3. Sexual and reproductive health of women refugees and asylum seekers under particularly difficult living conditions
3.1 First assessment
- Asylum seekers are health-insured within the framework of basic care scheme
- Asylum seekers barely have financial resources (are receiving 40 Euro pocket money /month); as a consequence, contraception or abortion are hardly affordable à for Vienna: [http://wohnen.fsw.at/grundversorgung/leistungen.html]
- Variety of different taboo subjects
- Different state(s) of knowledge
- Various previous medical treatment experiences
- Partially misinformation about medical options in Europe
- Lacking knowledge about the health care system in Austria (Mother-child-pass, etc.)
- Partially the experience of sexual violence in their home country or during flight
- Perspective unclear, great uncertainty concerning the asylum procedures (duration, decision, etc.)
- Memories are frequently traumatic (reasons for flight/war, flight over the Mediterranean Sea, relatives are left behind or died)
- No extended family /family members
- Complete external determination
3.2 Red flags
Special attention should be paid to:
- Medical examination of female physicians/ health care worker (and also female translators)
- Possibly referring to a gynaecologist or specialist of their first language
- Respecting and indicating confidentiality and discretion
- Important to convey: Contraception is not illegal!
- Introducing various kinds of contraceptive methods
- “Pill after”- available without recipe (in Austria)!
- Information concerning sexually transmitted diseases (STD’S), HPV (especially concerning young women)
- Mediation of body-awareness including
- Training the ability to set and preserve one’s own limitations
- Conveying contact points such as:
First love ambulances: First Love and First Love mobile are establishments of the Austrian Society for Family Planning (Österreichische Gesellschaft für Familienplanung, ÖGF). In such counselling centres girls will be counselled anonymously. In addition, girls may be gynaecologically examined without charge [http://www.firstlove.at/].
ÖGF: anonymous and free of charge counselling in public hospitals and ambulatories (in Vienna and immediate surroundings) concerning topics as sexuality, contraception (the spiral, implants, sterilisation, vasectomy…), pregnancy conflicts and abortion, prevention of sexually transmitted diseases [http://www.oegf.at/].
FEM/FEM Süd/MEN: FEM, FEM Süd and MEN offer immediate, competent, critical and gender specific health information and counselling as well as practical guidance within the medical system. There are health offers both in german and native language [http://www.fem.at/].
Additional factors, which should be considered in professional care/support:
- Is there a common language or is translation needed (relatives/own family is often too close, the same for spouses: feelings of shame, taboo)
- If an interpreter is needed: consent, payment, man/woman as translator, time should be taken into account (often there is an agreement made because of shame, but actually little was understood, etc…)
- Illustrative material (images, etc.) should be prepared to make anatomy and bodily functions comprehensible
- Establishing a trusting atmosphere
- Clarifying the framework and pointing to professional secrecy
- Clarification: is there a residence permit/health insurance/residence?
- How is the actual housing situation (residential home, private, temporary, many people, noise level, hygiene, room for privacy, etc.)
- Written information: is the woman able to read and write, and if yes, in what language(s)?
- Is female genital mutilation (FGM) also a topic to consider?
3.3 Legal aspects
Indicating women’s rights concerning their sexuality and reproduction is highly important! They are derived from human’s rights, which are signed by most countries of the world (also by Austria and Germany):
- Right of sexual self-determination
- Right of equal treatment
- Right to marry or not to marry
- Right of family planning
- Right to be informed about contraceptives and to use them
- Rights for women and girls in case of (unwanted) pregnancy
- Right, to be protected from (sexual) violence
(See also: Module 3)