One Size Does Not Fit All: Importance of Culturally Sensitive Sexual and Reproductive Health Education for Immigrant Communities

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By: Canadian Advisory of Women Immigrants (CAWI), Hani Rukh-E-Qamar, Rehma Khan, Roma Ranade, Crystal Yang, Naomi Phung, Isabella Kakish, Ana Dumitrache, Marianne Djigo, Yasemin Erdogan, Saba Al-Leswas, and Ushna Masroor

Immigrant women are among those marginalized groups who continue to face health inequities globally; the onset of the COVID-19 pandemic further exacerbated these inequities by way of changes in the healthcare systems’ priorities and capacity concerns. Immigrant women have more restricted access to health care compared to their non-immigrant counterparts, for example, we see higher mortality rate among immigrant gestational parents during childbirth compared to their non-immigrant counterparts in Europe and the United States.

Another key area where many immigrant communities have been traditionally impacted is access to culturally-sensitive and comprehensive sexual and reproductive health (SRH) education and resources. Comprehensive sexual education is defined by UNESCO as “a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. Specifically, immigrant women have restricted access to SRH resources due to cultural differences and stigmas associated with topics such as menstruation and sexuality. Additionally, various other barriers exist such as language barriers, socioeconomic barriers, and medical discrimination against ethnic minority communities. This restricted access further impacts immigrant women’s desire to access SRH education regarding topics such as contraception and unintended pregnancies, among other things.

The need for culturally sensitive SRH education and resources prompted the youth-led organization, the Canadian Advisory of Women Immigrants (CAWI), to conduct an ethically-approved community-based research project focused on the experiences of immigrant women, girls, and gender-diverse individuals across Canada. As a part of their SRH campaign, the group has led various panel discussions where community organizations, researchers, and individuals from the wider community contributed their expertise and knowledge to the discussion of SRH and SRH education pertaining to immigrant women, girls, and gender-diverse individuals. Some of these community panels featured the expertise of practitioners, researchers, and activists on the topic of SRH. Further, specific focus group discussions were held with immigrant women who have participated in SRH education in Canada to learn directly from their experiences. Through these discussions, many individuals pointed to the need for diverse educators, community-based and youth-led organizations, as well as creating space for young immigrant women to voice their concerns and needs. Additionally, many participants in the focus group discussion highlighted the need for culturally sensitive education as SRH is often associated with a stigma which requires specific training and environments. This may include offering education in immigrants’ native language and allowing for anonymity while asking questions. Cooper and Powe’s 2004 study reviewed documents ongoing racial and ethnic disparities in healthcare and linked patient-physician race and ethnic concordance with higher patient satisfaction and better healthcare process. They provided the recommendation that cultural competency training should be incorporated into education of health professionals and future research should also help provide additional insight into mechanisms by which concordance of patient and physician race, ethnicity, and language influences processes and outcomes of healthcare.

Although CAWI focused their campaign on the needs and experiences of Canadian immigrant communities, the results of these discussions can be framed in a global context, especially since the research CAWI conducts is based on the results of research from various countries, such as European countries, the United States, and Canada. Lack of adequate SRH education becomes an urgent public health issue when consequences include increased rates of STI and HIV transmission, along with the negative health outcomes associated with early pregnancy. According to the World Health Organization (WHO), the demographic with the largest reported proportion of STIs worldwide is youth under 25 years old. This highlights the fact that adolescents are particularly vulnerable to preventable infection and that there is a need for an increase in culturally specific and effective SRH education initiatives on a global scale. It is necessary that this education is formatted to be culturally relevant and to serve the specific communities that it is targeting. Without taking the time to create culturally specific sexual education programs, the barriers that prevent proper understanding of SRH education will persist and will continue to disproportionately impact ethnic minorities and immigrant communities worldwide.

The CAWI’s SRH team recommends that SRH educators, health practitioners, community organizations, and school teachers/professors avoid cookie-cutter practices when working with marginalized communities like immigrant women and girls. These communities have intersectional identities that impact their sexual and reproductive health and cannot be overlooked. CAWI also recognizes the importance of equal access to SRH resources for immigrant communities, a cause which can be promoted  through policy changes which prioritize health policies that are inclusive of and specific to immigrants’ needs. Additionally, our team recommends that culturally sensitive practices are used both on a community scale (schools, clinics, etc) and a larger scale (policy) to ensure we can better advocate for inclusivity and innovation while improving equitable access to healthcare resources.

In order to get one step closer to achieving these goals, it is pertinent that a new approach is taken in developing an SRH curriculum that accounts for diversity, and barriers that marginalized groups face. Our aim with CAWI’s SRH campaign is to move a step in the right direction, and we hope that the implementation of culturally sensitive SRH education continues on the right path. CAWI is currently developing an SRH curriculum and toolkit that intends to bring sexual health education to immigrant women, girls, and gender diverse folks by making SRH knowledge accessible. Our team aims to increase confidence and self-efficacy in our participants in the hopes that they we better able to advocate for their sexual and reproductive health needs. Through our efforts, our team also hopes to normalize conversations surrounding SRH in immigrant communities where it is highly stigmatized. Overall, the main goal of the curriculum is to help people understand the intersections of SRH with gender, race/ethnicity, and sexual identities while challenging ethno-cultural and sexual inequities in ways that would help people assert their rights in areas encompassed by SRH. We believe that learning about the needs of immigrant populations may lead to higher sexual health education and knowledge within these communities, which may contribute to increased feelings of empowerment and bodily autonomy within immigrant populations.