The HSE Crisis Pregnancy Programme is launching a summary of research with young migrant women on sex, fertility and motherhood. The summary draws from a qualitative study comprising research interviews with young women from three migrant communities: Chinese, Polish and Nigerian, as well as young women from the Muslim faith community. The qualitative study involved in-depth interviews with a total of 81 young migrant and minority ethnic women aged 18-30, participating in one-to-one interviews (n = 26), friendship pair interviews (n = 4) and nine focus group interviews (n = 51). The analysis explores the meanings these young women bring to their sexual relationships, sexual health, and reproductive healthcare decisions, including contraceptive use, pregnancy and motherhood. 

The research shows that while migrant women share many perspectives with Irish women in how they feel about fertility, sex and motherhood, there are some important differences in how each negotiates their sexual lives.  Perceiving responsibility for sexual morality as vested principally in girls and women is a key site of commonality, although with cultural nuances. 

Findings of this research show that migration and transition to a new cultural environment can involve encountering opposing meanings attached to relationships and sexuality in one’s culture of origin and the new host culture. Women from each of the diverse national, cultural and ethnic backgrounds represented in the study describe an association of fear, shame and guilt with sex and pregnancy before marriage in the cultural messages they receive from home.  Women in the study perceive Ireland as ‘westernised’ and representative of more permissive attitudes towards sexuality than their cultures of origin. They encounter conflicting messages about appropriate sexual behaviour for young women as they move between their culture of origin and Irish ‘westernised’ culture, and as they navigate between the various realms in their lives – home, school and peer group.

Migration involves certain expectations and pressures to succeed. Women in the study describe how the meaning of migration is usually as an opportunity to ‘better’ oneself.  Migrant families can feel the expectations of those ‘back home’ on them to progress, placing particular pressures on the next generation to succeed. For migrant families, a young, unmarried daughter becoming pregnant signals a failure to optimise enhanced educational opportunities in the new country of residence. It also signals a failure by her family to maintain the moral standards of their home country of origin. Young migrant women consider that respectability of not just the girl but also her family and her wider community depends on a young woman’s sexual propriety. These factors create particular conditions for a pregnancy to be construed as a ‘crisis’.

There were high levels of variation in the knowledge and experiences of migrant women of sexual and reproductive health services in Ireland including the role of GPs.  Whether a young woman comes to Ireland as part of a family or independently raises different issues. 

Within the study group, more Muslim and Nigerian women were second-generation migrants and were more likely to be integrated into the Irish health system through their families. Participants in these groups referred to how ‘cultural silences’ and a sense of shame in relation to sexuality inhibited them asking a GP about sexual health services. 

Young women migrating independently report low levels of engagement with Irish health services due to language issues and limited knowledge of services and pathways to access services. Pharmacies were often cited as a key source of information and advice on health issues. Some women also use websites as sources of contraception.

Women migrating independently who retain strong links to their home country describe engaging in ‘transnational’ health service usage. This involves returning home for healthcare. Reasons for doing so include perceived high cost of GP services in Ireland, while factors facilitating returning home include familiarity with services, lack of language barriers and preferences of approaches taken.  

Women are sourcing contraceptive products from pharmacies and doctors in their home countries, sometimes ‘bulk buying’ to try to ensure they have what they need until their next visit home. Polish women also operated outside of the Irish health system by attending Polish clinics operating in Ireland. 

Transnational health service use often results in migrant women establishing no contact with local GP services or sexual and reproductive health services. This leaves them at risk of being unable to avail of such supports and services locally and quickly if the need arose. As primary care services often act as an important point of contact and information for specialist services, not attending primary care means migrant women miss these opportunities to connect with services. Findings show low levels of familiarity and connectedness with crisis pregnancy support services (CPSS) among young migrant women in this study.  

Another factor inhibiting migrant women’s contact with sexual and reproductive health (SRH) services is the development of ‘localised’ terminology in this area in Ireland, including the term ‘crisis pregnancy’. Such service terms and titles are only understood through local ‘tacit knowledge’ acquired over time, which is unavailable to those recently arrived here. 

Accounts of women who did experience a crisis pregnancy illustrate lack of knowledge about crisis pregnancy support services, leaving them more isolated and reliant on personal networks, particularly parents.

Meanwhile, multicultural and migrant communities can also present new issues to primary care services. Two issues featuring in the study were female genital mutilation (FGM) and hymen reconstruction. Migrant women coming to Ireland may be survivors of FGM. Our findings highlight long-term psychological and physical consequences for women who have undergone FGM. 

Irish sexual and reproductive health services need to be cognisant of how this can be a feature of migrant women’s sexual health needs. AkiDwA, a minority, ethnic-led network of migrant women living in Ireland have produced the Handbook on FGM for Health-Care Professionals working in Ireland with the support of the HSE, and this handbook is available on www.akidwa.ie/publications/gender-based-violence/female-genital-mutilation/

Another specific issue featuring in the study was hymen reconstruction, a surgical procedure to reinstate the hymen for the purposes of presenting as sexually uninitiated. Hymen reconstruction was referred to by young Chinese women as a procedure that would resolve for them the need to present as ‘chaste’ on marriage when they return home to fulfil the cultural expectations of young women.

The study findings provide an important direction for service providers and policymakers in terms of making sure migrant women know the services that are available to them and ensuring that women experience culturally-sensitive care when they access any part of the healthcare system. The HSE has developed resources that will be useful to GPs such as the HSE Intercultural Guide which provides practical information to health and social care providers on culturally appropriate healthcare. The Positive Options website www.positiveoptions.ie, listing State-funded crisis pregnancy services includes multilingual information to which women for whom language is a barrier can be referred. 

In presenting these findings we are mindful of the diversity represented within migrant communities meaning issues highlighted here will not be experienced in the same way by all migrant women. The purpose of the research is to help build multicultural competency in this area among sexual and reproductive health policymakers and service providers including GPs in recognition of our multicultural society. 

The research summary discussed here is available at: www.crisispregnancy.ie/research-policy/research-summaries/