Our paper aimed to provide an overview of the main SRH issues and concerns affecting migrant Venezuelan women in Roraima, Brazil, with results showing that the main issues reported by these migrant women concerned unmet family planning needs and healthcare during pregnancy and following childbirth. Access to good quality SRH services is a basic human right and has the potential to save lives; nevertheless, these findings show that the provision of adequate SRH services to this population of migrant Venezuelan women is lacking. This was particularly true with respect to meeting family planning needs (use of and access to contraception), ability to use the required SRH services and access to ANC and postnatal care. Furthermore, the women’s ability to access healthcare and receive help to resolve these issues was very limited. Bearing in mind that most of the women interviewed in this study were actually residing in UN shelters, this finding suggests that such needs may be considerably greater among migrant women living in informal settlements.
Most of these migrant women were young, had migrated with a partner and children, and had more than nine years of formal education. Although 50% reported having had a formal job before migration, almost all reported that they were currently unemployed in Brazil. This is despite the fact that the women interviewed reported that their main reasons for immigrating to Brazil were lack of opportunities and the prevailing health problems in Venezuela. Migrants cannot be legally employed in Brazil unless they have documentation proving that they are legal residents in the country. Furthermore, they need documentation before they can move to another state with a larger population where the possibilities of obtaining formal employment are greater.
Regarding unmet family planning needs, access to LARC methods was particularly poor and this was a major concern of many women in this study. Women stated that their inability to access LARCs prevents their family planning needs from being met and increases the likelihood of an unplanned pregnancy, which continues to pose an important challenge for them given the reality of their daily life. However, the SRH situation for migrant women is similar to that of many Brazilian women. In Brazil, the prevalence of LARC use is only 1.9% in women of reproductive age29. This has often been directly associated with the high prevalence of unplanned pregnancy in the country30. Although the copper IUD is generally available at all Brazilian public healthcare facilities, the prevalence of its use is low, while, implants and the hormonal intrauterine system are only available in a few public healthcare facilities.
In line with these findings, it is equally important to emphasize that these SRH issues faced by migrant Venezuelan women are an improvement on the situation of migrant Venezuelan women in Colombia, where they have to pay for medical care31. The free provision of SRH care to migrant women, including the provision of ANC, intrapartum and postnatal care, vaccinations and contraceptives by the SUS, is an important action to protect women and infants, and is considered an ethical one. In addition, the cost to donors/governments of providing feminine hygiene products is significant and other possibilities such as the provision of menstrual cups should be considered in an attempt to reduce this cost. Conversely, in the United Kingdom, the decision by the National Health Service establishing that migrants and those not ordinarily resident in the country should have to pay for ANC, intrapartum and postnatal care has been considered a violation of bodily autonomy and a health risk to women and neonates32.
According to the Brazilian constitution, all citizens have the right to free healthcare within the SUS. Venezuelan migrants in Brazil enjoy similar health rights and full access without charge to the public healthcare system33. Yet, it is an important point that in Roraima, the state in which the largest number of these women is concentrated, the migrant population uses the same publicly funded programmes as the general population, and these programmes 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 state healthcare systems have failed to adequately prepare for the large numbers of migrants received; consequently, healthcare resources at health facility level are crippled because of the inadequate distribution of healthcare providers and resources to meet this increased demand. For example, the number of Venezuelan migrant women giving birth at the Boa Vista public maternity hospital increased from 288 in 2016 to 2,875 in 2019, representing 3.4% and 26.1%, respectively, of all the deliveries in the city for the same years27,28. This limited capacity of the healthcare system poses important risks for all women including migrants.
Access to the healthcare system is also associated with satisfaction. When evaluating the overall satisfaction of women with the SRH services provided, these migrant women reported that they were either satisfied or partially satisfied with the care they received at the healthcare facilities, particularly in relation to the ANC, intrapartum or postpartum care received. This finding is not surprising, as it is a longstanding tradition in Brazil to provide adequate care to pregnant women and children. The close proximity of the UN shelters to the primary healthcare units could also have helped increase satisfaction with prenatal care.
The phenomenon of this migration from Venezuela to other Latin American countries poses important SRH challenges in addition to the burden of communicable diseases36. Ensuring access to the MISP and principally to the essential SRH services within the MISP, as indicated above, as part of the SARS-CoV-2 response could present a unique opportunity in this population of migrant women. Indeed, provision of these much needed services could also help contain the spread of the pandemic in this migrant population37,38.
In summary and in line with these results, to be able to respond more responsibly to the SRH challenges identified here these findings need to be shared to make the relevant authorities aware of the health priorities of these migrant women and to address the potential barriers associated with access to care in order to fortify SRH services. This should be conducted in parallel with appropriate sensitisation and mobilisation of all multilateral organisations, policy makers and stakeholders to save time and resources and avoid the risks of stigmatisation that could further prevent migrants from obtaining timely access and coverage for necessary healthcare, including SRH. There are still important gaps to be filled in guaranteeing girls’ and women’s rights, with migrant women in particular being the most vulnerable group.
Strengths and limitations
The strengths of our study include the fact that it is the first to provide an overview of the status of SRHR issues and concerns among migrant Venezuelan women of 18 to 49 years of age in Brazil, including the availability and delivery of services, barriers to service uptake and related challenges in Brazil. The adequate sample size and selection permit generalisability of these findings to the larger population of migrant Venezuelan women in Brazil. The unwillingness of the women to disclose sensitive information related to SRH practices, service utilisation and health facility records constitutes a limitation of the study.