Opportunities, needs and barriers to preconception health and access to preferred contraception: a qualitative study of underserved migrant women.

Abstract

Background: Nearly a third of women (we have used the terms women/woman but recognise that not all pregnant or birthing people identify as women) who give birth in England and Wales are migrants (born outside the UK). Preconception health inequalities exist between underserved migrant women and UK-born women, but evidence for why they occur is scant. We aimed to explore the opportunities, needs and barriers to contraception and preconception health among underserved migrant women.

Methods: Twenty interviews and two focus groups were undertaken with 38 migrant women (asylum seekers, refugees and those with no recourse to public funds) aged 18-49 years from a diverse range of countries living in England. Those in non-English languages (Kurdish Sorani, Dari, Farsi, Arabic, Turkish and Punjabi) were undertaken with an interpreter or by community researchers in their own language. Data were analysed thematically.

Results: The women described traumatic life experiences and cultural pressures to have children. Awareness of preconception health and contraception varied. Most women preferred non-hormonal contraception. Many had never heard of sexual health clinics and believed only GPs could offer contraception. Healthcare communication was limited by lack of interpreters as well as some women being unable to read or write.

Conclusions: More support is needed for accessing contraception and preconception care from primary care. Healthcare communication regarding preconception health and contraception is needed in relevant languages and should be accessible to those who cannot read or who have no pre-existing knowledge of contraception. Healthcare professionals need to be cognisant of women's previous trauma including stillbirth, baby loss and non-consensual sex.