Table 2 Characteristics of quantitative studies and main findings

Morrison (2000) [47]; HC Thailand; CO Cambodia

As outlined in Table 1

Walking through camps women were randomly asked to participate;

Khao Phlu refugee camp Thailand maternal and child health centre;

survey

n = 102;

As outlined in Table 1

Contraceptive knowledge, beliefs and practices. Perceptions about FP

N/S

Contraceptive knowledge and use:

• 82% of married women wanted to stop or delay childbearing,

• 12% reported using a modern method of contraception,

• 61% mentioned fear of side effects,

• 24% cited lack of information on contraception,

• 42% reported discomfort over seeking contraceptives,

• 32–48% of women unaware contraceptive methods were available at refugee health centre and none knew about emergency contraception.

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Raheel et al. (2012) [65]; HC Pakistan; CO Afghanistan

Measure differences in knowledge and practice of contraception between healthcare subsidised and unsubsidised groups

Systematic random sampling to select households;

Karachi settlements of Afghan refugees; questionnaire survey

n = 650;

refugees; subsidy/no subsidy mean 33%/ 30%;

yrs. since arrival subsidy/no subsidy mean 10/13

Knowledge and practice about FP and contraceptive use with and without healthcare subsidies

SPSS

Mean/SD Binary logistic regression Adjusted odds ratios 95% CIs

Family planning awareness and use:

• 90% in subsidised group aware of FP, compared to 45% in unsubsidised group,

• use of contraceptives > 2-fold in subsidised group versus unsubsidised,

• access to subsidised care more likely resulted in contraceptive use with advancing age as compared to unsubsidised care.

Positive attitude towards FP and higher contraceptive use among Afghan women receiving a healthcare subsidy compared to those not receiving a subsidy despite their conservative background and marginal economic status.

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Kisindja et al. (2017) [66]; HC Congo; CO Congo

Investigate reproductive health and FP knowledge and needs of newly internally displaced women in North Kivu province.

Convenience sampling door to door; two Mugunga displacement camps; verbally administered survey

n = 155;

internally displaced;

14-45 yrs. (mean 28); yrs. since arrival

< 1 yr (34%)

< 2 yrs. (95%)

Reproductive health history, contraceptive use, and FP exposures, knowledge and desires

N/S

Contraceptive knowledge and use:

• 84% previously received information on contraception,

• 35% women knew of at least two contraceptive methods,

• 31% reported ever using contraception,

• 62% cited lack of interest, 21% lack of knowledge and 12% religious’ opposition for never using contraception

Contraceptive knowledge was moderate actual usage was low.

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Tanabe et al. 2017 [51], HC Bangladesh Jordan Djibouti Kenya Malaysia Uganda; CO Myanmar, Iraq, Democratic Republic of Congo, Somalia

As outlined in Table 1

Sampling frame – UNHCRs database and registered mobile phone and spatial sampling;

Multiple country locations - refugee camps, settlements, urban areas; household survey

n = 2733;

refugees;

15–49 yrs.;

yrs. since arrival N/S

Contraception- awareness, ever use, current use, and unmet need for FP

Descriptive frequencies Binary logistic regression

Contraceptive awareness and use:

• 74% reported awareness of at least 1 modern method of contraception,

• 48% married women reported ever use of modern contraceptives significantly < unmarried women 16%,

• 26% married women reported currently using any modern method to avoid or delay pregnancy, significantly > unmarried women 3%,

• 7% of women reported unmet need for contraception,

• Married women were over 7 x more likely to report unmet need compared with unmarried women.

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Raben and van den Muijsenbergh (2018) [67]; HC Nether-lands; CO various

Examine the extent Netherlands General Practitioners discuss and prescribe contraceptives to female refugees compared with other female migrants and native Dutch women

Extracted data from General Practice surgery databases;

Nigmegen, Rotterdam and Amsterdam, five General Practices;

database searches

n = 104;

refugees;

15–49 yrs.;

yrs. since arrival

mean 6.5 yrs. (range < 1–34)

Contraceptive method discussed or prescribed with General Practitioner

Two-tailed Pearson chi-squared test, independent samples t-test, one-way ANOVA, binary

logistic regression

Contraception access:

• 51% General Practitioners reported discussing contraceptives with women refugees, significantly < other migrants, 66% and < native Dutch women, 84%,

• in women from Sub Saharan Africa, contraception was significantly less often discussed, 29% compared with refugee women from other regions 68%.

Contraceptives were discussed or prescribed significantly < with refugees and other migrant women compared with native Dutch women.

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Pierce (2019) [68]; HC Jordan; CO Palestine

Examine regional coverage, source, and method of contraceptives; variation in reproductive health and social experiences by source of contraception; influences on utilisation of reproductive health services

Recruitment method N/S;

Jordan- urban area refugee camp households;

demographic and health survey

n = 10,105;

refugees;

15–24 (13%)

25–39 (56%)

40–49 (31%);

yrs. since arrival: multi-generational displacement

Modern contraceptive use, FP education at a health facility, contraceptive advice from medical personnel, source of contraception

Descriptive statistics Logistic regression of reproductive health odds ratios for background variables

Contraceptive use and intention:

• 14–43% used contraception, 15–55% contraceptive source (govt, pharmacy, private) used, 5–13% modern contraceptive method used,

• educational attainment, age, employment, number of living children, and wealth had a significant effect on modern contraception use,

• refugee camp existence significantly increases the likelihood of talking about FP at a health facility,

• women with large numbers of children > 13 x more likely to utilise UN relief agencies for contraception than those with fewer children.

Women living in refugee camps have greater access to FP resources

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Barnes et al. (2004) [69]; HC USA; CO Cuba, Bosnia, Vietnam, and others

Explore reproductive health concerns of Bosnian, Cuban, Vietnamese and other refugee women in the US

Recruitment method N/S;

Refugee Health Screening Program at local health department; review of medical charts

n = 283;

refugees;

18–74 yrs. (mean 34);

yrs. since arrival N/S

Self-reported medical history, reproductive health problems identified, referrals made, and prescriptions written

Descriptive statistics, z approximation test

Breast and cervical screening practices:

• 14% had at least one mammogram,

• 86% had never had a mammogram,

• 67% of women in the US had at least one mammogram for screening,

• rates of mammogram differed between US and refugee women significantly,

• 24% of refugee women had a Pap test within the past 3 yrs. compared to US women 79%.

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Redwood- Campbell et al. (2008) [70]; HC Canada; CO Albania

Describe reproductive health and mental health-related issues among Kosovar refugees settling in Hamilton, Ontario Canada

Random selection of phone numbers - fieldworkers contacted families;

Hamilton, Ontario (not further described);

survey questionnaire

n = 161; refugees; (18-49 yrs)

> 18 yrs. 85

18-49 yrs. 65 > =50 yrs. 19; yrs. since arrival N/S

Ever had a Pap smear, ever heard of a Pap smear, use of contraception, how to access contraception, ever had or heard of a mammogram

Descriptive statistics

Contraceptive use:

• 14% reported using some form of contraception

Screening awareness and access:

• > 50 yrs., 5% of Kosovar women had ever received a mammogram,

• 34% of women had ever received a Pap smear, of these 85% had received service in Canada,

• Kosovar women reported cervical and breast cancer screening rates in the home country or since arrival were significantly < Canadian rates.

Women have little or no history of routine preventive care similar to that which exists in Canada

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Lofters et al. (2011) [71]; HC Canada; CO

Middle East, North Africa, East Asia, the Pacific, Sub-Saharan African

Determine the independent effects on cervical cancer screening of; sociodemographic factors, health care system, culture and migration for immigrant women in Ontario.

Recruitment method N/S;

Ontario’s central metropolitan areas;

Data extraction from Landed Immigrant Data System database

n = 455,864;

refugees;

18–66 yrs.;

yrs. since arrival N/S

Women identified as appropriately screened - at least one Pap test in the 3 yr study period

Stratified multi-variate analysis Multi-variate Poisson models stratified SAS for adjusted relative risks

Factors associated with lack of screening:

• not being in the 35–49 yr age group,

• resident in lowest-income neighbourhoods,

• not being in a primary care patient enrolment model,

• not having a provider from the same region,

• not having a woman provider.

For all women, the highest population-attributable risk was seen for not having a woman provider:

• 17% for Middle East and North Africa,

• 27% for East Asia and the Pacific.

Immigrant class was only significant for Sub-Saharan African women and Western European women, with refugees being at > risk of non-screening in these two groups.

Women should connect with the health care system soon after arrival and find a regular source of primary care.

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Haworth et al. (2014) [57]; HC USA; CO Bhutan

As outlined in Table 1

Convenience sampling;

Burmese community venues and residences Omaha;

online survey tool

n = 42;

As outlined in Table 1

Perceived susceptibility to and severity of disease and perceived barriers and benefits to screening

Descriptive statistics

Cervical cancer and screening practices:

• 22% reported ever hearing of a Pap test,

• 14% reported ever having Pap test,

• 33% perceived susceptibility to cervical cancer,

• 71% women who had heard about Pap tests tended to believe more strongly about curability if discovered early compared to 45% of women who never heard about the test

A significant lack of knowledge exists in this community regarding cervical cancer and screening practices. Community health workers as health interventionists was well received.

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Odunukan et al. (2015) [72]; HC USA; CO Somalia

Understand Somali women’s comfort with components of physical exam by providers and interpreters of different genders and races

Convenience sample;

Mid-west United States, Primary Care Internal Medicine Clinics; pictorial survey

n = 50;

refugees;

18–90 yrs.

(median 46);

yrs. since arrival median 11 yrs. (range 0.2–30)

Participant comfort level with body parts being examined by the pictured physician Patient–interpreter gender concordance acceptability

Descriptive statistics Paired ratings of discomfort Bowker’s test of symmetry Simple linear regression

Physical examination:

• 98% reported “no problem” to physical examination by a woman provider,

• genitalia/pelvic examination (82%), breast examination (81%), and abdominal examination (71%) by male providers was “definitely a problem”,

• chest/back examination (29%), extremity examination (28%), and head/neck examination (25%) by male providers was “definitely a problem”.

Women preferred a woman provider for conducting examination for the pelvic, breast, and abdominal examinations and preferred woman interpreters to be present.

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Banke-Thomas et al. (2019) [73]; HC USA; CO Somalia

Assess factors that influence maternal and reproductive health access across four health care dimensions

Community networks using snowball sampling;

Franklin County, Ohio – participants residences;

community-based survey

n = 427;

refugees;

18–19 yrs. 46

20–34 yrs. 215

35–49 yrs. 166;

yrs. since arrival

<  4 yrs. 139

>  4 yrs. 288

Willingness to seek care, gaining entry to the health system, seeing a primary provider and seeing a specialist

Descriptive statistics Multivariate analyses. Cross tabs bivariate analysis odds ratios 95% CI and p values

Factors unique to Somali refugee population:

• younger, single women were more willing to seek care vs older, married women.

• 81% stated not having insurance was the most frequent reason for postponing public or private care

• minors were 2.5 x more willing to seek care than those who arrived in the US as adults

Those with insurance were at least:

• 2 x more willing to seek care

• 3 x more likely to enter the health system

• 3 x less likely to have difficulty in seeing a primary provider

• odds of Somali women not able to speak English well, being willing to seek care was almost 80% < those who were able to speak English very well

• odds of Somali women with female genital cutting being willing to seek care were about 50% < those who were not circumcised

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