In this paper, we focus on providing an overview of the main SRH issues impacting Venezuelan migrant women in Roraima State, Brazil. Access to good quality SRH services is basic human rights and has the potential to save lives. Our findings show that the provision of adequate SRH services to the Venezuelan migrant women population is limited. This was particularly true as it pertains to meet family planning needs (in terms of both use and access to), ability to use the needed SRH services as well as access to antenatal and postnatal care. Most of these migrant women were young, migrated with a partner and children and had more than nine years of education. Although, almost 50% reported to have had a formal job before migration; almost all these interviewed women reported that they are currently in Brazil are unemployed. This is in spite of the fact that the interviewed women reported their main reasons for migration to Brazil was because of the lack of opportunities and the prevailing health problems in Venezuela.
Also, their ability to access to health care to help resolve these issues was very limited, keeping in mind that the majority of the interviewed women in this study were actually residing in the UN shelters. This finding suggested that such needs are expected to be more severely exacerbated among the migrant women living in informal settlements.
Access to long acting reversible contraception (LARCs) was particularly lacking and this was of a major concern to many women in this research. Women indicated that their inability to access LARCs prevents them from meeting their family planning needs and increases their chances of unplanned pregnancies, which continues to pose an important challenge for them given their daily life realities.
In line with these findings, it equally essential to highlight that these prevailing SRH issues among the Venezuelan migrant women are better than the situation of Venezuelan migrant women in Colombia, country in which they have to pay to receive medical attention26. However, the SRH situation for migrant women is similar to those clustered in Brazil among the national population. For example, in Brazil the prevalence of LARC use is only 1.9% among women of reproductive age27. This is has been directly and often associated with the high prevalence of unplanned pregnancy in the country27. Although, copper-IUD is commonly available at all Brazilian public healthcare facilities, the prevalence of it use is low, while, implants and the hormonal IUD are only available in few institutions in the public health care facilities.
According to the Brazilian Constitution, all citizens have the right of free access to health at the National Health Service (SUS, Sistema Unificado de Saúde). Venezuelan migrants in Brazil enjoy these similar health rights and full access for free to the public health system28. Yet, it is important to highlight that the Roraima state, where these women migrants concentrate, the migrant population are using the same publicly funded programmes and these programs are facing severe shortages of healthcare providers, materials, medicines, contraceptives, tests and equipment. These shortages are directly attributed to the fact that both the municipal and the state health systems did not adequately prepare for the large numbers of received migrants, and thus health system resources at the level of health facilities are crippled because of the inadequate distribution of health care providers and health system to resources to meet these increased numbers. Only as an example the number of deliveries from Venezuelan migrants at the public Maternity hospital at Boa Vista were 288, 572, 1629 and 2875 for the years 2016, 2017, 2018 and 2019, respectively representing 3.4%; 6.6%; 16.4% and 26.1% of the total deliveries in the city29,30. This limited capacity of the health system poses important risks for all women including the migrants.
When we assessing the overall satisfaction of women with the SRH services provided, migrant women; however, reported that they were either satisfied or partially satisfied with the attention they received at the health facilities only when it comes to antenatal care. This finding is not surprising, as it is a long standing tradition in the country to provide adequate attention to pregnant women and children. The close proximity from the UN shelters to the basic health posts could also be attributed these observed satisfaction rates with antenatal care.
We also to date will not be able to estimate the impacts of the Covid-19 pandemic on the most vulnerable populations, like the migrants from Venezuela. These migrants are living in severe crowded conditions, in which maintaining physical distancing is almost impossible due to the characteristics of the shelters which included tends with almost 10 persons each one and one common area to offer meals with tables and chairs without the recommended physical distance. Official report on June 9, 2020 from the Brazilian Army indicated that 96 of their members who were based at the UN shelters tested positive for coronavirus, as well as 82 Venezuelan migrants including 7 deaths31–33.
At this time, access to SRH services and use of these services is expected to also become compromised among this migrant population34. These issues are already impacting the Venezuelan migrant population in the Roraima state, as per our study results. With that being said, it is crucial to emphasize that the maintenance of the essential SRH services among these women migrant population in these difficult times of Covid-19 is pivotal to respond to the pressing SRH needs of these migrant women35.
Our study presents strengths like to be the first to provide an overview of the status of SRHR issues and concerns among Venezuelan migrant women (aged 18–49 years) in Brazil, including availability and delivery of services, barriers to service uptake and related challenges in Brazil. The sampling size and sample selection allowed for adequate generalisability of these findings to the larger Venezuelan migrant women in Brazil. On the other hand, one limitation is the unwillingness to disclose sensitive information related to SRH practices, service utilisation and health facility records by women.
The phenomenon of the migrant population from Venezuela to other Latin American countries poses important SRH challenges and the burden of communicable diseases36. Ensuring access to the MISP and more so the essential SRH services with in the MISP indicated above, during Covid-19 response, could present a unique opportunity among this women migrant population, as it will allow for testing of symptomatic migrant women and simultaneously effective contract tracing. Thus, the provision of these needed services could also assist in controlling the spread of this epidemic in this migrant population37,38.
In summary and congruent with the results here in, to be able to respond more responsibly to the identified SRH challenges here in, we need to identify essential health priorities for these migrant’s women and address the potential associated barriers. This should be paralleled with adequate sensitisation and mobilisation of all multilateral organisations, policy makers and stakeholders to save time and resources and to avoid the risks of stigmatisation that could further prevent migrants from timely access and coverage to the needed health care including that of SRH. There are still important gaps to the realisation of girls’ and women’s rights, and migrant women are particularly among the most vulnerable group.