Opportunities, needs and barriers to preconception health and access to preferred contraception: a qualitative study of underserved migrant women

Objective Our objective was to explore opportunities, needs and barriers to contraception and preconception health among underserved migrant women. Design Qualitative study. Setting West Midlands, England. Sample Thirty-eight migrant women (asylum seekers, refugees and those with no recourse to public funds) from a diverse range of countries aged 18-49 years living in England. Methods Twenty interviews and two focus groups were undertaken within community organisations. Those in non-English languages (Kurdish Sorani, Dari, Farsi, Arabic, Turkish and Punjabi) were undertaken an interpreter, or by community researchers in their own language. Data were analysed thematically. Results Women described traumatic life experiences and cultural pressures to have children, frequently of male sex. Awareness of preconception health and contraception varied. Most women preferred non-hormonal contraception. Many had never heard of sexual health clinics and most believed GPs were the only place to obtain contraception. Gender roles and expectations significantly influenced women's preconception health, pregnancy planning, and contraception decisions. Healthcare communication was limited by lack of interpreters, plus some women being unable to read or write. Conclusions Many barriers and opportunities to improving preconception health and contraceptive access were identified. More support is needed for accessing contraception and preconception care from primary care. Healthcare communication regarding preconception health and contraception is needed in relevant languages, and accessible to those who cannot read. Healthcare professionals need to be cognisant of women's previous trauma, including stillbirth, baby loss and non-consensual sex.