Women, Migrations and Health Ensuring Transcultural Healthcare Donne, migrazioni e salute Assicurare l’assistenza transculturale sanitaria Zagotavljanje transkulturne zdravstvene oskrbe Edited by > Women, Migrations and Health Ensuring Transcultural Healthcare Donne, migrazioni e salute Assicurare l’assistenza transculturale sanitaria Ženske, migracije in zdravje Zagotavljanje transkulturne zdravstvene oskrbe Lead Partner/Partner capofila/Vodilni partner · Università degli Studi di Trieste, Dipartimento di Scienze Politiche e Sociali – DiSPeS, Italia. Project Partners/Partner progettuali/Projektni partnerji · I.R.C.C.S. materno infantile Burlo Garofolo, Italia; Univerza na Primorskem, Fakulteta za vede o zdravju, Slovenija; Bolnišnica za ženske bolezni in porodništvo Postojna, Slovenija. Associated Partner/Partner associato/Pridruženi partner · ANOLF – Associazione Nazionale Oltre Le Frontiere. The project is co-financed by the call for standard projects no. 4/2016 Program INTERREG V A Italy-Slovenia. Total project value: 611,072.85 EUR. Progetto finanziato a valere sul bando per progetti standard n. 4/2016 nell’ambito del Programma INTERREG V A Italia-Slovenia. Budget totale di progetto: 611.072,85 EUR. Projekt je sofinanciran v okviru razpisa za standardne projekte št. 4/2016 Program INTERREG V A Italija-Slovenija. Skupna vrednost projekta: 611.072,85 EUR. The content of this publication does not necessarily reflect the official positions of the European Union. The responsibility for the content of this publication belongs to the author(s). Il contenuto della presente pubblicazione non rispecchia necessariamente le posizioni ufficiali dell’Unione europea. La responsabilita del contenuto della presente pubblicazione appartiene all’autore(i). Vsebina publikacije ne odraža nujno uradnih stališč Evropske unije. Za vsebino publikacije je/so odgovoren/-ni izključno avtor/-ji. https://www.ita-slo.eu/integra Women, Migrations and Health Ensuring Transcultural Healthcare Donne, migrazioni e salute Assicurare l’assistenza transculturale sanitaria Ženske, migracije in zdravje Zagotavljanje transkulturne zdravstvene oskrbe Edited by Sabina Ličen Igor Karnjuš Mirko Prosen Women, Migrations and Health Ensuring Transcultural Healthcare Donne, migrazioni e salute Assicurare l’assistenza transculturale sanitaria Ženske, migracije in zdravje Zagotavljanje transkulturne zdravstvene oskrbe Edited by · Sabina Ličen, Igor Karnjuš, and Mirko Prosen Reviewers · Nada Gosić and Joeri Vermeulen Translators for Italian · Helena Bažec in Jadranka Cergol Gabrovec Cover Design ·NinaČelhar Published by ·UniversityofPrimorskaPress Titov trg 4, 6000 Koper www.hippocampus.si Editor in Chief ·JonatanVinkler Managing Editor ·AlenJežovnik Print-run ·200 Koper ·2019 © 2019 University of Primorska Distributed free of charge ISBN 978-961-7055-43-6 (pdf) ISBN 978-961-7055-44-3 (html) ISBN 978-961-7055-45-0 (printed) https://doi.org/10.26493/978-961-7055-43-6 Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=298382336 ISBN 978-961-7055-43-6 (pdf) ISBN 978-961-7055-44-3 (html) Table of Contents Preface Sabina Ličen ·7 Gendered Migration and the Social Integration of Migrants in Slovenia Karmen Medica ·11 Sexual and Reproductive Health as an Indicator of Social Integration: The Obstacle of a Patriarchal Culture and Forced Marriage in Migrant Communities Ornella Urpis ·23 Reproductive Health of Migrant Women in Slovenia: State of the Art Blaž Lenarčič and Mateja Sedmak ·35 Working on Epidemiological Data: Problems Encountered and Lessons Learned Giovanni Delli Zotti ·59 Human Papillomavirus Infection and Cervical Cancer in Immigrant and Refugee Women Andrej Cör ·73 Use of Modern Contraceptive Methods among Migrant Women Living in Slovenia Igor Karnjuš, Mirko Prosen, Urška Bogataj, Doroteja Rebec, and Sabina Ličen ·81 Migrants’ Experiences in the Healthcare System Marie-Louise Luiking and Harshida Patel ·95 Current Issues and Future Possibilities for Improving Healthcare forMigrantWomeninSlovenia Urška Bogataj, Mirko Prosen, Igor Karnjuš, Doroteja Rebec, and Sabina Ličen ·107 Migrant Women’s Perspectives on Reproductive Health Issues and Their Healthcare Encounters Mirko Prosen, Sabina Ličen, Urška Bogataj, Doroteja Rebec, and Igor Karnjuš · 117 Monoligual Health? Linguistic Barriers in Slovene Healthcare Experienced by Migrant/Refugee Women Uršula Lipovec Čebron, Lea Bombač, Nike Kocijančič Pokorn, and Miha Lučovnik ·139 When Language and Culture Interfere: Sexual and Reproductive Health of Migrant Women in the Coastal Region of Slovenia Zorana Medarić and Mateja Sedmak ·155 5 Table of Contents Cultural Competence in Nursing and Its Impact on the Quality of Care for Patients from Culturally Diverse Groups: A Systematic Literature Review Sabina Ličen, Igor Karnjuš, Urška Bogataj, Doroteja Rebec, and Mirko Prosen ·173 Strengthening Cultural Awareness of Nursing Students Barbara Donik, Mateja Lorber, and Majda Pajnkihar ·187 Culturally Sound Midwifery Care for Migrant Mothers: How Well the Midwifery Curriculum Prepares Graduates Ana Polona Mivšek, Nastja Pavel, Mateja Kusterle, and Petra Petročnik ·199 Sintesi · 211 Povzetki · 219 6 Preface Sabina Ličen University of Primorska [email protected] Today, migration is a global reality. People leave their homelands for various reasons such as poverty and low incomes, high unemployment, persecution and poor respect of human rights, internal conflict and war, etc. In recent times, our region and the area of neighbouring Italy have seen a growing number of migrant women migrate from their own country for reasons to do with reproductive health or birth. In fact, for many migrant women, issues associated with insufficient or poor sexual and reproductive health in their countries can lead to worse perinatal outcomes than those experienced by women generally. Moreover, migrant women in developed countries often experience more complicated pregnancy outcomes and less women are able to access preventive gynaecology services. The latter may be due to poor cultural competence knowledge among health professionals or other bar- riers encountered by migrant women. With a view to delivering culturally- sensitive healthcare to migrant women, the EU programme INTERREG V-A Italy–Slovenia 2014–2020 funded the project ‘Cross-Border Network for Mi- grant Women: Social Integration, Sexual and Reproductive Health (INTEGRA),’ led by the University of Trieste in Italy. The project outcomes included this scientific monograph ‘Women, Migra- tions and Health: Ensuring Transcultural Healthcare’ which addresses various aspects of migration and women’s health like social integration, sexual and reproductive health, along with related cultural practices, and the develop- ment of cultural competencies among healthcare professionals in delivering culturally sensitive healthcare. Chapter 1 introduces the reader to the main theme of the book – migrant women. Women are often heavily involved in the survival of their families and communities, but today the ‘feminisation of migration’ and ‘feminisa- tion of survival’ processes are very evident. Observation of the sexual and reproductive health of women can provide a good indicator of the extent of integration of cultural communities by revealing women’s capacity for auton- omy and self-determination, a fundamental condition for recognition of their rights and for identifying with the models and values of democratic society, as discussed in Chapter 2. Chapter 3 presents data on the number of migrant 7 Sabina Ličen women in Slovenia which is constantly rising, and notes it will be even higher in the future whereas a comprehensive and systematic approach to migrant women’s reproductive health is still missing. Chapter 4 considers the devel- opment of a sexual and reproductive health index that aims to identify at-risk individuals, or which require ‘targeted’ interventions. This implies the need to identify suitable indicators; namely, another of the INTEGRA project’s pur- poses. Chapter 5 explains that immigrant women from low- and medium- income countries have a higher prevalence of HPV and thus a greater risk of cervical pre-cancer and cancer than native women also due to barriers to access to screening programmes and vaccination uptake. Moreover, Chap- ter 6 discusses the available evidence on the factors associated with migrant women’s use of modern contraceptive methods in Slovenia. Chapter 7 ad- dresses the factors associated with migrants’ healthcare experiences in the host country. The model presented in the chapter can help increase nurs- ing professional’s awareness of the need to provide person-centred care and overcome transcultural differences. Chapter 8 describes migrant women’s so- cial integration in terms of their reproductive health relative to the health- care system in Slovenia. Chapter 9 outlines a qualitative content analysis ap- proach applied to a maternity hospital in Slovenia. The analysis highlights two themes: the experiences, expectations and barriers of a different health- care system; and the impact of culturally-based beliefs on women’s reproduc- tive health. Chapter 10 presents the main obstacles related to the main lan- guage barriers that arise between migrant/refugee patients and healthcare personnel in the area of gynaecology and obstetrics. Chapter 11 discusses mi- grant women’s reproductive health, with an emphasis on the perspectives of migrant women and healthcare professionals (doctors, midwives, commu- nity nurses, etc.)