Desigualdades en acceso a salud sexual y reproductiva de migrantes y refugiadas en contextos humanitários
DOI:
https://doi.org/10.62827/eb.v24i3.4067Palabras clave:
Refugiados; Enfermedades de Transmisión Sexual; Salud Reproductiva; Mujeres; Salud Sexual.Resumen
Introducción: Las mujeres migrantes y refugiadas enfrentan barreras multiescalares políticas, organizativas y socioculturales que comprometen el acceso a la salud sexual y reproductiva (SSR) en crisis humanitarias. Objetivo: Se analizaron las condiciones de SSR de las mujeres refugiadas en escenarios de crisis humanitarias. Métodos: Se llevó a cabo una revisión de alcance según el Joanna Briggs Institute (JBI) y el protocolo PRISMA-ScR para revisiones de alcance. El mnemónico PCC (Población/Concepto/Contexto) orientó las búsquedas en Literatura Científica de América Latina y el Caribe (LILACS), Literatura Internacional en Ciencias de la Salud (Medline/PubMed), CINAHL y Scopus (Elsevier), realizadas entre febrero y abril de 2025 sin límite temporal. Se incluyeron estudios desarrollados en África, América, Europa, Oriente Medio y Asia. Veinticuatro artículos cumplieron los criterios de elegibilidad: 10 estudios cuantitativos observacionales, 6 ensayos controlados, 5 estudios cualitativos y 3 de métodos mixtos. Resultados: Se identificaron barreras macro (subfinanciamiento, cobertura de seguridad restringida), meso (sobrecarga de servicios, ausencia de intérpretes, interrupciones pandémicas) y micro (estigma, trauma, vigilancia de la pareja). Estrategias de bajo costo —autoprueba de Virus de la Inmunodeficiencia Humana (VIH) mediante aplicaciones de salud móvil (mHealth), vales obstétricos, autoayuda guiada mostraron eficacia puntual, condicionada a la confidencialidad y a la mediación cultural. Persisten lagunas críticas en higiene menstrual, violencia de género asociada a eventos climáticos y análisis de costo-efectividad. Conclusión: La equidad en SSR exige ecosistemas multiescalares que articulen financiamiento anticíclico, servicios culturalmente mediadores y tecnologías seguras, con participación activa de las propias refugiadas.
Referencias
United Nations High Commissioner for Refugees. Global trends report 2025: forced displacement in 2024-2025 [Internet]. Geneva: UNHCR; 2025 [cited 2025 Feb 23]. Available from: https://www.unhcr.org/global-trends
United Nations, Department of Economic and Social Affairs. The Sustainable Development Goals report 2024 [Internet]. New York: United Nations; 2024 [cited 2025 Feb 23]. Available from: https://unstats.un.org/sdgs/report/2024/
World Health Organization. Maternal mortality: fact sheet [Internet]. Geneva: WHO; 2025 [cited 2025 Feb 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
United Nations Population Fund. Humanitarian action overview 2025 [Internet]. New York: UNFPA; 2024 [cited 2025 Feb 23]. Available from: https://www.unfpa.org/humanitarian-overview
Mengesha Z, Peters D, Bowden M, et al. Barriers to sexual and reproductive health care for African migrant women in high-income countries: a systematic review. Reprod Health. 2023;20:120.
Harerimana A, Mchunu G, Pillay JD. Menstrual hygiene management among girls and women refugees in Africa: a scoping review. Confl Health. 2025;19(1):20. doi:10.1186/s13031-025-00657-1
Muhaidat N, Karmi JA, Karam AM, et al. Period poverty, reuse needs, and depressive symptoms among refugee menstruators in Jordan’s camps: a cross-sectional study. BMC Womens Health. 2024;24:384. doi:10.1186/s12905-024-03193-x
Martins R. 30 anos da CIPD 1994: saúde, direitos sexuais e direitos (pós) reprodutivos na constituição da agenda de população e desenvolvimento. Rev Bras Estud Popul. 2024;41:e0284. doi:10.20947/S0102-3098a0284
Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. Supporting document for the Joanna Briggs Institute levels of evidence and grades of recommendation [Internet]. Adelaide: Joanna Briggs Institute; 2024 [cited 2025 Feb 23]. Available from: https://jbi.global/sites/default/files/2024-05/JBI-Levels-of-Evidence_2024.pdf
Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473.
Kunnuji M, Kanaahe B, Roth C, Bukoye F, Atukunda D, Alayande S, et al. Transactional sex in humanitarian settings: livelihood and demographic predictors. Afr J Reprod Health. 2024;28(Suppl 8):62–73. doi:10.29063/ajrh2024/v28i8s.7
Vilca LM, Sarno L, Passoni D, Antonazzo P, Pellegrini E, Guida M, et al. Impact of the COVID-19 pandemic on prenatal-care utilization among Italian and immigrant women: multicenter survey. Int J Public Health. 2024;69:1606289. doi:10.3389/ijph.2024.1606289
Logie CH, Loutet MG, Okumu M, MacKenzie F, Coelho M, Lukone SO, et al. Todurujo na Kadurok HIV self-testing and edutainment comic RCT with refugee youth in Uganda. J Int Assoc Provid AIDS Care. 2024;23:23259582241307057. doi:10.1177/23259582241307057
Logie CH, Okumu M, Berry I, Hakiza R, Baral SD, Musoke DK, et al. Findings from the Tushirikiane mHealth HIV self-testing pragmatic trial with refugee adolescents and youth in Kampala, Uganda. J Int AIDS Soc. 2023;26(10):e26185. doi:10.1002/jia2.26185
Okumu M, Logie CH, Ansong D, Mwima S, Hakiza R, Newman PA. Texting-based condom negotiation scale validation with forcibly displaced adolescents in Kampala. JMIR Public Health Surveill. 2022;8(4):e27792. Doi:10.2196/27792
Zhang M, Gurung A, Anglewicz P, Yun K. COVID-19 and immigrant essential workers: Bhutanese and Burmese refugees in the United States. Public Health Rep. 2021;136(1):117–123. doi:10.1177/0033354920971720
Scott HM, Wallis N. Maternity care for refugees living in Greek refugee camps: what are the challenges to provision? Birth. 2021;48(1):114–121. doi:10.1111/birt.12522
Sabri B, Vroegindewey A, Hagos M. Internet- and mobile-phone-based BSHAPE intervention for immigrant trauma survivors: development and preliminary evaluation. Contemp Clin Trials. 2021;110:106591. doi:10.1016/j.cct.2021.106591
Boakye E, Kwapong YA, Obisesan O, Ogunwole SM, Hays AG, Nasir K, et al. Nativity-related disparities in preeclampsia and cardiovascular disease risk among US women. JAMA Netw Open. 2021;4(12):e2139564. doi:10.1001/jamanetworkopen.2021.39564
Jones N, Pincock K, Baird S, Yadete W, Hamory Hicks J, et al. Intersecting inequalities, gender and adolescent health in Ethiopia. Int J Equity Health. 2020;19:97. doi:10.1186/s12939-020-01214-3
Xu SF, Wu JQ, Yu CN, Li YY, Zhao R, Li YR, Zhou Y. Comprehensive SRH/family-planning intervention among domestic migrants in China: a randomized community study. Int J Environ Res Public Health. 2020;17(6):2093. doi:10.3390/ijerph17062094
Tol WA, Leku MR, Lakin DP, Carswell K, Augustinavicius J, Adaku A, et al. Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: cluster randomised trial. Lancet Glob Health. 2020;8(2):e254–e263. doi:10.1016/S2214-109X(19)30504-2
Rade DA, Crawford G, Lobo R, Gray C, Brown G. Sexual health help-seeking behavior among migrants from sub-Saharan Africa and South-East Asia living in high-income countries: a systematic review. Int J Environ Res Public Health. 2018;15(7):1311. doi:10.3390/ijerph15071311
Cianelli R, Villegas N, McCabe BE, de Tantillo L, Peragallo N. Self-efficacy for HIV prevention among refugee Hispanic women in South Florida. J Immigr Minor Health. 2017;19(4):905–912. doi:10.1007/s10903-016-0462-7
Tsai HJ, Surkan PJ, Yu SM, Caruso D, Hong X, Bartell TR, et al. Stress, African ancestry and preterm birth among US-born versus immigrant Black mothers. Medicine (Baltimore). 2017;96(5):e5899. doi:10.1097/MD.0000000000005899
Sami S, Kerber K, Kenyi S, Amsalu R, Tomczyk B, Jackson D, et al. State of newborn care in South Sudan displacement camps: facility-based deliveries. Reprod Health. 2017;14(1):161. doi:10.1186/s12978-017-0417-z
Caballero TM, Johnson SB, Muñoz Buchanan CR, DeCamp LR. Adverse childhood experiences among Hispanic children in immigrant versus US-native families. Pediatrics. 2017;140(5):e20170297. doi:10.1542/peds.2017-0297
Patel P, Dahab M, Tanabe M, Murphy A, Ettema L, Guy S, et al. Tracking official development assistance for reproductive health in conflict-affected countries: 2002-2011. BJOG. 2016;123(10):1693–1704. doi:10.1111/1471-0528.13851
Bouchghoul H, Hornez E, Duval-Arnould X, Philippe HJ, Nizard J. Humanitarian obstetric care for Syrian war refugees: first six months in Zaatari Camp. Acta Obstet Gynecol Scand. 2015;94(7):755–759. doi:10.1111/aogs.12638
Tilley DM, Griggs E, Hoy J, Wright ST, Woolley I, Burke M, O’Connor CC; Australian HIV Observational Database. Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort. AIDS Care. 2015;27(11):1410–1417. doi:10.1080/09540121.2015.1113227
Kim SY, Sappenfield W, Sharma AJ, Wilson HG, Bish CL, Salihu HM, et al. Nativity and gestational diabetes in Florida, 2004-2007. Obesity (Silver Spring). 2013;21(1):E33–E40. doi:10.1002/oby.20025
Hynes M, Robertson K, Ward J, Crouse C. Prevalence of gender-based violence among conflict-affected populations in East Timor. Disasters. 2004;28(3):294–321. doi:10.1111/j.0361-3666.2004.00260.x
Piran P. Effects of social interaction between Afghan refugees and Iranians on reproductive health attitudes. Disasters. 2004;28(3):283–293. doi:10.1111/j.0361-3666.2004.00259.x
Ahmed A, Edward A, Burnham G. Health indicators for mothers and children in rural Herat Province, Afghanistan. Prehosp Disaster Med. 2004;19(3):221–225. doi:10.1017/S1049023X0000181
Barbosa LR. Educational intervention and the promotion of humanized practices in perinatal bereavement. Psicodebate. 2025;11(1):859-873. doi:10.22289/2446-922X.v11n1a4
Barbosa LR. Integration of technology and literature in humanistic education in health: effects of texts on the humanization of care. Arecê. 2024;6(3):5614-2. doi:10.56238/arev6n3-08
Centers for Disease Control and Prevention. Community Assessment for Public Health Emergency Response (CASPER) toolkit: third edition [Internet]. Atlanta (GA): CDC; 2019 [cited 2025 Feb 23]. Available from: https://www.cdc.gov/nceh/casper/pdf/casper-toolkit-3rd-edition-508.pdf
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Derechos de autor 2025 Luciene Rodrigues Barbosa (Autor)
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