title: Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives' perspectives.
abstract: BACKGROUND
  There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion.
  
  
  OBJECTIVE
  The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area.
  
  
  METHODS
  A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ) of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives' perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes.
  
  
  RESULTS
  Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services.
  
  
  CONCLUSIONS
  Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy terminations, and the delay in the first prenatal visit, as discerned by midwives. Future research should involve samples of immigrant women themselves, to provide a deeper understanding of the current knowledge, attitudes, and practices of the immigrant population regarding reproductive and sexual health to provide better health services.
authors.affiliation: National School of Public Health, Institute of Health "Carlos III", Spain; GESEC, Lleida University, Lleida, Spain; laotero@isciii.es.
authors.forename: Laura
authors.initials: L
authors.lastname: Otero-Garcia
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gea-Sánchez
authors.forename: Belen
authors.initials: B
authors.lastname: Sanz-Barbero
mesh_terms: D001291:Attitude of Health Personnel; D003469:Culture; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008880:Midwifery / Q000706:statistics & numerical data*; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
keywords: gender; health services accessibility; immigrants; midwives; primary health care; qualitative research; rural population; sexual and reproductive health; utilization; women's health