African immigrant women and refugee women face disproportionate reproductive health risks and adverse outcomes compared with the Canadian population. The diversity of African women and complexity of the migration process suggest the need for contextualized knowledge to better understand these challenges. I sought such knowledge through the use of the theoretical frameworks of place and intersectionality. These frameworks draw attention to the multi-level mixture of social relations in given contexts and how they create opportunities and oppression. The specific purpose of this research was to: a) explore how the reproductive health experiences of African immigrant and refugee women were shaped by the unique context of given places; b) consider how these women actively negotiated and constructed place in their search for reproductive health information, services, and support. A multiple case study was used to explore the reproductive health experiences of African immigrant and refugee women in three different areas of Ottawa, Ontario. These areas provided different local contexts (e.g., history, socioeconomic profile, proximity to downtown). In each area, data was collected through interviews with African immigrant and refugee women, interviews and focus groups with reproductive health service providers, and mapping of available services. In total, 19 immigrant and refugee women and 23 service providers participated in this study. The findings showed that African immigrant and refugee women’s reproductive health experiences were much more complicated than simple interaction with neighbourhood services. Their varied social positions in Canadian society were highly relevant. In addition, social networks based in places outside of the system (e.g., private homes, religious institutions) were environments in which they were comfortable and sought support for their reproductive health needs. Recommendations based on these findings include the need to engage communities and explore the delivery of information and services outside of the traditional places employed by the Canadian health care system.

Background: Historically, most refugees have originated from countries with high rates of infectious diseases. However, non-communicable diseases are becoming increasingly more common in refugee populations resettling in the United States. Purpose: Examine the prevalence of selected chronic conditions among newly arriving adult Cuban refugees and compare the results to the prevalence of the same chronic conditions among the other top five incoming refugee populations: Burmese, Bhutanese, Iranians, Iraqis, and Somalis Methods: Data used in this study were derived from the Department of State’s Medical History and Physical Examination Worksheet and included all adult (≥20 years) Cuban, Burmese, Bhutanese, Iranian, Iraqi, and Somali refugees identified through the Center’s for Disease Control and Prevention Electronic Disease Notification Center, and who entered the United States during October 2008-September 2011. Data were analyzed using SPSS version 19.0. Descriptive statistics, chi-square analysis, and logistic regressions were performed to assess the prevalence of chronic conditions, check for associations between country of origin and outcome of interest, and to estimate the relative risk for Cubans compared to the remaining top five incoming refugee populations. Results: A total of 99,920 adults were included in the study. The largest population was Iraqi (27.6%), followed by Bhutanese (26.2%), Burmese (24.4%), Iranian (8.6%), Cuban (7.9%), and Somali (5.3%). All outcomes of interest were significantly associated with country of origin. Cubans were at a greater risk for asthma but were not the greatest at-risk population for the remaining outcomes of interest. Conclusion: The prevalence of non-communicable diseases was higher among the incoming refuges than has been traditionally assumed. These findings point to the need for a better understanding of the health status of refugee populations and the development of culturally appropriate health programs that include education on prevention and treatment of chronic conditions.

Background: Refugees and refugee claimants experience health needs upon arrival in Canada. Retrenchments to the Interim Federal Health program (IFHP) in 2012 greatly reduced healthcare access for refugee claimants, generating concerns among healthcare providers and other stakeholders affected by the reforms. In 2014 a new IFH program temporarily reinstated access to some health services however, little is known about the reforms and more information is needed to map its impact on key stakeholders. This study aims to examine the perception of key stakeholders regarding the impact of the 2014 reforms on the policy’s intermediary goals: access and provision of healthcare. Methodology: Data was collected using semi-structured key informant interviews with refugee health policy stakeholders (n=23), refugees and refugee claimants (n=6), policy makers and government officials (n=5), civil society organizations (n=6) and professionals and practitioners (n=6). Data was analysed using a constant comparative approach with NVivo 10 (QSR International). A stakeholder analysis was used to map out key stakeholder perceptions, interests and influences in refugee health policy and a content analysis was further employed to abstract themes associated with barriers and facilitators to access and provision of healthcare in the current situation. Results: The findings provide information for management of stakeholder engagement revealing the perceptions of key stakeholders on the 2014 reforms: eight were opposed to the reforms, eight held mixed positions, four supported the reforms and one did not comment. Five facilitators to accessing healthcare were identified. Eighteen themes emerged under four health care access and provision barrier categories: cognitive, socio-political, structural and financial. There were four common themes perceived among all stakeholder groups: lack of communication and awareness of refugee and provider, lack of care provider training leading to unfamiliarity with IFHP, lack of continuity and comprehensive care and the political discourse leading to refugee and claimant social exclusion. Other common barrier themes included healthcare affordability for refugees and the healthcare system, fear of the healthcare system, and interaction with the Ontario Temporary Health Program. Conclusion: The study highlights that reforms to the IFHP in 2014 have transferred refugee health responsibility to provincial authorities and healthcare institutions resulting in bureaucratic strains, inefficiencies, overburdened administration and increased health outcome disparities as refugees and claimants choose to delay seeking healthcare due to existing barriers. There are some benefits to the reforms, but the lack of support and mixed opinions among the majority of stakeholders emphasize the need for reformulation of policy with stakeholder engagement. This study recommends future refugee health reform strategies incorporate stakeholder leadership, cooperation and perspectives, as revealed in this research, to successfully move healthcare policy from theory to practice. / Thesis / Master of Science (MSc)

Sexual violence is a prominent issue worldwide, especially during times of war and conflict. For refugee women, experiences with sexual violence are often incorporated in women’s reasons for forced migration. During the immigration process to Canada, refugee women are asked to share their narratives, at which point they may or may not disclose their histories of sexual violence. In June 2012, the Canadian government made substantial cuts to the Interim Federal Health Program. For refugee women who are survivors of sexual violence, this means that they are further limited in accessing services they might require in order to deal with the sexual violence they have experienced. Drawing from interviews we conducted with key informants (n=15) and refugee women (n=12) in both Toronto and Ottawa, this thesis explores both the lived experiences of refugee women and the changes, if any, that should be made to current service delivery. Our results show that there is a pronounced need for both small- and large-scale improvements at the systems and service delivery levels.

No description available.

Background: War disproportionately affects women and children, and gender based violence (GBV) has become an increasingly common means of fighting wars and targeting civilians. Such is the case in the Democratic Republic of Congo (DRC), particularly in the eastern provinces, where among the multitude of human rights violations, sexual violence and abuses against women and girls are committed on a large scale. Documented efforts addressing GBV in refugee communities have mainly focused on medical, programmatic, and legal responses; few studies explore the prevalence of GBV among conflict-affected populations. Objective: To determine the prevalence and correlates of outsider violence during and after conflict, and lifetime and past year intimate partner violence (IPV). To determine differences in the proportions of violence victimizations, including the differences in the proportions of outsider violence during and after conflict, and the differences in the proportions of lifetime and past year IPV. To describe patterns of reporting and healthcare seeking related to violence victimization. Methods: Cross sectional data were obtained from a sample of 810 women of reproductive age (WRA) living in two Rwandese refugee camps. GBV was defined as physical violence, sexual violence, or controlling behavior that is committed by intimate partners (IPV) or persons outside the family (outsider violence). Univariate analysis was used to describe the study population as a whole. The chi-square test for independence was used to measure significant differences between women who had identified experiencing GBV and those who did not. A z-test was conducted to explore differences in the proportions of outsider violence during and after conflict, and lifetime and past year IPV. Bivariate and multivariate logistic regression analyses were conducted to assess the unadjusted and adjusted associations between GBV and select variables of interest during and after conflict. Statistical analyses were conducted using SPSS version 14.0 Results: 434 WRA experienced GBV; of which 399 reported experiencing outsider violence before and after conflict, and 130 reported experiencing IPV. The logistical model indicated that there was a consistently significant association between a period of one to five years spent in a refugee camp and outsider violence during conflict (Adj.OR= 0.16; 95%CI:0.10-0.27; P <0.0001), lifetime IPV (Adj.OR=0.17;95%CI:0.10-0.32, p<0.0001), and IPV in the last year (Adj.OR= 0.15;95%CI:0.08-0.28, p<0.0001). Discussion: The results of this study illustrate the importance of assessing the impact of conflict on GBV among refugee and displaced populations. The high prevalence of GBV among this study population, with a prevalence of 53.3% for all forms of violence, is evidence of the great burden GBV poses on this population. Ongoing violence generated by conflict is a major public health concern that urgently requires effective interventions. For example, legal, health, and psycho-social services should be well integrated to adequately screen and address the needs of violence survivors.

This thesis examines the meanings of naturopathy through the experiences of twelve women with refugee backgrounds involved in naturopathic treatment at the Victorian Foundation for Survivors of Torture (Foundation House), a refugee torture and trauma rehabilitation service in Melbourne, Australia. The findings of this research show that the naturopathic encounter provided a transformative and meaningful meeting place for healing, a place in which the women felt at ease and in place.At Foundation House naturopathy has been practised alongside counselling since 1989, two years after the organisation’s inception. The women I interviewed for this project came from diverse sociocultural backgrounds and a wide range of countries including Iraq, Iran, Yemen, Afghanistan, Somalia, Burma and Serbia.The thesis brings together two contemporary fields of practice: Western models of refugee health care and traditional medicine. It argues for the place of non-biomedical approaches in refugee health care in a Western setting. The thesis takes an interdisciplinary approach to theorise the naturopathic encounter. The distinction between holistic and reductionist perspectives on health, illness and the body is underpinned by the theoretical work of medical anthropologists Nancy Scheper-Hughes and Margaret Lock and that of medical sociologist Aaron Antonovsky. A cultural studies perspective, influenced by the work of embodiment scholar Elspeth Probyn is employed to theorise these women’s experiences of the naturopathic encounter.This qualitative study is based on in-depth interviews and draws on grounded theory as an approach to data analysis. Descriptions of respite, renewal, and healing in the naturopathic encounter are cited as the most observable themes emerging from the women’s stories. These themes represent a health-oriented, as opposed to a disease-focused, perspective. Importantly, a health-orientated approach is congruent with the core tenets of naturopathic philosophy. Listening to the body is a crucial therapeutic tool in the naturopathic encounter, where primacy is given to supporting and strengthening health-creating strategies. I argue that this orientation disrupts the existing dominant biomedical approach to refugee health care. I draw on the work of Probyn to theorise the movement from the naturopathic encounter (NE) to the naturopathic meeting place (NMP). Central to this transposition is Probyn’s articulation of the body’s awareness of being in and out of place. This awareness lends itself to an understanding of the connectedness between past and present in the bridge-making that these particular refugee women have engaged in across cultures in the NMP.The thesis addresses an important but often neglected focus in refugee research: the resilience and agency of refugees. This positive aspect of refugee recovery is revealed in the research by theorising the women’s stories through Probyn’s embodiment analysis and cognisance of the ‘everyday’ as a productive and creative process. The research interrupts the ubiquitous image of the ‘disempowered refugee victim’. It highlights the practical wisdom and agency of these particular women that is often overshadowed in the complex resettlement process. It makes a call for further health-orientated research to broaden and deepen our understanding of the refugee experience.

This thesis examines the meanings of naturopathy through the experiences of twelve women with refugee backgrounds involved in naturopathic treatment at the Victorian Foundation for Survivors of Torture (Foundation House), a refugee torture and trauma rehabilitation service in Melbourne, Australia. The findings of this research show that the naturopathic encounter provided a transformative and meaningful meeting place for healing, a place in which the women felt at ease and in place.At Foundation House naturopathy has been practised alongside counselling since 1989, two years after the organisation’s inception. The women I interviewed for this project came from diverse sociocultural backgrounds and a wide range of countries including Iraq, Iran, Yemen, Afghanistan, Somalia, Burma and Serbia.The thesis brings together two contemporary fields of practice: Western models of refugee health care and traditional medicine. It argues for the place of non-biomedical approaches in refugee health care in a Western setting. The thesis takes an interdisciplinary approach to theorise the naturopathic encounter. The distinction between holistic and reductionist perspectives on health, illness and the body is underpinned by the theoretical work of medical anthropologists Nancy Scheper-Hughes and Margaret Lock and that of medical sociologist Aaron Antonovsky. A cultural studies perspective, influenced by the work of embodiment scholar Elspeth Probyn is employed to theorise these women’s experiences of the naturopathic encounter.This qualitative study is based on in-depth interviews and draws on grounded theory as an approach to data analysis. Descriptions of respite, renewal, and healing in the naturopathic encounter are cited as the most observable themes emerging from the women’s stories. These themes represent a health-oriented, as opposed to a disease-focused, perspective. Importantly, a health-orientated approach is congruent with the core tenets of naturopathic philosophy. Listening to the body is a crucial therapeutic tool in the naturopathic encounter, where primacy is given to supporting and strengthening health-creating strategies. I argue that this orientation disrupts the existing dominant biomedical approach to refugee health care. I draw on the work of Probyn to theorise the movement from the naturopathic encounter (NE) to the naturopathic meeting place (NMP). Central to this transposition is Probyn’s articulation of the body’s awareness of being in and out of place. This awareness lends itself to an understanding of the connectedness between past and present in the bridge-making that these particular refugee women have engaged in across cultures in the NMP.The thesis addresses an important but often neglected focus in refugee research: the resilience and agency of refugees. This positive aspect of refugee recovery is revealed in the research by theorising the women’s stories through Probyn’s embodiment analysis and cognisance of the ‘everyday’ as a productive and creative process. The research interrupts the ubiquitous image of the ‘disempowered refugee victim’. It highlights the practical wisdom and agency of these particular women that is often overshadowed in the complex resettlement process. It makes a call for further health-orientated research to broaden and deepen our understanding of the refugee experience.

This thesis examines the meanings of naturopathy through the experiences of twelve women with refugee backgrounds involved in naturopathic treatment at the Victorian Foundation for Survivors of Torture (Foundation House), a refugee torture and trauma rehabilitation service in Melbourne, Australia. The findings of this research show that the naturopathic encounter provided a transformative and meaningful meeting place for healing, a place in which the women felt at ease and in place.At Foundation House naturopathy has been practised alongside counselling since 1989, two years after the organisation’s inception. The women I interviewed for this project came from diverse sociocultural backgrounds and a wide range of countries including Iraq, Iran, Yemen, Afghanistan, Somalia, Burma and Serbia.The thesis brings together two contemporary fields of practice: Western models of refugee health care and traditional medicine. It argues for the place of non-biomedical approaches in refugee health care in a Western setting. The thesis takes an interdisciplinary approach to theorise the naturopathic encounter. The distinction between holistic and reductionist perspectives on health, illness and the body is underpinned by the theoretical work of medical anthropologists Nancy Scheper-Hughes and Margaret Lock and that of medical sociologist Aaron Antonovsky. A cultural studies perspective, influenced by the work of embodiment scholar Elspeth Probyn is employed to theorise these women’s experiences of the naturopathic encounter.This qualitative study is based on in-depth interviews and draws on grounded theory as an approach to data analysis. Descriptions of respite, renewal, and healing in the naturopathic encounter are cited as the most observable themes emerging from the women’s stories. These themes represent a health-oriented, as opposed to a disease-focused, perspective. Importantly, a health-orientated approach is congruent with the core tenets of naturopathic philosophy. Listening to the body is a crucial therapeutic tool in the naturopathic encounter, where primacy is given to supporting and strengthening health-creating strategies. I argue that this orientation disrupts the existing dominant biomedical approach to refugee health care. I draw on the work of Probyn to theorise the movement from the naturopathic encounter (NE) to the naturopathic meeting place (NMP). Central to this transposition is Probyn’s articulation of the body’s awareness of being in and out of place. This awareness lends itself to an understanding of the connectedness between past and present in the bridge-making that these particular refugee women have engaged in across cultures in the NMP.The thesis addresses an important but often neglected focus in refugee research: the resilience and agency of refugees. This positive aspect of refugee recovery is revealed in the research by theorising the women’s stories through Probyn’s embodiment analysis and cognisance of the ‘everyday’ as a productive and creative process. The research interrupts the ubiquitous image of the ‘disempowered refugee victim’. It highlights the practical wisdom and agency of these particular women that is often overshadowed in the complex resettlement process. It makes a call for further health-orientated research to broaden and deepen our understanding of the refugee experience.

Health appears as a fundamental right on the Declaration of Human Rights of 1948 onarticle XXV. In humanitarian research, health is often viewed as a secondary theme anddid not have that much relevance. This has changed recently and nowadays health isconsidered an important factor. Social determinants of health are social factors, such ashousing, nutrition, and sanitation, that have a deep influence on one’s health. Thosedeterminants are particular to each individual and the conditions in which it lives and canbe modified by one’s migratory journey. In fact, migration in itself can be seen as a socialdeterminant of health, once the implications of the journey directly affect their health.Health inequity and the disparities caused by it are direct consequences of the socialdeterminants of health.This thesis analyses productions on refugee health in relation to the barriers existent inboth accessing and providing healthcare services to pregnant and postpartum women inGreece. The discussion chapter analyses the data found, discusses social determinants ofhealth, the resulting health disparities, and arguments through an intersectionality lens.The result chapter discusses the most important factors, suggests actions to overcome thebarriers and discusses the responsibility of the global society regarding inequalities.