1 ADDITIONAL MODULE 2. SPECIFIC HEALTH CONCERNSUnit 4. Sexual and Reproductive Health Elaborated by: Mª Victoria López Ruiz, 2015
2 “…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a)
3 High rates of unwanted pregnancyLarge number of poorly controlled pregnancies High neonatal mortality Difficult with accessing screening programs for cervical and breast cancer Increased number of STIs Early age pregnancies and multiples pregnancies in Roma Population Keygnaert I et al. 2014; De Graaf JP, et al. 2013
4 Possible factor affecting SRH in migrantsPrevious values and experiences of Immigration: Level of education. Cultural and religious acceptance of Family planning and its settings of origin. Accessing to contraception. Difficulties in our environment: Lack of information about contraception Barriers to access to family planning, employment services. UNFPA-IOM Expert Group meeting New York, Mai 2006.
5 It is important to control some factors in perinatal careCountries of origin and last stay Countries that individuals come across of encountered Duration of the stay in Spain Housing characteristics and cohabitants Most frequent communicable diseases among migrant population (TB, STIs, HBV y C, HIV) Stress factors Activity and employment status Vaccination status (Vaccination record) Exhaustive Obstetric History Gynaecological history of STIs, EIP
6 "EPIDEMIOLOGICAL PARADOX".Migrants are not necessarily disadvantaged in terms of risk factors for sexual and reproductive health issues Infants of North African migrants are reported to have higher birthweights than their Belgian counterparts (Vahratian et al., 2004) Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than 'majority' receiving populations, and Asian and sub-Saharan African migrants at greater risk of preterm birth EAT/UNFPA
7 Source: Gagnon a J, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med [Internet] Sep;69(6):934–46.
8 Extra –EU migrant womwn are less often screened for cervical and breast cancerThe attendance of Dutch women at breast cancer screening in 2007–2008 was high (83%). The attendance rates of migrant women originating from Africa, Asia or Latin America (63%), such as Turkish women (62%) and especially Moroccan women (54%), were significantly lower (Vermeer and col. 2009) Source: Sanz-Barbero, B; Regidor, E; Galindo, S. Impact of geographic origin on gynecological cancer screening in Spain. Rev. Saúde Pública[online]. 2011, 45(6): ; Lasch, V; Maschewsky- Schneider, U.; Sonntag, U. Equity in Access to Health Promotion, Treatment and Care for All European Women. The European Women´s health Network (EWHNET). 2010
9 Language or communication problems Lack of information Extra –EU migrant women are less often screened for cervical and breast cancer Language or communication problems Lack of information Working or timetables problems The influence of cultural differences on the understanding of disease Religious issues The attendance of Dutch women at the breast cancer screening in 2007–2008 was high (83%). The attendance rates of migrant women originating from Africa, Asia or Latin America (63%), such as Turkish women (62%) and especially Moroccan women (54%), were significantly lower (Vermeer and col. 2009) . Sanz-barbero, B et al. 2011; Lasch, V et al. (EWHNET). 2010; Saadj A. et al
10 Female Genital MutilationAll procedures which involve partial or total removal of the female external genitalia or other injury to the female genital organs for cultural and other non-therapeutic reasons The World Health Organization (WHO) estimates that about 100 to 140 million women worldwide have been subjected to FGM. FGM has been documented in 28 countries in Africa and in a few countries in Asia and the Middle East. World Health Organization, 2008.
11 Female Genital MutilationWorld Health Organization, 2008.
12 Health risks of FGM Immediate risks: severe pain, haemorrhage, tetanus and other infections, septicaemia or even death In the longer term: Recurrent urinary tract infections and pelvic infections Difficulty with voiding or menstruating Difficulties with childbirth due Fistulas. Sexual sensitivity reduced Painful in sexual relaciones Behavioural disturbances Feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis Guidance from the British Medical Association
13 Health risks of FGM Immediate risks: severe pain, haemorrhage, tetanus and other infections, septicaemia or even death In the longer term: Recurrent urinary tract infections and pelvic infections Difficulty with voiding or menstruating Difficulties with childbirth due Fistulas. Sexual sensitivity reduced Painful in sexual relaciones Behavioural disturbances Feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC Vissandjée B et al, 2014; Guidance from the British Medical Association
14 Only 61% using contraception regularly Roma Population Any discussion of the reproductive health of Roma people must take into account the practice of forced sterilization of Roma women, prevalent in some countries, and its possible effect on present day help-seeking behaviour. Abortions were more common than in the majority population (2.41 abortions per woman, with 33% of women having had more than three) Only 61% using contraception regularly Roma women had their first pregnancy earlier. Hajio S,. Et al. 2000;
15 Sexual Reproductive Health interventions should stem from a holistic and positive approach and also address SH promotion in adolescents, women without children, men, elderly, LGBT and MSWs. Resource
16 Activity (1) The class is divided into four groups. Each group deals with one of the units of the module, (which consists of Chronic diseases, Communicable diseases, Mental Health and Sexual and Reproductive health).
17 Activity (2) In each of the groups the members have to discuss their experiences in clinical practice according to the subject that is assigned to them. It is about sharing experiences they have considered interesting or difficult, critical incidents, experiences, etc ... in an intercultural practice. Each group will have to choose one of the experiences set out by the group members.
18 Activity (3) Finally, the chosen experience has to be presented to the class * answering the following questions: Why do you consider this experience to be interesting? Which parts of your actions, or those of your colleagues, would you change? Do you think there are things that could be improved? Which things do you think have been done well?
19 Thank you and question Pictures: Andalusian Childhood Observatory (OIA, Observatorio de la Infancia de Andalucía) 2014; Josefa Marín Vega 2014; RedIsir 2014; Morguefile 2014.
20 References Keygnaert I, Guieu A, Ooms G, Vettenburg N, Temmerman M, Roelens K. Sexual and reproductive health of migrants: does the EU care? Health Policy [Internet]. Elsevier Ireland Ltd; 2014;114(2-3):215–25. De Graaf JP, Steegers E a P, Bonsel GJ. Inequalities in perinatal and maternal health. Curr Opin Obstet Gynecol [Internet] Apr;25(2):98–108 Carballo, M. Female migrants, Reproductive Health, HIV/AIDS & The Rights of Women. UNFPA-IOM Expert Group meeting New York, Mai 2006. Mora, L. Gender, reproductive rights and international migration. -EAT/UNFPA Gagnon a J, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med [Internet] Sep;69(6):934–46. Sanz-barbero, B; Regidor, E; Galindo, S. Impact of geographic origin on gynecological cancer screening in Spain. Rev. Saúde Pública[online]. 2011, 45(6): Vissandjée B, Denetto S, Migliardi P, Proctor J. Female Genital Cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences. BMC Int Health Hum Rights [Internet] Jan;14:13.
21 Lasch, V; Maschewsky- Schneider, U. ; Sonntag, ULasch, V; Maschewsky- Schneider, U.; Sonntag, U. Equity in Access to Health Promotion, Treatment and Care for All European Women. The European Women´s health Network (EWHNET) Saadi A, Bond B, Percac-Lima S. Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees. J Immigr Minor Health [Internet] Aug [cited 2014 Dec 6];14(4):633–9 World Health Organization. Eliminating Female genital mutilation: An interagency statement OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Geneva: World Health Organization, Available from: Female Genital Mutilation: Caring for patients and safeguarding children. Guidance from the British Medical Association Available from: Hajio S, Mckee M. The health of the Roma people : a review of the published literature. J Epidemiol Community Heal. 2000;54:864–9. Gagnon a J, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med [Internet] Sep;69(6):934–46.
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