Reimagining Reproductive Health Care for Refugee Women: Integrating Cultural Health Navigators into a Clinical Model.

Abstract

Background: Refugee women face barriers to reproductive health care, including limited English proficiency, transportation challenges, inconsistent insurance coverage, socioeconomic instability, and prevalence of trauma-related mental health conditions. This study describes the characteristics, diagnoses, and health care utilization of refugee women receiving care at the Refugee Women's Health Clinic (RWHC) of Valleywise Health (VH), a safety net health care system in the southwestern United States. Further, it examines the role of an integrated cultural health navigator (CHN) program in addressing access and care barriers for refugee women. Study objectives were to characterize demographics, health diagnoses, reproductive health care utilization, and the scope of CHN service delivery.

Methods: We conducted a retrospective cohort study using electronic medical record data from 21,062 refugee-identified patients seen at VH from 2009 to 2024, with a focused descriptive analysis of 7,504 women who received care at the RWHC. Analyses of CHN service delivery were conducted among a subset of 1,581 patients with available CHN flowsheet documentation.

Results: Patients originated from >100 countries, demonstrating extensive racial, linguistic, and religious diversity. Among RWHC patients, 48.1% experienced at least one pregnancy; 93.2% received prenatal care, and 55.3% initiated care in the first trimester. Mental health diagnoses were common, including anxiety (10.0%) and depression (9.8%). Preventive services were widely utilized, including sexually transmitted infection screening (43.1%) and contraceptive counseling (32.2%). CHNs supported approximately 5,000 patient encounters annually, with services focused on appointment adherence, enhanced interpretation and transportation access, and linkage to behavioral health and supportive services.

Conclusions: The RWHC and its integrated CHN program represent a community-based, equity-focused model of reproductive health care delivery for refugee women in a safety-net setting. Embedding CHN programs within clinical settings may mitigate socioeconomic, linguistic, and mental health-related care barriers by strengthening care coordination and access. This model offers a framework for advancing reproductive health equity among resettled refugee women.