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African Immigrant and Refugee Women's Experiences Seeking Reproductive Health Information, Services and Support

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African Immigrant and Refugee Women's Experiences Seeking Reproductive Health Information, Services and Support Negotiating and Constructing Place: African Immigrant and Refugee Women’s Experiences Seeking Reproductive Health Information, Services and Support Heather Louise Greenwood A thesis submitted to the Faculty of Graduate and Postdoctoral Studies in partial fulfillment of the requirements for the Doctorate in Philosophy degree in Population Health Interdisciplinary School of Health Sciences Faculty of Health Sciences University of Ottawa © Heather Louise Greenwood, Ottawa, Canada, 2017 Table of Contents Table of Contents .................................................................................................................. ii List of Tables ......................................................................................................................... v List of Figures ........................................................................................................................ v Abstract ............................................................................................................................... vi Acknowledgements ............................................................................................................. viii Chapter 1: Introduction ......................................................................................................... 1 Purpose and Research Questions ............................................................................................... 3 Contours and Meanings of Reproductive Health ....................................................................... 7 Researcher in Context ................................................................................................................. 9 Outline of Sections .................................................................................................................... 13 A Note on Terminology ............................................................................................................. 14 Chapter 2: Theoretical Framework ....................................................................................... 16 Intersectionality ........................................................................................................................ 17 Theories of Place ....................................................................................................................... 19 Social Location: Defining Key Concepts .................................................................................... 22 Health in the Context of Social Location and Place .................................................................. 25 Implications for Research Design .............................................................................................. 27 Chapter 3: Literature Review ............................................................................................... 29 African Migration to Canada – Trends and Drivers .................................................................. 30 Canadian Immigration Policy .................................................................................................... 34 Settlement and Integration ...................................................................................................... 37 Reproductive Health of African Immigrant and Refugee Women ........................................... 41 Interaction of Health and Immigration Policies .................................................................... 41 Reproductive Health Needs and Challenges ......................................................................... 44 Summary and Gaps ................................................................................................................... 47 Chapter 4: Methods ............................................................................................................. 50 Research Design ........................................................................................................................ 51 Research Site and Participants ................................................................................................. 55 Selection of the Cases ............................................................................................................... 56 Participant Sampling and Recruitment ..................................................................................... 60 African Immigrant and Refugee Women .............................................................................. 60 Reproductive Health Service Providers ................................................................................ 63 Data Collection Strategies ......................................................................................................... 64 Interviews with Immigrant and Refugee Women ................................................................ 64 Focus Groups and Interviews with Service Providers ........................................................... 67 Mapping ................................................................................................................................ 68 Field Notes ............................................................................................................................ 69 ii Data Management and Analysis ............................................................................................... 70 Trustworthiness and Rigour ...................................................................................................... 73 Role of the Researcher .............................................................................................................. 75 Chapter 5: Case Study - Central Ottawa ............................................................................... 79 Introduction to the Case ........................................................................................................... 80 The Participants ........................................................................................................................ 81 Profile of the Case Study Area .................................................................................................. 82 Reproductive Health Service Context ....................................................................................... 85 Map of the Reproductive Health Service Context ................................................................ 85 Service Provider Views on Key Issues and Challenges .......................................................... 92 Voices of African Immigrant and Refugee Women ................................................................ 107 Conclusion ............................................................................................................................... 119 Chapter 6: Case Study - West End Ottawa .......................................................................... 122 Introduction to the Case ......................................................................................................... 122 The Participants ...................................................................................................................... 123 Profile of the Case Study Area ................................................................................................ 124 Reproductive Health Service Context ..................................................................................... 126 Map of the Reproductive Health Service Context .............................................................. 126 Service Provider Views on Key Issues and Challenges ........................................................ 132 Voices of African Immigrant and Refugee Women ................................................................ 147 Conclusion ............................................................................................................................... 168 Chapter 7: Case Study – Southwest Suburban Ottawa ........................................................ 171 Introduction to the Case ......................................................................................................... 171 The Participants ...................................................................................................................... 172 Profile of the Case Study Area ................................................................................................ 173 Reproductive Health Service Context ..................................................................................... 176 Map of the Reproductive Health Service Context .............................................................. 176 Service Provider Views on Key Issues and Challenges ........................................................ 182 Voices of African Immigrant and Refugee Women ................................................................ 193 Conclusion ............................................................................................................................... 216 Chapter 8: Integrated Analysis, Recommendations & Future Directions ............................. 220 Integrated Analysis Across Case Studies ................................................................................. 221 The Context for African Women’s Reproductive Health in Ottawa ................................... 221 Immigrant Women’s Experiences: Across Cases ................................................................ 239 Comparison Between Data Sources...................................................................................
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