Intercultural interpreters’ perspectives on the provision of sexual and reproductive healthcare to Eritrean and Somali forced immigrant women in Switzerland: a qualitative exploration

Abstract

Objectives

This study aimed to explore and synthesise interpreters’ perspectives on the provision of sexual and reproductive health (SRH) care to Eritrean and Somali migrant women in Switzerland, and to identify and analyse the professional and ethical challenges they encounter in this context.

Design

An exploratory qualitative study from a social constructionist perspective. The interviews were recorded, transcribed, categorised and analysed through thematic analysis.

Setting and participants

The study was conducted in the canton of Basel-Stadt, northwestern Switzerland. We have purposively selected 10 Eritrean and Somali intercultural interpreters serving as crucial intermediaries in assisting immigrant women to access SRH services.

Results

Our analysis of the interpreters’ perspectives revealed three key thematic areas that they identified as central challenges for their Eritrean and Somali immigrant women: (1) perceived limited health literacy among patients, (2) sociocultural barriers that interpreters observed hindering patient provider communication and (3) structural difficulties that interpreters reported their patients faced in navigating the Swiss healthcare system. These challenges have now persisted for a long time, and research findings and recommendations do not appear to have changed practices. For example, while abortion services are fully covered by Swiss health insurance, contraceptive methods often require out-of-pocket payments. This financial disparity may discourage appropriate use of SRH services among immigrant women. The lack of culturally competent care and the limited availability of funding for intercultural interpreters were among important bottlenecks identified.

Conclusions

This study explored interpreters’ perspectives on the provision of SRH care to Eritrean and Somali immigrant women in Switzerland. Despite the outstanding Swiss healthcare system, a majority of Eritrean and Somali refugee women struggle to benefit from SRH services due to limited health literacy, language barriers and challenges in navigating the Swiss healthcare system. Partnerships and integration of community entities, such as the Swisso-Kalmo association for Somali women and different Eritrean communities, could contribute via facilitating entry points for access to SRH healthcare.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The use of intercultural interpreters as key informants brought both direct experience and deep knowledge of the research topic.

• The exploratory and transdisciplinary nature of the study enabled a detailed, nuanced understanding of immigrant women’s sexual and reproductive health care experiences within their specific contexts.

• The transferability of findings to other contexts may be limited given the fact that the qualitative nature of the study and the focus on a specific setting.

• A key limitation of this study is the lack of exploration into the roles of male partners and immigrant women.

Introduction

At the end of 2024, the number of people fleeing because of persecution, conflict and violence surpassed 123.20 million.¹ A high number of immigrants arrived in Europe, making Europe the second largest immigrant-absorbing continent after Asia.^2–4 This massive surge in refugees and asylum seekers has become a critical public health burden overwhelming the health system.^{5 6} Switzerland follows Germany, France, Spain and Italy among leading European destinations for African refugees and immigrants.^{4 7} East African refugees and asylum seekers, particularly those from Eritrea and Somalia, are among the leading immigrants arriving in the country, according to the State Secretariat for Migrants.^8–10 For example, with over 40 000 people, Eritreans constitute the largest group of asylum seekers and refugees.^{3 9}

Forced migration jeopardises the health of people on the move. This massive surge in refugees poses extra challenges in providing sexual and reproductive health (SRH) care to immigrant women.^{5 6 11} These SRH care include contraceptive counselling, antenatal and postnatal care, sexually transmitted infections (STI) screening and support for issues such as Female Genital Mutulation or Cutting(FGM/C) and sexual violence. These services are particularly relevant for migrant women, who may face unique barriers related to language, culture and legal status. Immigrant women generally experience higher rates of induced abortions, secondary caesarean sections (C-section), instrument-assisted deliveries and pregnancy complications.^{5 11–13} Consequently, mortality and morbidity risks are high among female refugees.¹⁴ Immigrants are generally considered healthier than non-immigrants on their arrival, but their health deteriorates in postmigration phase.¹⁵ The observed health declines among new arrivals are associated with barriers to healthcare, including language barriers, transportation access, cost, knowledge of available services and cultural insensitivity of care.^{15 16}

Immigrant women from sub-Saharan Africa have unique SRH needs because of their immigration status, legal uncertainties and cultural factors, which often limit their access to care, conflicting with human rights principles.^{5 17} Unfamiliarity with the health system, language difficulties, cultural differences and financial obstacles further hinder healthcare access. Additionally, sexual violence and exploitation—which disproportionately affect women and girls—further complicate their ability to seek and receive SRH care.^{5 13 17–19} Migrant women are 1.4 times more likely to experience birth complications, 50% increase in abortion and 10% increase in miscarriage or stillbirth—often linked to strenuous labour or lack of healthcare access in Russia.⁵ Similarly, a Swiss study revealed that Eritrean refugee women were 1.3 times more likely to have emergency C-sections than Swiss mothers.¹³

On arrival in their final host country, asylum seekers typically undergo health assessment, which generally includes medical examination, screening for selected communicable diseases and vaccinations.²⁰ Less attention has been given to other potential health problems, such as problems related to SRH needs and mental health issues.^{17 20} Similarly, refugee women in Switzerland encounter ongoing challenges in accessing SRH services, largely due to disconnection between the Western biomedical approach and the distinct SRH needs stemming from limited SRH knowledge, differences in cultural norms and complexity with the Swiss healthcare system.^{5 11 13 17 21} The underlying reasons for healthcare-seeking behaviour and its challenges remain poorly understood. Although the Swiss government covers the cost of healthcare for asylum seekers, strong barriers to accessing healthcare remain.¹⁷

The WHO recognises universal access to SRH care as a critical priority for global health.^{18 22} It is a cross-cutting priority that is deeply interconnected with multiple Sustainable Development Goals (SDGs), particularly SDG 3 (good health and well-being) and SDG 5 (gender equity).²² Refugees and asylum seekers arrive after arduous journeys through fragile and unstable countries, usually via conflict zones and deteriorating healthcare systems. These individuals often present complex health needs and SRH concerns.^{10 23} Owing to linguistic, cultural and systemic barriers, Eritrean and Somali refugee women face multiple challenges in accessing SRH services.^{11 17}

Despite Switzerland’s exceptionally high standard of healthcare, which is considered one of the top in the world, the healthcare needs of refugee women are inadequately addressed.^{11 24} The nation has universal healthcare coverage. However, inefficiencies, especially for healthcare access for non-native population groups still remain.^{11 25} The asylum policy in Switzerland could have an improved impact on the situation of these women.¹¹ Intercultural interpreters are essential entities strongly recommended to be part of the refugee healthcare model, yet interpreter services are not fully available.²⁶ Since 1999, the standard for community and intercultural interpreting in Switzerland (INTERPRET qualification system) has been part of the Swiss higher professional education and training system for non-academic educational paths.²⁷ Regional agencies oversee the placement of qualified intercultural interpreters, with 12 regional training institutes providing INTERPRET-accredited courses.^{22 27} To date, only a few studies have focused on the role of intercultural interpreters in mediating SRH care.^{8 28} The perspectives of intercultural interpreters remain a critically underused resource in understanding barriers to SRH for immigrant women. Addressing this gap, our qualitative study draws on the perspectives of professional interpreters to explore and describe their professional experiences, and challenges in providing SRH care to Eritrean and Somali immigrant women in Switzerland.

Methods

Study setting

The study builds on the qualitative arm of the Novel Integrated Infectious Disease Surveillance (NIIDS) project carried out in Switzerland and Ethiopia. Further details about the project have been previously reported.^{13 23 29} This study was conducted in the canton of Basel-Stadt, 1 of the 26 cantons in Switzerland. The canton of Basel-Stadt accounts for 2.3% of asylum seekers according to a preestablished distribution quota system.²⁵ The canton has promoted a health maintenance organisation (HMO) model, a type of managed care organisation in which physicians act as gatekeepers for access to healthcare.^{20 25} Each asylum seeker who was relocated to the canton of Basel-Stadt was assigned to one of the two existing HMOs. The patients had free access to the HMO to which they were assigned, and their healthcare costs were completely covered.^{20 25} Some institutions, such as hospitals, maintain in-house interpreter services; moreover, others—including schools—operate via lists of independent interpreters.²⁷

Study design

An exploratory qualitative study was conducted from a social constructionist perspective. Social constructionism argues that reality and knowledge are shaped by social, cultural and historical contexts rather than being objective or inherent.^30–32 This combination allows to explore how participants construct their understanding of the SRH issues among immigrant women. We conducted semi-structured and open-ended key informant interviews to explore the perceptions and experiences of intercultural interpreters toward SRH care provisions for Eritrean and Somali refugee women in Switzerland. We primarily employed an inductive method; we also incorporated a few predefined themes (deductive approach), such as language barriers.^{30 31 33}

Study participants

The study participants were intercultural interpreters ensuring accurate communication in clinical settings, providing SRH care to Eritrean and Somali refugee and asylum seekers women in the Swiss healthcare system. These respondents were selected because they are particularly valuable key informants with multiple years of experience in assisting vulnerable immigrant women. Intercultural interpreters serve as key informants by mediating between researchers and participants, enhancing data accuracy, fostering community trust and ensuring ethically sound findings—particularly in cross-cultural health research where sensitive SRH information could otherwise be misunderstood or misinterpreted due to linguistic and cultural barriers. They create a bridge between immigrants, healthcare providers and the healthcare system and understand the Eritrean/Somali and Swiss culture.

Participant recruitment

Two authors (NBZ and AC) reached out and recruited the key informants through purposive sampling techniques. Since the professional intercultural interpreter pool is generally small, key informants were purposively selected on the basis of their role in helping refugee women during SRH care, for the semi-structured interviews and partly open-ended conversations.

Data collection guide and interviews

The following guiding questions were included in the guiding tool: views about SRH care for immigrant women in Switzerland, challenges encountered when caring for immigrant clients, personal experiences working with refugee women and healthcare providers, and barriers to the use of available SRH services. Several revisions were made to the interview guide to accommodate new emerging ideas and perspectives. Open-ended in-depth interviews are considered the most suitable tool in cross-cultural research with minority groups.²³ Swiss German, Amharic and English languages were used to conduct the interviews as participants represented key language groups (Amharic, Tigrinya and Somali) and varied in work settings (hospitals, clinics, community, reception centres, social works, language centres, religious centres, professional training centres, sport centres, schools, non-governmental organisations and court cases). The interviews lasted for 45–90 min and took place at the locations where the key informants opted for; at the Swiss Tropical and Public Health Institute (TPH) headquarters or online via Zoom meetings. The data were collected between March and August 2023. A sample interview guide is provided below online supplemental file 1.

Patient and public involvement

The study participants were not involved in the study design or in the conduct or analysis of this paper. The project’s key findings will be disseminated as part of the NIIDS project, and potential follow-up projects that will result in sustainable health impacts will be considered.

Data analysis

Following a thorough review of the data, the entire dataset was coded, after which patterns and themes were identified.^{31 34} We primarily applied an inductive (data-driven) method, and we also incorporated some predefined themes (deductive approach). We developed preliminary code books, using pen-and-paper and Word, in which themes and subthemes were defined.^{30 31 33} Key themes were identified through an iterative process of qualitative coding, with findings further validated via expert consultations and peer feedback from experts in migration health. All discussions and interviews were tape recorded, transcribed and analysed with the assistance of MAXQDA software (VERBI software, 2024; Berlin, Germany). The final analysis was guided by a thematic framework analysis according to Braun and Clarke.^{30 33 34} Examples of code books with themes and sub-themes and supporting quotes are available (online supplemental file 2).

Researcher reflexivity

The reflexivity of the researcher is related to the dynamics between the research team social, cultural backgrounds and positions that impact the study.³⁰ Ongoing critical reflection by researchers influences the research process, which includes the practice of reflexivity.^{31 35} The principal investigator (NBZ) is a public health researcher who has worked as both researcher and healthcare provider within fragile settings in Ethiopia. The last author (AC) is a public health epidemiologist with longstanding experience working on migration health. The key findings were discussed, and feedback was incorporated into the publication. All coauthors have vast research experience in similar fragile and humanitarian settings. These perspectives are also shaped by our position, as researchers can reflect on and criticise assumptions and deal with biases.³⁶ The research team was transdisciplinary involving stakeholders, which helped us to consider different assumptions and minimise biases. Furthermore, additional notes, informal conversations, and peer debriefings were used to assure researcher reflexivity.

Data quality

The data quality was assured through establishing trustworthiness.^{31 35} The Standards for Reporting Qualitative Research (SRQR) guidelines were used for data reporting.³⁷ The principles of credibility, reliability, confirmability and transferability were assessed to check the rigour and trustworthiness of the findings.³⁸ Quality checks were conducted on the data transcripts and the extracted codes to increase validity. The principle of data saturation was applied to transition from one idea to the other. Additionally, data triangulation was achieved through a combination of different data sources—interviews, field notes and expert feedback.

Results

A total of 18 participants were recruited for the study. 10 intercultural interpreters (5 men and 5 women) were willing to participate in the in-depth interviews. Six interpreters were from Eritrea and four were from Somalia. The participants spoke either Tigrinya or Somali, the national languages in Eritrea and Somalia, respectively, plus Amharic, English and Swiss German. They had been living in Switzerland for an average of 5–10 years, and their routine interpreting activities usually involve three to six interpretations each per week.

Sociodemographic characteristics of the study participants

The mean age (range) of the interpreters was 38.6 (28–54) years. All were professionally trained intercultural interpreters certified by INTERPRET, a Swiss national association offering courses and accreditations for intercultural interpreting tasks.²⁷ They offered a mixed educational background—while all held a certificate, more than half had acquired a bachelor’s degree in different fields of study. They reported to have worked at different organisations, including hospitals, federal reception centres known as the ‘Bundesasylzentren’, family health centres, schools, social support offices and law offices, in predominantly refugee housing areas for an average of 5–10 years. Four participants preferred to be interviewed in Swiss German, two preferred to be interviewed in English and four preferred to be interviewed in Amharic. Pseudonames and only two indirect identifiers were assigned not to compromise the anonymity of our study participants, as they could be easily identified (table 1).

Table 1. Sociodemographic characteristics of the study participants, Basel, Switzerland, 2023.

Name (fictional)	Gender	Age range
Aster	Female	50–60
Roba	Male	30–40
Henok	Male	20–30
Kalkidan	Female	20–30
Selam	Female	30–40
Hana	Female	30–40
Abdi	Male	40–50
Momina	Female	20–30
Muktar	Male	30–40
Mohammed	Male	50–60

Themes and categories

The analysis of the main findings thematically explored three major themes: limited health literacy towards SRH, the sociocultural–language barrier and the structural barriers related to the complexity of navigating the Swiss healthcare system.

Limited knowledge, awareness and stigma toward SRH care

Study participants reported none or limited formal training for interpretations with refugees in general and with women in particular regarding SRH care and services in Switzerland. The interpreters believe that Eritrean and Somali immigrant women are unaware of available services, leading to low utilisation of SRH services, and they remain vulnerable to unintended pregnancies, unsafe deliveries and STIs, thus exacerbating health disparities. The available options for contraception, vaccinations and maternal care remain less clear for immigrant women. In addition, competing priorities such as asylum status, economic hardships and caregiving responsibilities further reduce women’s ability to prioritise medical appointments.

Hana, an intercultural interpreter, mentioned,

Health counseling, gynecological checkups, breast examinations or SRH education are not common practices back home, except for recent initiatives, especially in urban schools. Hana, aged 40–50 years

The study participants mentioned that some women (also men) were sexually violated during their arduous journey to Europe. Experiences with rape, unwanted pregnancy, STI and mental illness were reported. However, those victims do not volunteer to disclose this information because of the stigma foreseen. Roba, an interpreter and software programmer, described the situation as follows:

…I came across to support a young woman very advanced in her pregnancy who traveled to the asylum center… she got pregnant because of sexual violence, --raped in the Libyan desert… but as you know, owing to fear of stigma, she couldn’t reveal her situation to anybody; rather, she manifested it through different complaints and developed mental conditions… it is complicated. In addition to females, male immigrants are also included. The smugglers and peers committed to most cases. Sometimes when the immigrants finish their money, the smugglers forced them to work as sex workers (both young girls and boys). Roba, aged 30–40 years

Eritrean and Somali immigrant women come from contexts where preventive SRH care is not prioritised, leading to low awareness and reluctance to use the available services. They are often obsessed by their legal status and family members back home. They require time to align with their new surroundings and understand the new healthcare approach. The participants described that Eritrean and Somali refugee women are very conservative, with little to no contact with or socialisation with the local Swiss population. Rumour and speculations about collaboration between healthcare providers and asylum centres to disclose their health status, which in turn potentially affects their asylum application. As a result, many refugee women fear the asylum process and miss essential SRH care appointments for prenatal care, family planning and STI screenings, increasing their risk of health complications.

Abdi, an intercultural interpreter and consultant, added

Our community women often take pregnancy for granted. Antenatal care and childbirth are normal and are taken as usual life circumstances, and individuals marry, become pregnant and perform labor, which is a normal part of their life process. Whether the women give birth at home or in a hospital doesn’t make a difference for Somali women. Abdi, aged 40–50 years

He added, “immigrant women mostly rely on informal networks (friends, families, relatives…) for health awareness, leading to misinformation and fear toward contraceptives and other SRH needs.

I see refugee women are too reluctant and do not even make efforts to socialize with the Swiss community. They show little interest in exchanging with GPs and prioritizing their health needs. They speculate that the breaching of physician-client confidential information to the external officers in the asylum centers is one of the restrictive barriers. Abdi, aged 40–50 years

Sociocultural context and language expectations

The sociocultural (language) barrier was the second predominant theme that emerged in the analysis. Culture and language go hand in hand. Differences in expectations surrounding language and culture are dominant issues that affect both clients and healthcare providers. We use the term ‘culture’ not as a polite shorthand for stereotypes based on age, gender or ethnicity, but to mean the shared conventional understandings found within any group.³⁹ Perceived sociocultural (particularly language) barriers, including hesitancy toward SRH care, a low emphasis on preventive care and limited decision-making power influenced by gender norms, have been reported most repeatedly.

Language expectations

There are multiple occasions where clients and healthcare providers do not understand each other. Clients have no access to adequate healthcare because they cannot communicate in the Swiss German language spoken by a healthcare provider. Henok, an interpreter, recalled his recent interactions with a client at a hospital:

Healthcare providers, for example, expect the clients to be able to understand Swiss German or come up in accompaniment with a friend or somebody that could help with language translations. Henok, aged 20–30 years

Some hospitals provide translation services, but these services may only be available through costly phone lines. In other cases, friends or family members act as interpreters, although their involvement in clinical settings raises concerns about trust, accuracy, professionalism and confidentiality. For example, healthcare providers often expect word-for-word translation, but this is not always possible, especially when interpreters lack familiarity with medical terminology. Such gaps can potentially influence the client’s quality of care and satisfaction. Mohammed described his frustration as follows:

Healthcare is also compromised by not understanding each other…so, sometimes, we, as translators, have hard times understanding medical terminologies that the doctor spoke in German, so it is hard, so we can’t translate it accurately in native language. Mohammed, aged 50–60 years

Additionally, Selam explained her viewpoint on medical jargon:

Many women, even we interpreters, do not understand medical terms such as ‘Pap smear’ or ‘contraception.’ When I translate directly, they still look confused. Thus, I prefer indirect phrasing. I have to explain using Tigrinya analogies. Selam, aged 30–40 years

Moreover, interpreters are expected to translate the client language and not respond by themselves. Muktar recalled this experience in the asylum centre:

I witnessed that interpreters quite often would answer questions on the clients’ behalf. You find yourself in a circumstance where the GP asks a woman about her complaint, and the interpreter answers it herself. Muktar, aged 30–40 years

This common practice can make clients hesitant to share their health issues openly. There is no way to ensure that confidentiality is maintained when informal networks (family members or friends) are used for medical translations. Selam, aged 30–40 years

A woman once asked me, ‘Will the nurse tell my husband if I decide to take a contraceptive?’ They often fear the associated stigma. Selam, aged 30–40 years

She also added:

…Eritrean refugee woman explained her frustration as if the doctor was asking a woman about her marital status to judge her, not for medical purposes. I think similar misunderstandings often influence care quality and client satisfaction.

Eritrean and Somali refugee women often rely on informal networks. Momina, who holds a double profession as a nurse and interpreter, highlighted this problem when the informal system is used to translate a medical appointment. She expressed that the lack of trained interpretation risks both privacy and therapeutic communication:

[This] is not ideal because there is confidential information, even past pregnancies… a woman might have unwanted pregnancy… multiple abortions. … Therefore, she might not want her friends knowing that; such sensitive information shared with health providers through nonprofessional translators can be disclosed outside of the medical setting, which can affect quality of care and client social life. Momina, aged 20–30 years

Expectation of cultural awareness

Healthcare culture plays a crucial role in shaping therapeutic interactions. Cultural norms influence women’s perceptions of health services. The available difference in approaches to cultural practices has a negative effect on health-seeking behaviour, health understanding, SRH experience, the ability to express symptoms and perceived medical needs. This issue becomes even more complex when informal interpreters without cultural competency may inadvertently omit or reframe critical health details, leading to misunderstandings and compromising the quality of care. Their personal beliefs or cultural norms shape health-seeking behaviours and treatment preferences. Momina, a professional interpreter, explained:

I once stopped a consultation to clarify a doctor; ‘she is not refusing medication—she is just fasting for a religious reason. Momina, aged 20–30 years

Healthcare providers working with immigrant women often lack cultural competence and awareness of the client context, leading to distrust. Aster, an Eritrean interpreter with a double profession of nursing and interpreting, revealed her view as follows:

I know that Eritrean refugee women often refuse epidurals owing to the cultural belief that enduring pain is ‘natural’ and demonstrates mom’s strength. They also believe that epidurals can harm the newborn. On a similar note, I heard that Somali women believe in natural labor, and they fear C-sections. Aster, aged 50–60 years

Cultural differences regarding gender

Gender expectations have been shown to have an essential influence on health-seeking behaviour among immigrant women. For example, women from Somali cultural backgrounds and/or women with female genital mutilation prefer female interpreters and female healthcare personnel. They feel comfortable when a person of the same sex understands their SRH needs.

Roba, an interpreter, stated:

Yes, that [gender] is important; it is part of the sensitive health issues that individuals do not want to discuss with someone of the opposite sex. Roba, aged 30–40 years

Another interpreter also added:

Somali women don’t want to go to a male gynecologist and disclose them what their problem is. Healthcare providers obtain or gather too little information about the needs of women. A doctor once asked a Somali refugee woman if she would be willing to provide a cervical sample for a Pap smear, and she was reluctant to undergo the procedure. I saw that she was embarrassed. In addition, we were there as interpreters. We [interpreters] are part of the immigrant community, which makes it super complex to talk about such sensitive procedures. Muktar, aged 30–40 years

Structural barriers to navigate the Swiss healthcare and cost implications

Immigrant women find it complex to navigate the Swiss healthcare system. Antenatal classes tailored to immigrant women are difficult to attend, as they are not offered close to refugee centres and transportation is very challenging. Henok, an interpreter, explained his view as follows:

Many immigrant women miss critical medical appointments because of transportation barriers. They feel as if the system isn’t made for them. Henok, aged 20–30 years

Again, Momina added,

I’ve seen women skip antenatal visits because they couldn’t afford travel tickets. They don’t realize that insurance could cover it—no one explains this. Momina, aged 20–30 years

The incidence of abortion is reported to be higher among refugee women. Even though condoms are freely available, other methods of contraception demand a prescription and need to be paid fully or partially by women according to the insurance system. However, abortion care is available for free, and health insurance will cover the cost when needed.

Aster, mentioned:

There are many abortion cases, especially from Eritrean and even Somali women. This is because they find it weird to go through their family doctor and have a prescription to obtain contraceptives, which are often available without a prescription in Africa. In contrast, safe abortion services are covered by health insurance. It looks like the Swiss health system is promoting abortions over contraceptives. Aster, aged 50–60 years

Even though very few Eritrean immigrants understood health services, another barrier was that they often forgot their appointment times. Non-adherence to appointments, treatment and care was reported. Legal status uncertainty often prevents immigrant women from accessing care where system navigation also creates additional obstacles.

Abdi also said:

There are differences between cantons in the approach to health service delivery and the health insurance system. For example, in [Canton X], hospitals book interpreters in advance. In [Canton Y], women arrive to find no interpreter, so they leave untreated. Abdi, male interpreter, age 45 years

Health providers are reported to have training gaps in cultural competency to effectively serve diverse refugee populations. Hana explained this as follows:

I think it would be important to train healthcare providers about different cultural competencies to effectively address the needs of their clients. Hana, aged 30–40 years

Access to and provision of comprehensive and equitable healthcare for immigrants appear inconsistent, with variations or disparities in treatment across different groups. According to the open in-depth interviews with the key informants, for example, Ukrainian refugees in Switzerland seem to be more privileged with free and relaxed entry or admission requirements, free transport tickets, free language classes and quick integration into the job market.

Roba described his feelings as follows:

We have recently witnessed many relaxed new regulations for in favor of Ukrainian refugees. Switzerland has relaxed entry requirements for Ukrainian refugees. Ukrainian refugees received free public transport, free language classes, and quick integration into the job market. The Swiss government provided them with “S” status, which completely simplified the asylum process, which is a great example of solidarity. These kinds of kindness need to be cultivated to empower all refugees.

Discussion

Forced immigrant women from Eritrea and Somalia face significant challenges in receiving SRH services in Switzerland. Cultural norms, language barriers and a lack of education often prevent them from understanding the importance of SRH care, leading to misconceptions and reluctance to seek SRH services. Multiple studies have explored similar barriers related to navigating the Swiss healthcare system, presence of conflicting priorities and financial reasons.^{16 40 41} When immigrants find healthcare, there are different expectations between clients and the healthcare system in the host country, which can still deter women from taking up care.^{16 40 42} Similarly, maternal health services in high-income countries struggle to address immigrant women’s sociocultural and health needs.^{43 44}

Acknowledge that while interpreters provide a unique and valuable ‘insider’ perspective on the cultural and linguistic dynamics of these interactions, their accounts are inherently a secondhand interpretation, filtered through their own professional and cultural lenses. These intercultural interpreters from diverse backgrounds in our study provided invaluable insights into the divergent expectations shaping refugee women’s SRH care experiences.⁴⁵ The lack of timely and adequate SRH care can exacerbate complications and put both mothers and children at risk.^{21 42 44 46–48} This study revealed three substantive barriers that prevent immigrant women from accessing SRH care: (1) limited health literacy regarding SRH, (2) sociocultural and language barriers, and (3) structural challenges in navigating the Swiss healthcare system.

Inadequate knowledge about SRH and available services has been widely reported to be the first substantial barrier to SRH care. Similarly, our findings align with reports from Switzerland and others conducted in similar settings.^{16 42 49} Access to comprehensive SRH information is essential for understanding the services available in the host country.^{21 46 48} However, a lack of information and SRH non-literacy emerged as a major barrier hindering accessibility and becoming acquainted with the system.^{21 42 46} The lack of knowledge may also be related to the availability and accessibility of SRH services.^{21 48} A lack of clarity in health communication regarding medical confidentiality protocols is essential for immigrant women, ensuring that they understand that sensitive health information remains protected and cannot be disclosed to third parties.⁵⁰ Interventions to increase immigrant women’s health literacy to promote SRH service use have been highlighted in multiple studies.^{21 42} Thus, the provision of regular health promotions to improve immigrant women’s health knowledge and availability of SRH services is important for better service use.^{21 42 46 48}

Sociocultural and language barriers were the second most predominant theme that emerged in our analysis. Research has identified sociocultural obstacles across multiple levels: organisational (eg, leadership and workforce composition), structural (eg, care delivery systems) and clinical (eg, client–provider interactions).⁵¹ This is a significant barrier and is well covered in similar studies.^{13 23 51} The differences in sociocultural expectations are seen, for example, in Somali refugee women, who insist on seeing a female physician.^{23 41} Immigrant women expect healthcare providers to understand their linguistic and cultural needs; however, this is not always the case in the Swiss healthcare system.^{17 18} Cultural norms influence Eritrean immigrant women’s and Somali immigrant women’s perceptions of SRH and service use. Different cultural perspectives can influence how clients understand health, communicate symptoms and seek medical advice. Without a culturally sensitive interpretation, key nuances may be lost—even when translation is technically accurate. For example, pain or distress is explained indirectly in some cultures.⁵² If interpreters lack cultural competence, they may inadvertently omit or reframe critical details, leading to misunderstandings or inadequate care. Differences in cultural and language expectations around the cultural competencies of healthcare providers have been reported among immigrant women and the healthcare system.^{21 40 51} Similarly, cultural and language expectations have been widely studied to prevent or delay access to SRH care.^{16 17 19 21 23 28 41} A lack of culturally sensitive healthcare that is cognizant of clients’ sociocultural needs is illustrated to be a barrier to SRH care. Similar to our findings, Chinese immigrant women in Canada subsequently avoided healthcare because their physicians disregarded or dehumanised their cultural needs.^{51 53 54} Healthcare providers were also reported to lack cultural competencies, leading to distrust and skipping of care.^{8 17 28 51} The provision of SRH services by communities, culturally sensitive care training and home healthcare visits could make it possible to improve the use of SRH services.^{21 52 55–57}

In addition to sociocultural challenges, the language barrier is widely perceived as one of the most significant challenges hindering effective client healthcare provider therapeutic communication toward sensitive SRH topics.^{23 28} Similar findings are reported across primary care physicians providing healthcare to immigrants in Switzerland.^{19 28 40} Linguistic challenges are exacerbated by the lack of training for healthcare providers on culturally sensitised care approaches.^{21 47} Given that 25% of the country’s population consists of international migrants, linguistic diversity poses considerable obstacles in the health system.⁴⁰ Addressing these language barriers is crucial to ensure equitable and high-quality healthcare for Switzerland’s diverse population.⁴⁰ The Swiss healthcare system recognised the importance of culturally competent care by including a multicultural department in practices to hire more culturally diverse staff.^{16 58} A positive effect was observed among healthcare providers trained on culturally sensitive healthcare.^{21 55–57 59}

The immigrant women in our study did not often prioritise SRH care as more of their immediate survival needs—such as food, shelter and safety. Factors contributing to these barriers include the fact that immigrants have to deal with many urgent tasks, such as asylum status; obtaining housing, employment and language courses; and resolving settlement issues.⁶⁰ Study participants frequently missed critical medical appointments, as they did not prioritise routine health checkups, including SRH care. Similar reports report that many immigrants deprioritise SRH care due to discrimination, gendered power dynamics and delayed care until emergencies arise.⁶¹ Adherence issues to appointments, treatment and care and other healthcare services are frequently reported practices among refugees and asylum seekers.⁶² Legal status uncertainty often prevents immigrant women from accessing care where system navigation also creates additional obstacles. Immigrant women in Spain (eg, Moroccan and Pakistani communities) face language barriers, cultural stigma around SRH topics and a lack of trust in providers, leading them to skip appointments.^{51 63} The authors identified ‘low-risk perception’ and ‘cultural unacceptability of services’ as key reasons for avoiding SRH care.^{21 23 48 51}

Structural barriers were the third major theme inadvertently mentioned to impact the needs of Eritrean and Somali immigrant and refugee women’s SRH needs. Switzerland has a mandatory health insurance policy that covers costs for physician consultations, medical treatment, laboratory examinations and healthcare expenses through the Swiss government (cantonal governmental bodies).¹⁷ However, there is no national funding for interpreting services in primary healthcare insurance schemes. This is a strong barrier to healthcare access and specific needs in the immigrant community.^{27 40} Eritrean and Somali refugee women are reported to frequently rely on informal networks for health advice due to distrust of institutional systems.⁸ Professional intercultural interpreters could mitigate these issues, although their availability is often inconsistent, leading to reliance on informal networks, which may increase accuracy, confidentiality, trust and healthcare quality.^{8 45 64}

Our study revealed that immigrant women face barriers in accessing contraceptives, as these require a prescription and may involve out-of-pocket costs depending on insurance coverage. In contrast, abortion services are fully covered by health insurance and remain more readily available when needed. Even though condom use is readily available, it is often problematic, as it relies on male partner willingness and cooperation. Notably, the abortion rate among female asylum seekers is 2.5 times higher than that among host community-dwelling women.¹⁹ Moreover, the complexity and presence of bureaucratic delays and cantonal differences in insurance schemes impact access to SRH services.^{10 65} This problem is similarly reported in many Swiss studies, although the nature of the problem and the level of difficulty vary according to country setting.^{18 63 66 67} Understanding how the health system works and shows up during medical appointments are important barriers reported in similar asylum-providing high-income countries.^{63 66 67} Furthermore, the study revealed that access to comprehensive and equitable SRH care remains inconsistent, particularly in addressing the specific health needs of immigrant women. Parallel research has identified institutional racism in healthcare as a contributing factor to these disparities.^{43 44 68} Despite this, Western nations continue to depend on international migrants to mitigate labour shortages, strengthen national economies and contribute to demographic stability.¹⁶

The professional intercultural interpreters are not neutral linguistic experts but active, skilled and empathetic professionals who ensure that communication is not just heard but understood. Their role is indispensable in moving from a merely available healthcare service to one that is truly accessible, culturally competent and equitable for forced immigrant women. Recognising, formally training and adequately supporting these professionals is not an added cost but a fundamental investment in effective and ethical healthcare.⁴⁵

Strengths and limitations

A key strength of this study lies in the use of intercultural interpreters as key informants, whose direct professional experience and deep contextual knowledge provided rich insights into the complexities of providing SRH care to Eritrean and Somali migrant women in Switzerland. Furthermore, the exploratory and transdisciplinary design of the study enabled a detailed understanding of migrant women’s SRH care experiences within their specific sociocultural and structural contexts, capturing dimensions that may not have been accessible through quantitative approaches alone.

However, we would like to acknowledge the following limitations when interpreting the findings. First, we wish to strongly emphasise that our findings reflect the perspectives of intercultural interpreters, not the direct experiences of Eritrean and Somali migrant women. The absence of direct exploration with migrant women constitutes a significant limitation of this study. Male partners’ roles are similarly underexplored despite their crucial influence as gatekeepers in migrant women’s SRH decision-making. To fully understand women’s needs and barriers to care, future research must centre their direct, unmediated voices that actively involve both women and their partners.

Second, the qualitative nature of the study may limit the transferability of the findings to other contexts. Despite these limitations, we believe our study contributes valuable insights into the underexplored professional perspectives of interpreters and highlights important directions for future research, policy and practice.

Implications for research, policy and practice

Improving SRH service access and utilisation for migrant women requires a multipronged approach that addresses structural barriers in health systems, builds cultural competence among providers, engages refugee communities in service design and implements supportive policies to guarantee equitable healthcare access and patient-centred care. The Swiss healthcare system should prioritise culturally sensitive health promotion and community engagement to establish SRH as a tangible priority. Implementing targeted and patient-centred care targeted at women’s cultural backgrounds could make a meaningful impact in fostering trust and collaborating with community stakeholders toward equitable SRH access.

To address these challenges, the healthcare system in Switzerland needs to prioritise collaboration with refugee-led associations, which play a pivotal role in bridging SRH care gaps through community-based interventions. Refugee communities could facilitate SRH awareness, available services and accessibility would further foster the uptake of existing services. Social integration efforts will help to improve the cultural responsiveness and financing of intercultural interpreters for improved accessibility and availability. The out-of-pocket costs for contraceptives stand in contrast with the fully insured abortion services and create a financial barrier that systematically disadvantages preventive reproductive care for refugee women. An increased accessibility to contraceptives would reduce the frequency of abortions. The reallocation of funding from safe abortion care toward free female contraceptives is likely to contribute to better SRH outcomes.

Conclusions

This exploration underscores that understanding the interpreter’s perspective is not ancillary but central to addressing the complex challenges of providing SRH services. Integrating these insights is a vital step toward ensuring that access to SRH is a reality for all forced migrant women. By centring the expertise of professional intercultural interpreters, the healthcare systems can move beyond a one-size-fits-all approach and bridge the critical gap between service provision and equitable SRH needs for refugee women. The key findings revealed the complexity of SRH care delivery with a focus on sociocultural, health literacy and structural complexities in Switzerland. Cultural norms surrounding gender roles are often reported to deter vulnerable women from seeking care.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.