Empowering Migrant Women with Sexual Health Education

"This is the first time I’ve ever spoken about these things out loud."

Dr Alexandra Hawkey, Research Fellow at the Translational Health Research Institute at Western Sydney University, often hears this statement as she helps migrant and refugee women explore their sexual and reproductive health. 

Hawkey would like all migrant and refugee women to have equitable access to preventative sexual and reproductive health services. That means women would know how to prevent sexually transmitted infections (STIs), unintended pregnancies, and even cervical cancer. Ideally, they would also have access to culturally tailored resources in their preferred language and support from healthcare professionals to make informed decisions about their own sexual health. 

It turns out that gaining knowledge about prevention is just a starting point for migrant and refugee women, says Hawkey. "Women want to learn so much more, enough to take a holistic approach to sexual and reproductive health," she explains. "They want to learn how to navigate complex sexual relationships with their partners."

Hawkey was a lead author on a paper reporting these findings in the journal Ethnicity and Health in 2021. The paper was written as part of an Australian Research Council grant to study sexual and reproductive health across the lifespan of migrant women in Australia and Canada. The project collected migrant women’s stories through interviews and focus groups, asking them what kind of sexual health support and education they wanted to receive. 

One challenge that Hawkey and her co-investigators faced was that the women, from countries including Afghanistan, India, Sri Lanka and Sudan, found talking about sex to be deeply taboo.  

"Women are trying to adhere to their cultural norms and still enjoy meaningful sexual relationships. They need support and new skills to negotiate this with their partners, who are also transitioning to a new country and experiencing new norms around gender roles and women’s rights."

Many women described wanting to receive sexual and reproductive health education in a group format, particularly being able to discuss their experiences with other women from similar cultural backgrounds.  

"Talking about these subjects and shared experiences in the context of a shared cultural understanding may help normalise these conversations," Hawkey says. "But some women thought the topics were too private to be spoken about in a group" and emphasised the need for empathetic healthcare professionals who take the time to address their concerns during consultations.  

Indeed, a key finding was that women need varied access to health resources. "Their resettlement issues often come first," Hawkey says. "But sexual and reproductive health sessions could be incorporated in English lessons or held in conjunction with childcare to reduce additional barriers for them to access these resources."

Hawkey acknowledges that reaching intimate partners is also vital. "If women go home to a partner who’s not receptive to new ideas, they will find it challenging to adopt the practices they learn about, like contraception — issues such as condom use," she says. "We need to get men on board. It’s one of the key goals moving forward." This recommendation, and others, were included in guidelines for healthcare professionals in Australia who work with migrant and refugee women in sexual and reproductive health. 

Recognising gaps in contraception knowledge, Hawkey is now undertaking an NHMRC Emerging Leadership Research Fellowship grant to delve deeper into migrant and refugee women’s perceptions and experiences of fertility management.