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Health Status Health Services Health Care Reform Diverse Communities of Women
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Experiences of Immigrant and Refugee Women in Quebec with the Health Care System Le Centre d’excellence pour la santé des femmes – Consortium Université de Montréal
The continuing influx of immigrants and refugees has transformed Canadian society, forcing revision of our public programs, including health care. Research indicates that the health of immigrants deteriorates with their length of stay in Canada and that they often comprise vulnerable groups (Chen et al., 1996). Since 1997, researchers associated with the Centre of Excellence for Women’s Health – Consortium Université de Montréal (CESAF) have conducted ten studies with different populations of immigrant women in Quebec. All of the studies aim to understand the health experiences of immigrant women and whether they are receiving adequate and appropriate care from the Canadian health care system. This work adds an important gender focus to research on immigrant health in Canada as issues of family dynamics in the context of immigration have often been neglected. Highlights from several of these projects are discussed below; further information is available from CESAF on these or related projects. Several CESAF-sponsored studies have been completed in partnership with women from the French-speaking countries in North Africa and the Middle East such as Algeria, Tunisia, Morocco and Lebanon, Spanish-speaking women from the Americas, women from China and Haiti, and South Asian women. For example, factors which influence health behaviours and the use of preventive health services of South Asian immigrant women living in Montreal were examined by Vissandjée et al. (1999). In order to assess the influence of the length of stay, two cohorts of South Asian women were selected: recent immigrants (1- 3 years) and past immigrants (5 to 10 years). Preliminary findings reveal that 40% of the respondents perceive their health to have deteriorated since their arrival in Canada. Of the health behaviours examined, approximately three out of four women identify sleeping, nutrition and physical activity as essential for good health while 98% consider relaxation crucial for their health. Yet fewer than half of the women actually conduct these activities on a regular basis. Migration also appears to affect women’s perinatal experiences. Research suggests that it is not ethnic origin which presents risk during the perinatal period but factors arising from migration such as the loss of family and other social and economic support networks which in turn may lead to poverty, isolation and/or psychological problems which renders immigrant women potentially vulnerable during the perinatal period. One outcome of CESAF work is improved tools to identify women in the general population requiring additional support during the perinatal period (Battaglini et al., 1999). With regard to their preferences for physicians, Muslim women in Quebec indicated that the quality of care they receive in relation to reproductive and sexual health revealed that the majority of study participants preferred “Canadian” over Arab doctors, though they showed no preference concerning the preferred sex of their gynecologist (Gastaldo et al., 1998). These results concur with those of Weinfeld et al. (1998) which indicate that gender and ethnic matching in the delivery of health care services does not always translate into excellent care. In looking for ways to improve access to health services for immigrant women, Weinfeld et al. (1998) explored the benefits of ethnic/gender matching between health professionals and women and men from different ethnic origins. This concept builds upon the notion of ethnic matching, a concept founded on the assumption that service provision is optimized when ethnicity, race, language, and geographic area of origin coincide between clients and health services providers. While intuitively appealing, it has not yet been established whether matching the ethnic origin of a professional with a client necessarily ensures better diagnosis or treatment, nor whether professionals of ethnic origin are necessarily free of prejudicial stereotypes regarding their own or other ethnic groups. This study augmented this notion of ethnic matching with gender matching in a study of the mental health issues facing immigrant women in Quebec and barriers to the use of culturally sensitive and social services. To date, the results of studies such as this offer a conflicting views of whether ethnic/gender matching leads to significant long-term health improvements. Like most Canadians, Muslim immigrant women were primarily concerned about the quality of care available rather than with issues of immigration per se. Women with difficulties preferred to have their husbands translate during visits to physicians rather than friends or relatives, though they recognized that Canadian physicians perceived this as a form of dependency (Gastaldo et al., 1998). A majority of women respondents in most of the studies worried about cuts to health care expenditures, the lack of time for medical consultations, the length of time it sometimes took to establish a diagnosis and a lack of continuity in programs. These concerns echo those of other Canadian women. An evaluation of a telephone service that provides health information, education and on-line consultations to women and men in Montreal from the perspective of its cultural sensitivity and adequacy at meeting the needs of immigrant women. Consultations on the service was undertaken with Spanish-speaking women from the Americas, Arab-speaking women from the Middle East and North Africa, and Chinese and Haitian women. The objective of this research was to examine the role/use, strengths and weaknesses of a health information service provided by CLSCs (community-based health centres) in the context of their use by these women and their families and to identify factors which promote continuity and quality of care (Vissandjée & Dallaire, 2000). The potential impact of this research is significant as the use of telephone call centres in health is currently being tried and explored in several jurisdictions. In initial work on the effects of age on migration, a literature review revealed that while migration is a challenging experience for anyone, it can be more so for older people because of the losses not only of family and friends but also of a familiar physical, social and cultural environment. Migration presents a challenge to one’s identity, may impose communication barriers, and require significant changes to family structure and practices. Immigration may be especially challenging for older women as they are more likely than other migrants to be poor (Talbot et al., 1998). Taken together, these studies, and others undertaken through CESAF, form a foundation for further research into gendered aspects of the migration experience. This work should beneft policy makers, program planners, health services providers and other researchers.[3] For further information contact: NOTES CESAF (2000). Acquis et défis de la production des connaissances dans le cadre des activités du Centre d’excellence pour la santé des femmes Consortium Université de Montréal (CESAF) 1997-2000, recherche et rédaction: G. Daudelin, Montréal, Centre d’excellence pour la santé des femmes - Consortium Université de Montréal. Chen, J., Wilkins, R., Ng, E. (1996). "Health Expectancy by Immigrant Status, 1986 and 1991", Health Reports, 18(3): 29-37. Gastaldo, D., de Lima, J., Chakir, F., Vissandjée, B. (1998). Immigrant Women, Reproductive and Sexual Health and Religion: How Muslim Immigrant women perceive the quality of health care they receive in Quebec. Rapport final de recherche, Centre d’excellence pour la santé des femmes - Consortium Université de Montréal. Talbot, L. R., Soucy, O., Soave, L. (1998). Vers l’utilisation des services de réadaptation adaptés aux femmes/familles multi-ethniques dont une personne présente une déficience physique. Rapport final présenté au Centre d’excellence pour la santé des femmes - Consortium Université de Montréal. Vissandjée, B., & Dallaire, M. (1998). Adéquation des services Info-Santé CLSC aux besoins des femmes immigrantes. Résumé du projet d’étude. Vissandjée, B., Mayatela, R.M., Mulay, S., Siddiqui, S., Gravel, S., Renaud, J., Dupere, S. (1999). Les comportements de santé des mmigrantes sud-asiatiques, le temps de séjour fait-il une différence? Centre d’excellence pour la santé des femmes - Consortium Université de Montréal. Weinfeld, M., Kirmayer, L., Lam, C., Vissanjée, B. (1998). Barriers to Care and Issues of Ethnic/Gender Match. Final report submitted to Centre d’excellence pour la santé des femmes - Consortium Université de Montréal. |
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