Trauma-Informed Sexual Health Care Among Survivors of Intimate Partner and Sexual Violence in Refugee Resettlement Contexts: A Scoping Review

Background and Purpose: There is a critical need to address sexual and reproductive health (SRH) care among refugee women in resettlement contexts. Discrimination and oppression related to gender, race/ethnicity, immigration status, and language exacerbate barriers limiting women’s access to SRH care. Trauma-informed perspectives are particularly critical in SRH given risks of gender-based violence (GBV) pre-, peri-, and post-migration, but the extent to which trauma-informed practices inform SRH care in resettlement contexts is unknown. The purpose of this scoping review is therefore to examine the intersection of SRH and GBV-related service needs among women in resettlement and identify models of trauma- informed SRH care in resettlement contexts.

Methods: Key search terms were based on Boolean phrase searching with synonyms for the following concepts: intimate partner violence, sexual violence, sexual and reproductive health, and refugee women and girls of reproductive age (14 and older). Databases included Academic Search Premier, Medline, CINAHL, PsychInfo, PubMed, and Web of Science, producing 770 articles. English-language journal articles published between 2000 and 2020 were included. After removing duplicates and screening based on titles and abstracts, 310 studies were eligible for full-text review. The final screen omitted review and conceptual articles and studies that did not take place in a country that resettles refugees, resulting in eight articles.

Results: Studies included in the final analysis were conducted in the United Kingdom (n = 3), Canada (n = 2), United States (n = 1), Switzerland (n = 1), and Sweden (n = 1). Regarding SRH needs, studies focused on HIV/AIDS and STIs (n = 3), pregnancy, labor, delivery, and post-partum care (n = 4), and general SRH service needs (n = 2). Findings suggest that, compared to non-refugee patients, refugee women in resettlement contexts are more likely to miss SRH appointments, need language interpretation services, have outdated tests, and report a history of sexual violence. The studies highlight the extreme hardships women have endured associated with intimate partner violence and sexual violence and related unmet SRH needs. Three studies explicitly addressed trauma-informed SRH care to support refugee GBV survivors, including those who experienced unwanted pregnancies due to sexual assault; yet no studies evaluated trauma-informed SRH programs in a resettlement context.

Conclusions and Implications: The results of this scoping review illustrate significant barriers to effective SRH care among refugee women in resettlement. Importantly, the search outcome and analysis underscore the resounding lack of research on the integration of trauma-informed approaches within SRH care to address GBV and other traumas associated with forced migration. Efforts to mitigate barriers and respond effectively and holistically to complex SRH needs of refugee women require coordinated and trauma-informed responses, and bridging health care and social work to provide coordinated wrap-around care. Evaluations of these efforts will help to address significant health disparities among marginalized populations and ensure the social work profession embraces sexual and reproductive rights as a matter of social, racial, and political justice.