Maternal health among Venezuelan women migrants at the border of Brazil

Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021

BACKGROUND

The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil.

METHODS

A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling.

RESULTS

The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil.

CONCLUSIONS

Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Experiences of pregnant Venezuelan migrants/refugees in Brazil, Ecuador and Peru: a qualitative analysis

BACKGROUND

It is estimated that since 2014, approximately 7.3 million Venezuelan migrants/refugees have left the country. Although both male and female migrants/refugees are vulnerable, female migrants/refugees are more likely to face discrimination, emotional, physical, and sexual violence. Currently there is a lack of literature that explores the experiences of pregnant Venezuelan migrants/refugees. Our aim is to better understand the experience of this vulnerable population to inform programming.

METHODS

In the parent study, Spryng.io's sensemaking tool was used to gain insight into the gendered migration experiences of Venezuelan women/girls. A total of 9339 micronarratives were collected from 9116 unique participants in Peru, Ecuador and Brazil from January to April 2022. For the purpose of this analysis, two independent reviewers screened 817 micronarratives which were identified by the participant as being about someone who was pregnant, ultimately including 231 as part of the thematic analysis. This was an exploratory study and an open thematic analysis of the narratives was performed.

RESULTS

The mean age and standard deviation of our population was 25.77 ± 6.73. The majority of women in the sample already had at least 1 child (62%), were married at the time of migration (53%) and identified as low socio-economic status (59%). The qualitative analysis revealed the following main themes among pregnant Venezuelan migrants/refugees: xenophobia in the forms of racial slurs and hostile treatment from health-care workers while accessing pregnancy care; sexual, physical, and verbal violence experienced during migration; lack of shelter, resources and financial support; and travelling with the hopes of a better future.

CONCLUSION

Pregnant Venezuelan migrants/refugees are a vulnerable population that encounter complex gender-based and societal issues that are rarely sufficiently reported. The findings of this study can inform governments, non-governmental organizations, and international organizations to improve support systems for pregnant migrants/refugees. Based on the results of our study we recommend addressing xenophobia in health-care centres and the lack of shelter and food in host countries at various levels, creating support spaces for pregnant women who experience trauma or violence, and connecting women with reliable employment opportunities and maternal healthcare.

Barriers and facilitators to access sexual and reproductive health services among young migrants in Tarapacá, Chile: a qualitative study

BACKGROUND

Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile.

METHODS

A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22).

RESULTS

Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions.

CONCLUSIONS

This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.

Perinatal health outcomes of international migrant women in Brazil: A nationwide data linkage study of the CIDACS birth cohort (2011-2018)

BACKGROUND

We investigated perinatal outcomes among live births from international migrant and local-born mothers in a cohort of low-income individuals in Brazil.

METHODS

We linked nationwide birth registries to mortality records and socioeconomic data from the CIDACS Birth Cohort and studied singleton live births of women aged 10-49 years from 1st January 2011 to 31st December 2018. We used logistic regressions to investigate differences in antenatal care, adverse pregnancy outcomes, and neonatal (i.e., ≤28 days) mortality among international migrants compared to non-migrants in Brazil; and explored the interaction between migration, race/ethnicity and living in international border municipalities.

RESULTS

We studied 10,279,011 live births, of which 9469 (0.1 %) were born to international migrants. Migrant women were more likely than their Brazilian-born counterparts to have a previous foetal loss (ORadj: 1.16, 1.11-1.22), a delayed start of antenatal care (i.e., beyond 1st trimester) (1.22, 95%CI:1.16-1.28), a newborn who is large for gestational age (1.29, 1.22-1.36), or a newborn with congenital anomalies (1.37, 1.14-1.65). Conversely, migrant women were less likely to deliver prematurely (0.89, 0.82-0.95) or have a low birth weight infant (0.74, 0.68-0.81). There were no differences in neonatal mortality rates between migrants and non-migrants. Our analyses also showed that, when disparities in perinatal outcomes were present, disparities were mostly concentrated among indigenous mothers in international borders and among live births of Black mothers in non-borders.

CONCLUSION

Although live births of international migrants generally have lower rates of adverse birth outcomes, our results suggest that indigenous and Black migrant mothers may face disproportionate barriers to accessing antenatal care.

Sexual and Reproductive Health Care for Irregular Migrant Women: A Meta-Synthesis of Qualitative Data

Migratory movements are a political, social, and public health issue on a global scale. Access to sexual and reproductive health services for irregular migrant women (IMW) is a public health issue. The aim of this study is to identify qualitative evidence of IMW's experiences of sexual and reproductive health care in emergency and primary care settings. The methods employed involve conducting a meta-synthesis of qualitative studies. Synthesis includes assembling and categorising findings based on similarity in meaning. The search was conducted between January 2010 and June 2022 using PubMed, WOS, CINAHL, SCOPUS, and SCIELO databases. Out of the initial pool of 142 articles identified, only 9 fulfilled the predetermined criteria and were subsequently included in the review. Four main themes were established: (1) the need to focus emergency care on sexual and reproductive health; (2) unsatisfactory clinical experiences; (3) forced reproduction; and (4) alternating between formal and informal healthcare services. The attitudes of IMW towards sexual and reproductive health are influenced by culture, educational level, fear, barriers, and the attitude of healthcare providers. Healthcare institutions need to be aware of the IMW's experiences to understand the specific difficulties they face. IMW calls for socially and culturally sensitive health care, cultural mediators, improved communication, and safe environments that ensure confidentiality.

Mortality among over 6 million internal and international migrants in Brazil: a study using the 100 Million Brazilian Cohort

Background

To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course.

Methods

We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.

Findings

The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05).

Interpretation

Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants.

Funding

The Wellcome Trust.

Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador

Objectives.

To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador.

Methods.

Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador.

Results.

Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population.

Conclusion.

The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

Sexual and reproductive health and rights in humanitarian settings: a matter of life and death

It is estimated that approximately 4.3 million sexually active persons worldwide will receive poor and/or limited access to Sexual and Reproductive Health (SRH) services in their lifetime. Globally, approximately 200 million women and girls still endure female genital cutting, 33,000 child marriages occur daily, and a myriad of Sexual and Reproductive Health and Rights (SRHR) agenda gaps continue to remain unaddressed. These gaps are particularly pertinent for women and girls in humanitarian settings where SRH conditions including gender-based violence, unsafe abortions, and poor obstetric care are among the leading causes of female morbidity and mortality. Notably, the past decade has featured a record high number of forcibly displaced persons globally since World War II and has led to over 160 million persons requiring humanitarian aid globally, 32 million of whom are women and girls of reproductive age. Inadequate SRH service delivery continues to persist in humanitarian settings, with basic services insufficient or inaccessible, putting women and girls at higher risk for increased morbidity and mortality. This record number of displaced persons and the continued gaps that remain unaddressed pertaining to SRH in humanitarian settings require renewed urgency to create upstream solutions to this complex issue. This commentary discusses the gaps in the holistic management of SRH in humanitarian settings, explores why these gaps persist, and addresses the unique cultural, environmental, and political conditions which contribute to continued SRH service delivery inadequacies and increased morbidity and mortality for women and girls.

Factors influencing utilization of communicable disease prevention and treatment education among the floating population: a cross-sectional study in China

BACKGROUND

In China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China's population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services.

METHODS

A sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants.

RESULTS

A total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30-49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05).

CONCLUSION

Our findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.

Maternal Care and Pregnancy Outcomes of Venezuelan and Colombian Refugees

BACKGROUND

Ecuador is a major host country for Colombians fleeing violence and Venezuelans escaping a complex humanitarian crisis, many of whom are pregnant women.

METHODS

We used national birth registry data (2018-2020) to compare the maternal care and infant outcomes of Venezuelan and Colombian immigrants with Ecuadorian nationals.

RESULTS

Venezuelan immigrants had a lower adjusted odds (AOR) for adequate prenatal care (AOR = 0.64;95%CI = 0.62,0.67) but a higher AOR for institutional (AOR = 2.68;95%CI = 1.84,3.93) and C-section delivery (AOR = 1.28;95%CI = 1.23,1.32) and birthing infants who were moderate-late preterm (AOR = 1.12;95%CI = 1.05,1.20), very preterm (AOR = 1.20;95%CI = 1.04,1.40), extremely pre-term (AOR = 1.65;95%CI = 1.27,2.14), low birthweight (LBW) (AOR = 1.11;95%CI = 1.05,1.17), very LBW (AOR = 1.35;95%CI = 1.12,1.62), and extremely LBW (AOR = 1.71;95%CI = 1.36,2.16). Colombians had decreased AORs for adequate prenatal care (AOR = 0.82;95%CI = 0.78,0.87) but increased AORs for institutional (AOR = 2.03;95%CI = 1.19,3.46) and C-section deliveries (AOR = 1.07;95%CI = 1.01,1.13) and birthing infants with moderate-late preterm (AOR = 1.17;95%CI = 1.05,1.30) but not LBW.

DISCUSSION

The findings underscore the need to address the causes of adequate prenatal care, excess C-sections, and poorer infant outcomes among refugee and immigrant women, especially Venezuelans.

Prenatal care in the era of economic collapse

OBJECTIVES

To describe the effect of economic collapse on prenatal care.

METHODS

This is an observational study aiming to depict the changes that occur in prenatal care in the case of an economic collapse. Biochemical screening and ultrasound examinations, as well as medical emigration and private-public sector activity, are discussed.

RESULTS

Starting October 2019, Lebanon experienced significant and unprecedented economic degradation leading to 81% degradation of the local currency, 85% inflation, and socio-economic suffering, and the situation is currently still deteriorating. The impact on the medical infrastructure has been global and hit all areas. The crisis is multifaceted, varied in the way it played out across public and private sectors, and did not affect them equally. Some were better prepared than others to cope with severe fiscal pressure mainly through the support of non-governmental organizations. All aspects of prenatal care are affected by the crisis.

CONCLUSIONS

Given the multiple strains on the Lebanese health care system today, the plight of antenatal care providers needs assistance to ensure adequate follow-up of pregnancies.

Perceptions of Health Needs among Venezuelan Women Crossing the Border in Northern Chile during the COVID-19 Pandemic

In parallel to the COVID-19 pandemic, Chile has experienced a significant influx of international migrants, many of whom are Venezuelan women who have entered the country through unauthorized crossing points. In this context, gender and migration intersect as the social determinants of health, leading to their experiencing a range of adverse events. This poses important challenges in terms of short- and long-term health outcomes, the social determinants of health, and access to healthcare. This study aims at describing Venezuelan women's perceptions of their health needs as they migrate to Chile via an unauthorized crossing point, with a focus on adverse events throughout the migration cycle, self-reported health needs, and responses. A qualitative case study was carried out with 22 participants in the Antofagasta region of Chile, including Venezuelan migrant women, healthcare professionals, and social workers from the public healthcare system, stakeholders from non-governmental and international organizations, and local government officials. The semi-structured, individual interviews were analyzed thematically. The results show that Venezuelan women face a range of adverse events throughout the migration cycle. The perceived health needs that are reported are sometimes linked to these adverse events or existed prior to migration and were exacerbated throughout the migratory cycle. Addressing these physical and mental health needs is essential for short- and long-term individual and public health; however, despite substantial efforts to ameliorate the situation, persisting gaps in access to care are reported.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

Background

The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders.

Methods

Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19.

Results

Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts.

Conclusions

Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Predisposing and Enabling Factors Associated with Venezuelan Migrant and Refugee Women's Access to Sexual and Reproductive Health Care Services and Contraceptive Usage in Peru

Objective

Over 6 million migrants and refugees from Venezuela have left their country in the past decade; 1 million of them reside in Peru. Venezuelan migrant and refugee women are known to have limited access to sexual and reproductive health care services (SRHS) and contraceptive usage. To date, research to understand factors influencing access to those services is limited. This study aims to determine which enabling and predisposing factors influence Venezuelan migrant and refugee women's access to SRHS and contraceptive usage.

Methods

This is a retrospective cross-sectional study of the first survey administered to the Venezuelan population residing in the Peru in 2018. The survey covered six cities in the country (Metropolitan Lima, Callao, Tumbes, Cusco, Trujillo, Arequipa). The sample for the study included Venezuelan migrant women of reproductive age (15–49 years old). Anderson's Behavior Model of Health Services is the conceptual framework of the investigation. Logistic regression models were fit to examine the relationship between different predisposing and enabling factors and women's access to SRHS and contraceptive usage.

Results

The sample size includes a total of 3378 Venezuelan women of reproductive age. 50.7% of the women were between the ages of 21–30 and over 90.6% of the sample were residing in Metropolitan Lima. Only 20.2% of the women reported they had access to modern contraceptives. Results from the study suggest having insurance, residing in Trujillo, and having a higher socio-economic status were associated with more access to certain sexual reproductive health care services and contraceptive usage.

Conclusion

This study identified different predisposing and enabling factors relevant to the access to SRHS and contraceptive usage. Difference in access and usage are particularly pronounced based on insurance status, geographical location, and socio-economic status. Displaced Venezuelans will remain abroad for an extended period of time, if not permanently. Focus should shift from providing humanitarian aid to integrating the migrants and refugees, particularly the most vulnerable groups, into the local economic and healthcare system.

Assessment of the availability of sexual and reproductive healthcare for Venezuelan migrant women during the SARS-CoV-2 pandemic at the north-western border of Brazil-Venezuela

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Access to essential SRH services.

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Less SRH services offered.

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Lack of availability and access to contraceptives.

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Impact on health infrastructure.

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Reallocation of beds to attend COVID-19 cases.

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Shortage of healthcare providers.

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Challenges and opportunities for strengthening SRH services.

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Doubts about the management of the pandemic due to conflicting messages.

Background

The public healthcare system of Roraima state, at the north-western border Brazil-Venezuela, experienced an impact due to the incoming of Venezuelan migrants and to the SARS-CoV-2 (COVID-19) pandemic. After the beginning of the pandemic, the Brazilian government closed the border; however, migration continued through informal paths. There is scarce information regarding the availability of sexual and reproductive health (SRH) services at settings impacted both by migration and the COVID-19 pandemic. Consequently, we aimed to assess the availability and access to SRH services for Venezuelan migrant at Roraima state during the COVID-19 pandemic.

Methods

We conducted a cross-sectional study with data collected during the pandemic using an electronic questionnaire. We interviewed three policy makers responsible for the directorate of primary care both at the municipal and state level; the directors of the two public hospitals and the two referral centres for women's health in Boa Vista, and in Pacaraima the director of the hospital and of the basic health post. We also interviewed 20 out of the 34 (58.8%) managers of the basic health posts in Boa Vista and 10 healthcare providers (physicians and nurses). Data collected covered issues pertaining to access to SRH services, and explored the impacts of the COVID-19 on continuation, access, and use of SRH services.

Results

It was reported that 60% of the beds in the public sector were reallocated for COVID-19 cases and 26 out of the 34 (76%) health posts assessed interrupted the provision of SRH services, including contraceptive provision and gynaecological consultation, since these were considered not essential services. Most of the participants, (25/36; 69.4%) reported that both the state and the municipal health authorities implemented community outreach using telephone, social media, radio, and television, with guidance for the population on how to seek care using the healthcare network.

Conclusions

The healthcare system in Roraima was impacted firstly by the need to provide SRH to a large number of Venezuelan migrant women, and after an effort to adapt to the reality that this migrant crisis posed; this system was affected by the needs to adapt to the COVID-19 pandemic.

Narratives of experiences of violence of Venezuelan migrant women sheltered at the northwestern Brazilian border

Objectives

To know the experiences of Venezuelan migrant women living in shelters in Roraima state at the northwestern border between Venezuela and Brazil regarding situations of violence as part of the dynamics of everyday life.

Materials and methods

Data were collected in January 2020 through 12 focus group discussions (FGDs) with 5 to 14 Venezuelan migrant women aged 18–49 years old living transitorily in five shelters established by the United Nations High Commissioner for Refugees (UNHCR) and the Brazilian government. We obtained individual and shared views on the experiences regarding violence that migrant women may experience in their everyday life. To organize the FGDs, variations in age and the time women were living at the shelters were considered. All FGDs were held in a place at the shelter that guaranteed privacy and secrecy so that women could express themselves freely. The initial question was broad and open ended and was followed by more specific questions about situations of domestic violence and other types of violence.

Results

The main themes identified were the following: i) women’s perceptions on domestic violence, ii) women’s perceptions on how humanitarian organizations were managing the episodes of domestic violence, and iii) situations considered violence in everyday life at the shelters. The FGDs showed that the reported violence inside the shelters was high, and several forms of violence emerged. Violence was identified as physical aggression and psychological threats, and violence in everyday life at the shelter included xenophobia when the migrants went outside the shelters that was perceived and described as violence.

Conclusions

According to the perspective of Venezuelan migrant women violence was part of everyday life among those living in the UNHCR shelters at the northwestern border of Brazil-Venezuela. These women are not comfortable with this situation, and it is difficult for them to understand and handle the episodes of violence.

Reproductive health among Venezuelan migrant women at the north western border of Brazil: A qualitative study

BACKGROUND

Venezuela has been immersed in an economic and social crisis with a high number of migrant people. An important proportion of Venezuelan migrants have crossed the north western border Brazil-Venezuela were the United Nations High Commissioner for Refugees (UNHCR) has established 13 shelters. Our objectives were to know perspectives and views of Venezuelan migrant women hosted at UNHCR shelters on some SRH issues.

METHODS

We conducted a qualitative study between November 2019 and February 2020 with 12 focus group discussions (FGDs), with 111 Venezuelan migrant women of reproductive age (18-49 years old). FGDs were performed in a closed space that guaranteed confidentiality, were recorded, verbatim transcribed and data were analised for thematic manifest content.

FINDINGS

The themes identified were perspectives on: i) health care for pregnant and postnatal women, ii) access to modern contraceptive methods, and iii) HIV and sexually transmitted diseases (STDs). Despite the general satisfaction with obstetric care, women noted few challenges pertaining to their experiences during first entry to antenatal care, labour, delivery and postnatal care. They were in agreement that access to long-acting reversible contraceptives was difficult, mainly to the copper-intrauterine device (IUD); which when available it was erratic. Hormonal-IUD and implants were almost inexistent. This was of major concern to the women, as it prevented them from the ability to plan their reproductive lives. Although knowledge on STDs/HIV prevention and transmission was adequate; the predominance of traditional gender imbalance in the relations was observed and these attitudes have been discussed as a barrier for migrant women to protect themselves against HIV/STD infection.

CONCLUSION

These migrant women needed help to understand the language and functioning of the healthcare system, to overcome barriers and challenges while seeking access to SRH care. They faced significant gender vulnerability that needs to be addressed within their new life. Our findings could be useful for health authorities and international organisations to start actions to improve SRH and mitigate suffering.