Reproductive coercion as a form of family violence against immigrant and refugee women in Australia.

Reproductive coercion (RC), generally considered a form of intimate partner violence (IPV), refers to perpetrator behaviours and actions that are intended to interfere with and control the autonomous decision-making of a person regarding their reproductive health. To date there are few studies that document RC as experienced by immigrant and refugee women. In this article, we explore cases of RC as described by women who were part of a larger qualitative study investigating violence against immigrant and refugee women in southern Australia. The study aimed to identify the types of RC detailed in immigrant and refugee women's narratives, and to illustrate the contexts in which these experiences occurred. Analysis followed Baxter and Jack's (2008) case study methodology; whereby particular "cases" are used to describe a phenomenon in context. Thirteen women from seven countries described experiences that fit definitions of RC. The cases describe various types of RC including violence during pregnancy with the intent of causing miscarriage, forced abortion, contraception sabotage and forced pregnancy. As well as intimate partners, some women described multiple perpetrators being complicit in their experience of RC, especially in regard to controlling women's access to, and interactions with health services. More information is needed about immigrant and refugee women's experiences of RC, and how vulnerability to multi-perpetrator violence affects health service access. In particular knowledge about how multi-perpetrator RC can affect consent processes for women who already face barriers to health care requires attention. Further research is required to address knowledge gaps about appropriate prevention and advocacy work about RC in refugee and migrant communities, and what training is needed for professionals in the family violence sector, women's health services, women's organisations, multicultural and ethno-specific services.

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions.

BACKGROUND: Reproductive coercion and abuse (RCA) interferes with a person's reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors. METHODS: Data were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person. RESULTS: RCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting. CONCLUSIONS: RCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

Reproductive coercion and abuse (RCA) is behaviour that interferes with a person's decision to become pregnant or to continue a pregnancy. We classified RCA into behaviours that attempt to promote pregnancy or to prevent/end a pregnancy. Drawing on data collected from 5107 people seeking counselling support for their pregnancy from two Australian services, this research explored how common the different types of RCA are. The research also looked at whether a person's age or whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person made any difference to the type of RCA they experienced. We found that 15.4% of people reported RCA, with similar proportions reporting behaviours attempting to promote pregnancy and prevent/end pregnancy. Around 2% reported experiencing both forms of RCA. We found that there were no differences in frequency of RCA based on age or whether the person identified as being from a migrant or refugee background, although we found that people who identified as Aboriginal and/or Torres Strait Islander were proportionally more likely to experience RCA that was pregnancy promoting. Given how common RCA is, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be included in any conversations around sexual and reproductive health care and education.

The MuSeS project: a mixed methods study to increase understanding of the role of settlement and multicultural services in supporting migrant and refugee women experiencing violence in Australia.

BACKGROUND: Violence against women is a major human rights and public health issue globally. The experience of violence affects women across Australia, including the large number of migrant and refugee women who permanently or temporarily resettle in the country. Many women who experience violence find it difficult to access support, and evidence suggests women who have resettled in Australia face additional barriers to violence-specific services. Previous research, however, indicates many migrant and refugee women experiencing violence have contact with, and may disclose violence to, settlement and multicultural services. There has been limited research documenting current knowledge of, and practices by, settlement and multicultural services in relation to violence. The MuSeS project will address this knowledge gap and identify strategies settlement and multicultural services can use to better support women experiencing violence. METHODS: This mixed methods research project will be conducted in six geographic communities across three Australian states: South Australia, Tasmania and Victoria. The different migration and resettlement patterns seen in these jurisdictions will enable generation of data relevant to settings across the country. The project has been designed in consultation with partner organisations from the settlement and multicultural service sector to ensure the research addresses their concerns and priorities. A mix of quantitative and qualitative methods will be used to generate rich data to inform strategies for settlement and multicultural services to better support women experiencing violence. These methods include an anonymous online survey of settlement and multicultural service providers to assess current knowledge, practices and professional development needs; in-depth interviews with settlement, multicultural and specialist (refugee) mental health service providers; in-depth interviews with refugee women; and focus group discussions with frontline workers and volunteers working with settlement and multicultural services. DISCUSSION: Findings from this two-year research project will generate an in-depth understanding of the current and potential role of Australian settlement and multicultural services in supporting migrant and refugee women experiencing violence, and inform strategies to strengthen services' capacity to appropriately respond. Given the prevalence of violence against women globally, findings will be useful for services engaging with migrant and refugee populations around the world.

ASPIRE: A multi-site community-based participatory research project to increase understanding of the dynamics of violence against immigrant and refugee women in Australia.

BACKGROUND: One in three women around the world are or have been subjected to violence. This includes in Australia, where violence against women is an urgent public health and human rights issue. Immigrant and refugee women who have resettled in Australia are known to face barriers accessing services aimed at preventing and responding to family violence. However there is little evidence about the contexts, nature and dynamics of violence against immigrant and refugee women to inform appropriate responses to enhance their safety and well-being. The ASPIRE project will address this gap by identifying opportunities for the development of responsive local and community-based interventions for family violence against immigrant and refugee women, contributing to the currently limited Australian research in this area. METHODS/DESIGN: This participatory research project will work with communities in eight geographic locations (two inner-city, three outer-suburban, and three regional) across two states (Victoria and Tasmania), to generate evidence about immigrant and refugee women's experiences in a range of settings. The project will engage stakeholders and communities through extensive consultation prior to data collection and by facilitating community members' participation in generating and analysing data. A mix of qualitative methods will be used to generate rich data about the family, cultural and place-based contexts that shape the prevalence and dynamics of violence against immigrant and refugee women; women's prevention and help-seeking efforts; and community attitudes about and responses to violence across a range of cultural groups. Methods include in-depth interviews with women who have experienced family violence, key informant interviews with local community service providers, focus group discussions with men and women from predominant cultural groups that have migrated to areas covered by the research sites, and Photovoice with community leaders. Bilingual health educators will contribute to development of the research approach, the collection and analysis of data, and the dissemination of findings. DISCUSSION: Findings from this two-year study will be disseminated to communities, service providers and policy-makers, providing evidence to inform culturally-appropriate prevention and support interventions, and building local communities' awareness and capacity to respond to violence against immigrant and refugee women.

Diabetes care and service access among elderly Vietnamese with type 2 diabetes.

BACKGROUND: Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use. METHODS: Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework. RESULTS: Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access. CONCLUSIONS: Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.