Table 1.

Summary of included studies (N = 38) on determinants of access to and engagement in sexual and reproductive health (SRH) services amongst im/migrant women in Canada (2008–2018)

Type of SRH care	Canadian Province	Study design	Immigration variables	Key findings
Ahmad et al. [56]	Ontario	Qualitative	South Asian born in India (68%), Pakistan (27%), and Bangladesh (5%) Mean years lived in Canada: 14.3	Social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support, limited knowledge about available resources, myths about partner abuse, and children’s wellbeing delayed help-seeking for GBV. Aspects of HCPs including trust, judgmental, gender, regular inquiries about abuse, and availability of supportive services determined access
Alaggia et al. [79]	Ontario	Qualitative	Immigrants and refugees from Punjab, Bengal, South Asia and South America	Barriers to disclosure/reporting GBV: Cultural practices; reluctance of police intervention; isolation; staying for the children; economic barriers; fear of immigration status repercussions Immigration laws and policies contained systemic and structural barriers (e.g., unrealistic criteria required for immigration applications in cases of sponsorship due to IPV)
Amankwah et al. [37]	Canada	Quantitative	Chinese, South Asian, Filipino, Other Asian, Black, and Latin American, most of whom lived in Canada for > 10 years	Visible minority women were > 2 × as likely to not get a Pap test. Recent arrivals who did not have a regular doctor were at highest risk for not having a Pap test. Risk AOR for women never having a Pap test: Those living in Canada for < 10 years (AOR 2.2) compared to those living in Canada for > 10 years (AOR 1.1). Not having a regular doctor (AOR 2.8)
Chang et al. [52]	British Columbia	Qualitative	Chinese (93.3%) and Taiwanese (7.7%) who migrated in the last 5 years. Lived in Canada for 4–6 years (53.8%) and 1–3 years (46.2%)	Barriers to traditional postpartum practices included a lack of social support, and formal institutional structures. Help from Chinese family members, friends and informed healthcare providers were facilitators. Issues included unregulated/unreliable paid helpers, uninformed/insensitive providers, financial constraints, and structural limitations
Donnelly [66]	Canada	Qualitative	Vietnamese Canadian	Challenges included HCPs’ lack of cultural awareness about the private body, patients’ low socioeconomic status, the HCP-patient relationship, and limited institutional support
Ganann et al. [65]	Ontario	Quantitative	Immigrants: English and French Canadian, Chinese, South Asian, Jewish, Italian, Portuguese, Other	Immigrant women were significantly more likely to experience fair/poor postpartum health status, higher risk for postpartum depression, and rate community health services as fair/poor (12.2% vs. 3.6%), and were less likely to be able to access care for emotional health problems (5.1% vs. 1.0%)
Grewal et al. [53]	British Columbia	Qualitative	Immigrants from Punjab who lived in Canada for 2 years on average	Traditional health beliefs and practices related to the perinatal period included diet, lifestyle, and rituals. The role of family members was important in supporting women during perinatal experiences. Both positive and negative interactions were had with HCPs in the Canadian health system
Guruge and Humphreys [70]	Ontario	Qualitative	Sri Lankan Tamil immigrants	Negative GBV support experiences were shaped by services that were unfamiliar, inappropriate, not culturally and linguistically appropriate, uncoordinated, not confidential, and had discriminatory and racist practices
Higginbottom et al. [76]	Alberta	Qualitative	Sudanese immigrants who migrated from Sudan, Egypt, and Lebanon in the last 5 years	Pregnancy and delivery were believed to be natural events related to personal agency, without a need for special attention or health interventions. Sub-Saharan culture supported ideology of patriarchy. Pregnancy and birth reflected empowerment for women, which may not have been respected by husbands
Higginbottom et al. [80]	Alberta	Qualitative	Immigrant women who spoke Arabic, Urdu, Tagalog, French, Swahili, Hassaniya or Tigriniya	Verbal communication; unshared meaning; non-verbal communication to build relationships based on trust; trauma, culture and open communication determined maternity care experiences, and were impacted by pre-migration histories, cultural factors, accessible healthcare and health outcomes
Higginbottom et al. [61]	Alberta	Qualitative	Sudanese (n = 12), Filipino (n = 8), Chinese (n = 6), Colombian (n = 2), n = 1 Tajikistan, India, Mauritania, Pakistan, Eritrea	Accessibility of maternity services was determined by communication barriers, lack of social support, cultural beliefs, lack of information, inadequate health care, and cost of medicines. Determinants of client satisfaction included cultural shock, stereotypes, discrimination, immediate discharge, short consultation time, lack of confidentiality, and lack of consent
Hulme et al. [58]	Ontario	Qualitative	Mandarin and Bengali-speaking women	Varied perceptions of risk and preventative health for breast and cervical cancer. Barriers to health system engagement and screening were related to ‘navigating newness’, including transportation, language, time off work, and childcare; fear of screening and cancer; painful or traumatic experiences; access to female providers. Women were generally willing to be screened
Jarvis et al. [64]	Quebec	Quantitative	96% of uninsured women had precarious status; 4% were Canadian citizens; 57.7% were undocumented; 9.9% were visitors or students; 28% were asylum seekers	Uninsured women had fewer prenatal visits than insured women (6.6 vs. 10.7, p = 0.05). Uninsured women presented later in pregnancy and had fewer routine prenatal screening tests. Most uninsured women had inadequate prenatal care utilization (61.9% vs. 11.7%, p < 0.001). There were significant differences in adequacy of services between insured and uninsured women
Khadilkar and Chen [82]	Ontario	Quantitative	Recent immigrants (< 10 years) and non-recent immigrants (> 10 years)	Recent immigrant women were less likely to have had a Pap test in the past 3 years than those who were Canadian-born (PR 0.77; 95% CI 0.71, 0.84). Both groups showed similar results for recommended Pap testing intervals. Higher income and level of education, younger age, and being married were independently associated with better Pap testing rates
Kingston et al. [51]	Canada	Quantitative	Recent immigrant women (< 5 years) (7.5%), non-recent (> 5 years) (16.3%) and Canadian-born women (76.2%)	Immigrant women were more likely to report high levels of postpartum depression symptoms (13.2% vs. 6.0%), and less likely to have access to social support (74.1% vs. 90% during pregnancy, 67.8% vs. 87.1% during postpartum), and to rate their own/infant’s health as optimal Duration of residence in Canada was a key determinant
Lee et al. [54]	Ontario	Qualitative	Women (n = 10) from Hong Kong (n = 3) and Taiwan (n = 2)	Preference for linguistically and culturally competent HCPs, with obstetricians over midwives. Women built strategies to deal with inconveniences of Canada’s healthcare system, and have multiple resources of pregnancy information. Some merits of the Canadian healthcare system, but a need for culturally sensitive care and understandings of Chinese women’s experiences
Lofters et al. [73]	Ontario	Quantitative	Global immigrant women who were family sponsored, refugees, economic migrants, and other	Being born in a Muslim-majority country was significantly associated with lower likelihood of being up-to-date on Pap testing after adjustment for region of origin, neighborhood income, and primary care-related factors [ARR 0.93; 95% CI 0.92–0.93]. ARRs were lowest for women with no access to primary care (ARR 0.28; 95% CI 0.27–0.29)
Lofters et al. [39]	Ontario	Quantitative	Women were economic migrants (44.3%), family sponsored (40.9%) and refugees (14.2%). 15.1% lived in Canada for < 10 years	Appropriate cervical cancer screening occurred for 61.1% of women. Living in low-income areas was associated with lower rates of cervical cancer screening (ARR 0.88, 95% CI.0.88–0.88) Recent arrival was associated with lower rates (ARR 0.81, 95% CI 0.8–0.81). Cervical cancer screening rate was 53.1% over a 3-year period for immigrant women living in urban areas, lower than expected
Logie et al. [57]	Ontario	Quantitative	ACB women living with HIV. Citizens (36%), immigrants (34.8%), asylum seekers (16.8%), refugees (8.1%), undocumented (3.1%) and visa holders (1.2%)	Age was not significantly associated with variables, while income was associated with significantly higher overall quality of life scores, social environments and relationships. Determinants included engagement in and continuity of HIV care, including access, needs-based care, communication with health professionals, and appointment time-keeping
Merry et al. [62]	Ontario and Quebec	Qualitative	Asylum seekers from Nigeria, Mexico, India, Colombia, and St. Vincent who lived in Canada for < 2 years	Determinants to postpartum care included isolation; difficulties reaching mothers postpartum; language barriers; low health literacy; lack of psychosocial assessments, support and referrals; and IFHP being limited and confusing
Merry et al. [81]	Quebec	Quantitative	Women in Canada for < 5 years. Economic and temporary residents, family sponsored, refugees, asylum seekers, and undocumented	Predictors of unplanned caesareans included being from sub-Saharan Africa/Caribbean (OR 2.37, 95% CI 1.02–5.51) and admission for delivery in early labour (OR 5.43, 95% CI 3.17–9.29). Among women living in Canada for < 2 years (OR 1.77, 95% CI 0.98–3.20), predictors were also being a refugee, asylum seeker, or undocumented (OR 4.24, 95% CI 1.16–15.46)
Mumtaz et al. [23]	Alberta, Saskatchewan and Manitoba	Quantitative	Newcomer women (n = 140) included landed immigrants, refugees, students, visitors and temporary workers	Few received information on emotional and physical changes during pregnancy (87% vs. 95%)—more from books (27% vs. 17%) and nurses (20% vs. 13%), and less from family doctors (10% vs. 15%) and friends (10% vs. 20%). Rates of C-sections were higher for newcomers (36.1% vs. 24.7%), who were also less likely to report “very satisfied” with care
Ng and Newbold [75]	Ontario	Qualitative	No participant socio-demographic information	Determinants of prenatal care included language; cultural sensitivity and type of care; complexity of delivering care; cultural awareness; provider type; and level of professionalism
Newbold and Willinsky [71]	Ontario	Qualitative	No participant socio-demographic information	Barriers to family planning and reproductive health care included language; role of gender in decision-making; misconceptions or a lack of knowledge about family planning; and cultural sensitivity. There were complexities in experiences with professional and non-professional interpreters, and HCP misunderstandings about other cultures
Ochoa and Sampalis [69]	Quebec	Qualitative	Permanent residents (n = 11), asylum seekers (n = 10), citizens (n = 1), denied refugee status (n = 2), tourists (n = 1). Lived in Canada for 2–3 years (32%), 6–12 months (24%), 4–5 years (24%)	HIV/STI care experiences characterised by uncertainty, deception and fraud, and included family separation and discrimination. Risk was related to unequal gendered power Vulnerability was determined by experiences across the life course; migratory status; sexual and occupational abuse; language barriers; a lack of social support; and ability to access health services
O’Mahony and Donnelly [26]	Canada	Qualitative	Non-European immigrant and refugee women living in Canada for < 10 years	Immigration policy and gender roles were key barriers to postpartum care. Structural barriers, including precarious status and emotional and economic dependence sometimes left women vulnerable and disadvantaged in protecting themselves against postpartum depression
O’Mahony et al. [28]	Canada	Qualitative	Women from Central and South America, China, Middle East, and South Asia, and lived in Canada for < 2 years (n = 14), 2–5 years (n = 9), and 6–10 years (n = 7)	Determinants of postpartum depression and seeking for support and treatment included cultural influences (e.g., meaning of postpartum depression, community beliefs), socioeconomic influences (e.g., seeking employment, workplace discrimination), and spiritual and religious beliefs. Social stigma determined decision-making about health practices and coping
Pelaez et al. [74]	Quebec	Qualitative	HCPs serving newly arrived im/migrant women No socio-demographic information on im/migrant women	Barriers to maternity care were related to HCP expectations and communication and access to appropriate care. This was influenced by background and social positions and how HCPs balanced women’s needs with the perceived requirement to adhere to standard procedures and regulations
Redwood-Campbell et al. [68]	Ontario	Qualitative	Newly immigrated (living in Canada for < 5 years) women and Canadian-born women who spent 0.5–16 years in Canada	Determinants of cervical cancer screening: Knowledge gaps and needs; attitudes towards screening; role of HCPs and health system; culture. Women indicated a strong need for information on screening, and had positive feelings about being proactive. Some differences regarding preferences for female clinicians, which was a higher priority than language
Reitmanova and Gustafson [78]	Newfoundland and Labrador	Qualitative	Immigrant Muslim women. Some were Canadian citizens	Women experienced discrimination, insensitivity and a lack of knowledge about religious and cultural practices by providers in accessing pregnancy care, labour and delivery, and postpartum care. Barriers to emotional support and culturally and linguistically appropriate information were further complicated by adjustments associated with immigration
Sou et al. [59]	British Columbia	Quantitative	Migrant sex workers from China (76.9%), U.S. (3.8%), and Philippines (2.2%). 41.8% moved to Canada in the last 5 years	Structural determinants of inconsistent condom use included servicing in formal indoor venues (OR 0.17, 95% CI 0.07–0.41), sex work as primary source of income (OR 0.26, 95% CI 0.09–0.76) and difficulty accessing condoms in the workplace (OR 4.75, 95% CI 1.49–15.15). These were independently correlated with increased odds of inconsistent condom use
Sou et al. [60]	British Columbia	Quantitative	10.5% of women were recent im/migrants (< 5 years) and 13.8% were long-term im/migrants (> 5 years) at baseline	In the final model, recent immigration (AOR 3.23, 95% CI 1.93–5.40), long-term immigration (AOR 1.90, 95% CI 1.22–2.96), police harassment including arrest (AOR 1.57; 95% CI 1.15–2.13), and lifetime abuse/trauma (AOR 1.45, 95% CI 1.05–1.99) remained significantly and independently associated with elevated odds of unmet health needs in the last 6 months
Vahabi and Lofters [67]	Ontario	Qualitative	Muslim landed immigrants and Canadian citizens from Iran, Pakistan and India. Lived in Canada for > 10 years (n = 18, 60%), 5–9 years (n = 5, 17%), 0–4 years (n = 7, 23%)	Barriers to cervical cancer screening included beliefs and health practices of home countries; limited knowledge about guidelines; a lack of culturally appropriate health information and knowledge about the Canadian health system; access to female physicians; language and ethnic mismatch; long wait times; access to transportation, and time constraints
Vanthuyne et al. [77]	Quebec	Quantitative	HCPs and service providers serving immigrant populations No socio-demographic information of im/migrant women	Some HCPs perceived uninsured migrants as “deserving” of universal access to healthcare, while most viewed those uninsured as “undeserving” of free care. For most, the right to healthcare for immigrants with precarious status was perceived as a “privilege”
Vigod et al. [29]	Ontario	Quantitative	Immigrant women (13% refugees, over 50% from Asia). 40% migrated in the last 5 years, 30% 5–10 years ago, and 32% over 10 years ago	Compared to long-term residents, im/migrant women were less likely to use postpartum mental health services (14.1% vs 21.4%, OR 0.60, 95% CI 0.59–0.61). Hospitalization risk was similar and did not change much after adjusting for variables/covariates. 19.4% used mental health services within 1 year postpartum
Wiebe [72]	British Columbia	Quantitative	Women born in 75 different countries—38.1% born in Asia and 46.6% born in Canada	Immigrant women presenting for abortion were less likely to be using hormonal contraception when they got pregnant (12.5% vs 23.5%, P < .0.001), had more negative attitudes towards it (62.6% vs 51.6%, P < 0.003), and reported more barriers (24.8% vs 15.3%, P < 0.001). Those who spent more time in Canada were more likely to have similar responses to Canadian-born women
Wilson-Mitchell and Rummens [63]	Ontario	Quantitative	South Asian mothers who were asylum seekers, Canadian born and landed immigrants, temporary workers, and visitors	Most uninsured women received less than adequate prenatal care. Over 50% received inadequate prenatal care and 6.5% received none. Uninsured mothers experienced more C-sections due to abnormal fetal heart rates. The number of prenatal visits reported for the uninsured group (mean = 6.04, t = − 6.173, α = 0) was significantly lower than for the insured (mean = 8.70)
Winn et al. [55]	Alberta	Qualitative	HCPs providing care for refugee women No socio-demographic information of im/migrant women	Key barriers to maternity care included language, navigating the health system, and culture. Strategies to manage barriers included team-based approaches to care, service coordination, paying out of pocket, and donations to provide care for uninsured. Federal funding cuts left many without coverage, and further strained limited resources