Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review.

INTRODUCTION: Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS: We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS: The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION: Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.

Trust and COVID precautionary measures during the early days of the COVID-19 pandemic: Evidence from two African countries.

This study examines how trust was associated with social distancing during the early days of the COVID-19 pandemic in Burkina Faso and Kenya. It fills gaps in previous research on trust and health by 1) simultaneously considering the relationship of individual- and aggregate-level indicators of trust, and 2) evaluating trust in local government and national government separately. Performance Monitoring for Action (PMA) data on COVID-precautionary measures and individual-level trust measures were spatially linked with aggregated trust data from the Afrobarometer to create a multilevel dataset. PMA data show that women in Kenya were generally more likely to report taking COVID-precautionary measures relative to Burkinabé women, although levels of these measures were high in both countries. Hierarchical logistic models for each country show levels of interpersonal trust mattered more in Burkina Faso. Although the association between individual-level trust in government and social distancing was not statistically significant, overall levels of trust in the region where an individual lived were associated with social distancing. We found a significant interaction effect between regional trust in the national government and regional trust in local government: individuals in regions where trust was high in both national and local government were the most likely to socially distance; individuals in regions with low local government trust but high national government trust were less likely to report social distancing. We unpack possible implications of these findings; they point to the importance of a unified government front within African countries in promoting health safety measures during a pandemic.

Domestic migration and mobile phones: A qualitative case study focused on recent migrants to Ouagadougou, Burkina Faso.

Migration has long been used as a strategy for livelihood diversification in rural, subsistence communities. Yet in order for migration to effectively serve as a livelihood diversification strategy, it should meet certain conditions: migration should ease financial burdens, should confer access to economically valuable resources and information, and should broaden social networks. Using qualitative data gathered in 25 interviews with rural migrants to Ouagadougou, Burkina Faso, we examine how mobile phone technology has impacted migration as a livelihood diversification strategy. Our results show that while mobile phones facilitate migration, the advantages conferred may benefit migrants at the expense of the home communities. Mobile phones alleviate financial constraints, enable access to broader networks, and facilitate informational and resource support among migrants. Our results show limited evidence of migrants using mobile phone technology to provide resources or information to the home community. Our results highlight the need to reconsider the ways in which migration can be used as a livelihood diversification strategy in light of changing communication technologies to promote the economic success of both migrants and their home communities.

Birth-preparedness for maternal health: findings from Koupéla District, Burkina Faso.

Maternal mortality is a global burden, with more than 500,000 women dying each year due to pregnancy and childbirth-related complications. Birth-preparedness and complication readiness is a comprehensive strategy to improve the use of skilled providers at birth, the key intervention to decrease maternal mortality. Birth-preparedness and complication readiness include many elements, including: (a) knowledge of danger signs; (b) plan for where to give birth; (c) plan for a birth attendant; (d) plan for transportation; and (e) plan for saving money. The 2003 Burkina Faso Demographic and Health Survey indicated that only 38.5% of women gave birth with the assistance of a skilled provider. The Maternal and Neonatal Health Program of JHPIEGO implemented a district-based model service-delivery system in Koupéla, Burkina Faso, during 2001-2004, to increase the use of skilled providers during pregnancy and childbirth. In 2004, a cross-sectional survey with a random sample of respondents was conducted to measure the impact of birth-preparedness and complication readiness on the use of skilled providers at birth. Of the 180 women who had given birth within 12 months of the survey, 46.1% had a plan for transportation, and 83.3% had a plan to save money. Women with these plans were more likely to give birth with the assistance of a skilled provider (p=0.07 and p=0.03 respectively). Controlling for education, parity, average distance to health facility, and the number of antenatal care visits, planning to save money was associated with giving birth with the assistance of a skilled provider (p=0.05). Qualitative interviews with women who had given birth within 12 months of the survey (n=30) support these findings. Most women saved money for delivery, but had less concrete plans for transportation. These findings highlight how birth-preparedness and complication readiness may be useful in increasing the use of skilled providers at birth, especially for women with a plan for saving money during pregnancy.

Epidemiology of HIV infection in urban Burkina Faso.

We conducted a cross-sectional study of sexually transmitted disease and HIV infections among a random sample of the 2364 adult population in 2000 in Bobo-Dioulasso, the second largest town in Burkina Faso. The prevalence of HIV infection was 5.2%. Risk factor analysis was conducted among sexually active men 20 to 34 years old and women 15 to 24 years old. Factors independently associated with HIV infection among men were having been married (adjusted odds ratio (aOR)=8.19 [1.70-39]), reporting more than two non-marital partners in the last 12 months (aOR=6.07 [1.14-32.4]), reporting a past urban residence other than Bobo-Dioulasso (aOR =6.37 [1.96-20.7] and having a positive serology for HSV-2 infection (aOR=12.0 [3.49-40.9]). Among women the factors were being Christian (aOR=3.73 [1.20-11.6]), having had a first sexual partner more than 24 years old (aOR =4.30 [1.35-13.6]) and having a positive serology for HSV-2 infection (aOR =4.40 [1.32-14.6]). HIV infection in Bobo-Dioulasso therefore depends on both exposure factors (sexual behaviours) and transmissibility cofactors (HSV-2).