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Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel
Authors:Tsega Gebreyesus  Nora Gottlieb  Zebib Sultan  Habtom Mehari Ghebrezghiabher  Wietse Tol  Peter J. Winch
Affiliation:1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAtgebreye@gmail.com"ORCIDhttps://orcid.org/0000-0001-9382-5076;3. Department of Healthcare Management, Technical University Berlin, Berlin, Germany"ORCIDhttps://orcid.org/0000-0001-9199-2321;4. Department of Nursing, Cincinnati State Community College, Cincinnati, OH, USA;5. Department of Human Rights Under Pressure - Ethics, Law, and Politics at the Minerva Center for Human Rights, The Hebrew University in Jerusalem, Jerusalem, Israel;6. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;7. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"ORCIDhttps://orcid.org/0000-0001-8569-5507
Abstract:ABSTRACT

Objectives: In recent years, there has been a mass migration of Eritreans (many seeking political asylum) into Israel after precarious irregular movement across international borders. This study qualitatively explores the structural barriers to family planning (i.e. contraceptive services) for Eritrean women in Israel that are rooted in their temporary legal status and the patchwork of family planning services.

Design/Methods: From December 2012 to September 2013, we interviewed 25 key informants (NGO workers, researchers, Eritrean community activists, International NGO representatives and Ministry of Health officials) and 12 Eritrean asylum seekers. We also conducted 8 focus groups with Eritrean asylum seekers. Data were analyzed using both inductive and deductive coding.

Results: We identified 7 main barriers to accessing family planning services: (1) distance to health facilities; (2) limited healthcare resources; (3) fragmentation of the healthcare system; (4) cost of contraceptive services; (5) low standard of care in private clinics; (6) discrimination; and (7) language barriers.

Conclusion: The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers’ efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.
Keywords:Family planning  contraception  Eritrean women  migration  Israel  Middle East
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