Australia classified as a rural and regional location. Qualitative interviews were conducted with a group of 21 individuals (nine WoRB and 12 service providers). Thematic analysis identified four overarching themes—Communication Barriers and Lack of Fluency in English, Challenges Accessing Everyday Basic Needs, Loss of Connection to Culture of Origin and Inability to Access Mainstream Mental Health Services for Help. Participants also highlighted a number of unique gender-related vulnerabilities experienced during resettlement, which were exacerbated in regional locations due to health services being overstretched and under-resourced. Results of the current study are discussed in regard to policy and practical implications, taking into consideration the unique vulnerabilities experienced by WoRB, which, to date, are often overlooked.

Professional mental health support seeking in Women of Refugee Background resettled in Australia: An exploratory study of facilitators and barriers.

The present study is the first to investigate factors influencing professional mental health support seeking in Women of Refugee Background (WoRB) in Australia. WoRB are a vulnerable population with a range of complex mental health needs. Despite this, research has indicated that WoRB are an underrepresented population in the utilisation of mental health support services. This is a particular concern in Australia, due to an increasing number of WoRB being resettled. A multivariate logistical regression was conducted on a sample of 450 WoRB resettled in Australia from the Building a New Life in Australia (BNLA) data set to investigate factors associated with seeking professional mental health support. Several factors were identified as being significantly associated with professional mental health support seeking in WoRB resettled in Australia, including age, resettlement location, marital status, prearrival trauma involving violence against women, language barriers and health-related variables, including mental distress and long-term disability. The current study provides a unique insight into professional mental health support seeking from a gendered perspective in WoRB resettled in Australia. Insights into factors that influence seeking professional mental health support in this highly vulnerable population must inform mental health practice, service delivery and policies.

Pregnancy complications among refugee women: A systematic review.

Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared with their native counterparts, whereas other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand whether pregnancy disparities between this population and their native counterparts exist, and the causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared with native women. We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628. We identified 19 articles eligible for inclusion: 12 were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared with native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81). The small number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.

Short Take: Walking Interviews with Refugee-background Women

Walking interviews generate contextualized dialogs and place-based narratives prompted by sites and routes. We used walking interviews with three refugee-background women in Australia to find out what the act of walking could reveal about notions of home and broader narratives of forced migration. We used a participatory approach to privilege women’s perspectives as co-creators of new knowledge on the topic.

NARRATIVES OF NAVIGATION: Refugee-Background Women's Higher Education Journeys in Bangladesh and New Zealand

Navigating higher education (HE) is a complex exercise for many students, including those from refugee backgrounds. Internationally, only a very small percentage of refugee-background students access HE. In a 2018 study, we explored 37 women students’ narrative accounts of international study in Bangladesh and New Zealand. Our participants included 10 women from refugee backgrounds. Theoretically, our research was a response to calls from critical scholars to consider the different circumstances that shape students’ international study, and the ethical and pedagogical implications of these for ‘host’ institutions. In this article, we explore the refugee-background women’s accounts of accessing, navigating, and thinking beyond HE, and their thoughts on factors that support refugee-background students’ success in HE. We argue for the need to: reject ‘grand narratives’ in relation to refugee-background students; acknowledge students’ ‘necessary skillfulness’ while supporting their capacity to navigate HE; and recognise refugee-background students’ commitments and influence beyond HE institutions.

Gender, (im)mobility and citizenship in a refugee women’s driving programme: exploring emotional citizenry in Aotearoa New Zealand

During resettlement, refugee-background women often become socially and spatially immobilised with heavy domestic responsibilities, lack of language skills, and lack of access to personal transport. To empower women to navigate spatial and social dimensions of resettlement landscapes, Wellington-based non-governmental organisation ChangeMakers Refugee Forum implemented a driving initiative entitled Turning the Curve. In this article we draw upon a mixed-method evaluation of Turning the Curve to explore differences within stakeholders’ assessments of the programme’s ‘success’. Specifically, we highlight tensions around the temporalities of ‘success’; with some individuals emphasising the achievement of a license in a set timeframe, and others supporting an open-ended approach. Paying attention to these temporalities enabled us to explore relationships between citizenship practices, patience, and waiting. We argue that Turning the Curve’s curation of spatial encounters between learner drivers and driving volunteers enacts Askins’ concept of emotional citizenry, and that the programme’s disposition to patience and a quiet politics of waiting extends emotional citizenry beyond space through time. Through this disposition, more innovative forms of being together emerge and women’s rights to the city are enabled. We conclude that other resettlement efforts could learn a great deal from the emotional citizenry of Turning the Curve as a means to enhance more gender-equitable outcomes from service provision and training during refugee resettlement.

“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

ProblemNational guidelines recommending mental health screening in pregnancy have not been implemented well in routine maternity care. Women of refugee background are likely to have experienced traumatic events and resettlement stressors, yet are not often identified with mental health issues in the perinatal period. BackgroundGlobally, perinatal mental health conditions affect up to 20% of women. Many difficulties in accessing mental health care in pregnancy exist for women of refugee background including stigma, and cultural and language barriers. Technology can provide an efficient and effective method to overcome some of these barriers. AimTo determine if a digital perinatal mental health screening program is feasible and acceptable for women of refugee background. MethodsThis qualitative evaluation study used focus group and semi-structured telephone interviews with refugee and migrant women from four communities. Interpreters were used with women who spoke little or no English. Data were analysed using both an inductive and deductive approach to thematic analysis. FindingsUnder the three key themes: ‘Women’s experiences of perinatal mental health screening in pregnancy’; ‘Barriers and enablers to accessing ongoing mental health care’ and ‘Improvements to the program: the development of audio versions’, women found the program feasible and acceptable. DiscussionScreening using a mobile device offered women more privacy and opened up discussions with midwives on emotional health. Improvements in service coordination and access to further mental health management for women is required. ConclusionPerinatal mental health screening is an acceptable and feasible option for women of refugee background. Integrated models of care, case management, and patient navigators are options for improvements in uptake of referral and treatment services.

Implementing innovative evidence-based perinatal mental health screening for women of refugee background

ProblemNational guidelines recommend repeated screening for depression and anxiety for all women in the perinatal period. Routine screening in pregnancy is limited due to service, community and individual barriers. BackgroundPerinatal depression and perinatal anxiety affect up to 20% of all women. Women of refugee background are at even greater risk for perinatal mental health conditions due to refugee experiences and resettlement stressors. AimTo evaluate the acceptability and feasibility of a perinatal mental health screening program for women of refugee background from the perspective of health professionals. MethodsA mixed methods design guided by the Normalization Process Theory was used. Data were collected at a dedicated refugee antenatal clinic in the south-eastern suburbs of Melbourne, Australia. An online survey (n=38), focus groups (n=2; 13 participants) and semi-structured interviews (n=8; 11 participants) with health professionals were conducted. FindingsUnder the four constructs of the Normalization Process Theory, health professionals reported improvements in identifying and referring women with mental health issues, more open and in-depth conversations with women about mental health and valued using an evidenced-based measure. Key issues included professional development, language barriers and time constraints. DiscussionImplementing a perinatal mental health screening program has been positively received. Strategies for sustainability include professional development and the addition of audio versions of the measures. ConclusionThis perinatal mental health screening program is acceptable and a feasible option for health professionals. Health professionals value providing more holistic care and have more open discussion with women about mental health.

Enhancing general practice referrals for women of refugee background to maternity care.

This paper presents the findings from a quality improvement project implemented by a maternity hospital located in a region of high refugee settlement. The project was designed to improve the completeness of general practice referral information to enable triage to maternity care that would best meet the needs of women of refugee background. Referral information included four data items - country of birth, year of arrival in Australia, language spoken and interpreter required - used in combination to provide a proxy measure of refugee background. A communication strategy and professional development activity engaged general practitioners (GPs) in the rationale for collecting the four data items on a new referral form. Audits of referrals to the maternity hospital before, and at two time points following the quality improvement activity, indicated that very few referrals were completed on the new form. There were modest improvements in the recording of two items - country of birth and interpreter required. Overall, two-thirds of referrals did not contain information on interpreter requirements. Changing practice will require a more cohesive approach involving GPs in the co-design of the form and development of the quality improvement strategy.

Improving access, equity and health literacy: group pregnancy care and information for refugee background women

Improving access, equity and health literacy: group pregnancy care and information for refugee background women