Table 4.

Additional exemplars and findings of determinants of access to and engagement in sexual and reproductive health(SRH) services amongst im/migrant women in Canada (2008–2018)

Theme	Population	Main finding	Qualitative exemplars of women’s lived experiences of barriers and facilitators to SRH care	Quantitative findings of barriers and facilitators to SRH care
Health system navigation and access to SRH service information	Chinese newcomer women N = 13	Positive experiences navigating the Canadian health system facilitated access to maternity care [54]	“Here in Canada it is better because it’s one-to-one when your doctor examines you at prenatal visits. Back home there were often some other women waiting inside the examining room and overheard the conversation between you and your doctor.” (p. 5)
	HCPs N = 10	Inadequate health insurance coverage, costs and limited understanding of the health system created barriers to maternity care [55]	“P2: We heavily involved like, social work to figure it out [levels of coverage], like all of the front staff, and they had to be like on the ball. And then things kept on changing […] so it just made it very confusing […]” (p. 8)
			“P2: Some did have their kids in the NICU and one even had their child die, and then and they ended up being presented with a massive bill, massive bill. So, it’s just you know, it’s tragic on a personal level, and then to have the added financial burden on top of it, it was cruel. And the babies are Canadian, if they’re born here, they’re born as Canadians.” (p. 9)
			“P6: So, we had a walk-in in clinic at the Travelodge and I was one of the [health care workers] mandated at the walk-in clinic […] and if they came to me and they were prenatal, I would definitely call the clinic that day and say we need an appointment for this pre- natal patient, can we fit her in? Literally fit her in. So, then we would require some rearranging of appointments, and scheduling and all that stuff…” (p. 9)
	Immigrant women from 9 different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Inadequate care, high costs, and quick discharge led to poor satisfaction and quality of maternity care [61]	“It’s hard to find a family doctor because I phoned everyone … it took me for a while, and then you can’t go with him because his appointment [book] was full. I phoned a lot of clinics and then they cannot accommodate. (IW-Rural Town) It might take up to one year to find a family doctor. Moreover, after finally getting a family doctor and referral to a specialist clinic there was often another long waiting period because of the shortage of gynecologists or obstetricians. Some women complained that they received their first appointments in the advanced stages of their pregnancy. The issue of long wait periods was a great barrier to accessing care at an appropriate time.” (p. 8)
			“She preferred to stay in the hospital a little bit longer, maybe one more day or anything. But [the] OB didn’t care and sent her home and then she actually fainted or lost consciousness at home and then her husband would have to call 911 and send her back to the hospital.” (IW-Urban Town) (p. 9–10)
	Latin American immigrant women N = 25 [permanent residents (N = 11), refugee status claimants (N = 10)]	Shortage of doctors, delays, and a lack of referrals created barriers to accessing HIV/STI services [69]	“I had a high-risk pregnancy, they told me that I had to see a gynaecologist, and that there was a waiting list…. Many women tell me that they come to term in their pregnancy without ever seeing a gynaecologist. I was under a lot of stress because I was already four months pregnant and no one had seen me. I was bleeding eight days in my home, I would go to the health centre and they told me to go home, until the eighth day, I lost the baby.” (p. 422)
	Chinese newcomer women N = 15	‘Inconvenient’ health system created barriers to maternity care [54]	“My OB wasn’t on duty and I had another OB that was ‘on call’ and he did not know anything about me and my pregnancy. It was difficult, especially, I had DM (diabetic mellitus) during pregnancy and my labour lasted sixteen hours.” (p. 4)
	Muslim, West and South Asian immigrant women N = 30	Lack of knowledge of Canadian health system created challenges in accessing cervical cancer screening [67]	“For an immigrant there are lots of things that you don’t have enough information and you need someone to help you, and fortunately I have friends and family here and ask them to help me, and I chose my family doctor by their recommendation. But if they weren’t here, I think maybe I had a lot of problems, because we are not familiar with this system, it takes time to know how you can do many things”. (p. 7)
	Immigrant women N = 4,55,864	Health insurance and characteristics of health providers were predictors of access to cervical cancer screening [39]		Appropriate cervical cancer screening occurred for 61.1% of women. Screening rates were low among women aged 25–49 and living in low-income areas (Absolute Risk Reduction (ARR)) = .88 CI = .88–.88)
				Cervical cancer screening was low amongst women registered with Ontario’s universal health insurance plan in the last 10 years (mainly recent immigrants)
	Refugee claimant women from five different countries N = 112	Difficulties reaching women, and limited and confusing health insurance coverage created barriers to postpartum care [62]	“I called several times. She was unavailable. It was difficult to locate her. A worker states she has left the shelter. ‘Jessica’, a person who lived at the shelter, knows the client and gave me her phone number.” (35 y.o., Nigeria, 7 mos in Canada) (p. 288)
			“Paediatrician refused to see baby because she had no medicare. One month later the paediatrician gave her an appointment but when mother said she still had no medicare then he cancelled it.” (36 y.o., Mexico, 6 mos in Canada, Montreal) (p. 289)
	Uninsured and insured new immigrant and refugee claimant women N = 437	A lack of health insurance negatively influenced perinatal experiences for both mothers and infants [63]		Most uninsured pregnant women received less than adequate prenatal care. More than half received clearly inadequate prenatal care, and 6.5% received no prenatal care. Insurance status related to type of HCP, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced more caesarian sections due to abnormal fetal heart rates, and required more neonatal resuscitations
	Chinese immigrant women N = 13	Multiple resources to obtain pregnancy information facilitated access to maternity care [54]	“My own mother couldn’t come due to a visa issue and my husband didn’t know how to cook, so we hired a Yue-Sao. She stayed three hours every morning for a month to cook Zuo Yue Zi meals for me. She was a nurse back home, so she is professional and knowledgeable. She is my consultant for postnatal practices.” (p. 6)
	Immigrant women from 9 different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Limited and inadequate health information negatively influenced access to maternity health services [61]	“The thing is, when people come here, because they have no idea about community resources, they don’t go. They don’t come” (HCP-Rural Town), (p. 7)
	Newcomer women N = 140 Canadian-born women N = 1137	Low levels of pregnancy knowledge negatively influenced pregnancy outcomes and experiences [23]		No differences in newcomer ability to access prenatal care compared to Canadian-born women, but fewer received information regarding emotional and physical changes during pregnancy (87% vs. 95%, p < 0.001)—less from friends (10% vs. 20%), more from books (27% vs. 17%), more from nurses (20% vs. 13%), less from family doctors (10% vs. 15%). Rates of C-sections higher for newcomers (36.1% (95% CI 28.2, 44.8) vs. 24.7% (95% CI 22.2, 27.5), p = 0.02), and more likely to be placed in stirrups for birth and have an assisted birth
				Less likely to report “very satisfied” with care received since birth (p = 0.03)
	Muslim, West and South Asian immigrant women N = 30	Limited knowledge about cervical cancer and screening guidelines limited access to screening [67]	“I have a question, what do you mean by screening? Is it a different program than when we go to family doctor and we do a check-up, we do blood testing?” (p. 5)
			“So my family doctor has to ask me to do this? May be sometimes I’m not at risk so my doctor does not do it. Right?” (p. 5)
Positive and negative experiences with health personnel	Chinese im/migrant women N = 13	Informed HCPs improved access to postpartum care [52]	“My midwife… felt that I was relatively weak due to having a Caesarean, so in the ten days after giving birth, she came to my home three times, that’s why I did not need to go out to see the pediatrician on my own”(P8 (p. 390)
			“The community nurses here visit about one hour each time. They would recommend a better place to breast- feed, which posture is better, and they would check if the baby is feeding correctly. She would help you like a postpartum doula. The second time they will call first to ask if you need anything. If there is a need she will come again”(P1)(p. 390)
	Im/migrant women N = 15 HCPs N = 5	Positive interactions with HCPs facilitated perinatal experiences [53]	“…the women describing the nurses as playing a positive and important role in making the childbirth experience less scary by monitoring the women’s labor, encouraging and coaching the women, providing massage, and offering explanations about the stages of labor.”(p. 296–297)
	HCPs N = 10	HCPs that specialized in refugee health and practice diverse strategies of care improved maternity care experiences [55]	“P8: [community-based organization] is extremely well supported with other disciplines. So, we work closely with the social workers and they’re very instrumental in helping provide supports, just resources, physical resources, but also trying to get the social supports in place to.”(p. 7)
	African, Caribbean and Black women living with HIV N = 173	Factors influencing engagement in and continuity of HIV care subsequently affected quality of life (QOL) [57]		Bivariate correlation results: Age not significantly associated with QOL for African, Caribbean and Black women living with HIV, but income associated with significantly higher overall QOL and social environments and relationships
				Engagement in and continuity of HIV care was significantly associated with QOL (p = 0.003)
	Chinese im/migrant women N = 13	Barriers to implementing traditional postpartum practices due to unregulated, unreliable paid helpers and uninformed, insensitive providers [52]	“[The postpartum doula] has been paid in cash already, and she does not have a license or belong to a postpartum organization, so it is completely non-binding. And we cannot do ten “zuo yue zis” in a lifetime…To Chinese people “zuo yue zi” is done once or twice, at most three times, so postpartum doulas do not mind whether they have recurring customers…You have heard a lot of bad reports. After all, in this market the supply is less than the demand, that is, there are more mothers seeking postpartum doulas and there are less postpartum doulas” (P8) (p. 390–391)
			“[The nurse said]...“Why do you not take a shower?” I felt I was being judged and thought of as “How come you’re so dirty?” Not only was her facial expression clear, her tone of voice was quite obvious to make me feel very uncomfortable” (P8) (p. 391)
	Health and academic personnel N = 237	Negative perceptions of im/migrants by HCPs contribute to stigma and discrimination in maternity care [77]	“Some healthcare workers perceive uninsured migrants as “deserving” of universal access to healthcare
			Negative perceptions of migrants coupled with pragmatic considerations push most workers to view the uninsured as “undeserving” of free care
			For most participants, the right to healthcare of precarious status immigrants has become a “privilege”, that as taxpayers, they are increasingly less willing to contribute to.”
	Im/migrant women N = 15 HCPs N = 5	Negative interactions with HCPs limited women’s access to perinatal services [53]	“I had lots of pain and I was not in condition to stand up but they said, “No, you have to stand up.” I tried [but] when I stood, I had so much pain that I fell down. The nurses don’t really care what happens to the patients. The nurses told me that you should do your things yourself.” (p. 297)
	Im/migrant women from nine different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Short consultation times, a lack of confidentiality and informed consent, and insensitivity from HCPs limited access to maternity care [61]	“I also have another client who has been hospitalized many times and people will come to visit her, and some people are curious and they will go to the front desk and ask: What happened to her? Why is she sick? And the nurse out loud told them.” (HCP-FGI-Urban Town) (p. 9)
			“Oh. Okay. Do you feel painful?” “No.” “Okay, you can go.” Like I don’t care. That’s the information but, I don’t care about you. Just the doctor in this way, just cold.” (IW-Urban Town) (p. 9)
	South Asian im/migrant women N = 22	Lack of supportive services for intimate partner violence (e.g. trust, non-judgmental) prevented access to care [56]	“Everyone here is telling you more or less that they spoke to the doctors, I think that doctors should be part of the circle that if they get a clue that a lady is going to be abused he should double-check, or confirm. The doctors should be part of the system to check for woman abuse” (FG1, p. 11) (p. 619)
	HCPs N = 10	Expectations of provider type and level of professionalism negatively influenced access to prenatal care [75]	“First-generation immigrants often avoid midwifery care, because they see midwifery care where they come from is the lowest level of obstetric care…. They come here, and they have access to the big shiny hospital and the big shiny obstetrician and, in their country, that is a symbol of status and success and probably does reflect good healthcare. So, why would you go to a midwife? You wouldn’t do that. You would go to the big shiny place.” (p. 567)
			“Well, you’re a nurse. How can you be looking after me? You are not a doctor. I need to see the doctor.” And, “I am getting second-rate care because I am seeing a nurse, just a nurse.” (p. 567)
	Im/migrant Muslim women N = 6	Insufficient care provided by HCPs negatively influenced access to maternity health services [78]	“Some women felt that they received inadequate support or inattentive care. One participant reported that when she needed assistance, she found a nurse “reading a fashion magazine and drinking Tim Horton’s [coffee].” (p. 105)
	Refugee claimant women from 5 different countries N = 112	Inadequate assessments by nurses created challenges in postpartum care [62]	“She did not mention it [skipping meals] because the [nurse] had not asked.” (p. 288)
	HCPs N = 10	Lack of coordination, and HCP’s unfamiliarity with refugee health and inability to address needs created barriers to maternity care [55]	“P7: Not a lot of [health care professionals] take the extra step to look at what’s going to happen when the baby’s born […] sometimes you need the physician who’s the first point of care often for the patients, to recognize their social concerns in terms of you know social detenninants of health […] so that you can refer her to the proper resources because she is so vulnerable, and it’s really common that these women don’t get any services.” (p. 8)
			“P9: Sometimes our [refugee] patients even ask us in triage like financial concerns, and I don’t know what to say at all. Like that’s something I would like to be more educated on, like what kind of services are available to you [refugees].” (p. 10)
Language barriers, and availability of culturally safe and language-specific care	Family planning HCPs N = 9	Language barriers and judgment in family planning and reproductive health services limited access [71]	“Well, language is a huge barrier… A lot of times women, even if they speak a little bit of English, you know I try to encourage them to go to another clinic because they haven’t had a checkup for, you know, god knows how long. The thing is always that ‘there are some things I want to discuss that I won’t know how to say in English. I may not understand what they are telling me.” (Canadian health care worker) (p. 374)
			“I have two Afghani women … and both of them thought they might be pregnant and want abortions. So they came on their own, and they actually didn’t want interpreters because they were worried that the interpreters would judge them because they believed in their interpretation of their religion that you cannot have access to, well, abortion services in general.” (Physician at community health center) (p. 375)
	Im/migrant Muslim women N = 6	A lack of awareness of religious and cultural practices hindered access to maternity health services [78]	“Like when I was pregnant during Ramadan [the month of fasting] and I asked my doctor about fasting. She told me ‘I don’t like to tell you not to fast.’ I prefer if there can be some Muslim physician who can give them more information about such topics. They don’t understand it. If they have more ideas about the issue it will be better.” (p. 107)
	Family planning HCPs N = 9	Misconceptions and a lack of knowledge impacted family planning access experiences [71]	“The other thing I find totally doesn’t fly with the immigrant women … a lot of them don’t look down there, they don’t touch down there, they are so ashamed…” (p. 377)
			“So it has been an uphill battle to explain about birth control and family planning. The notion of actually being able to make those decisions is also quite new to many couples. Even as a couple, because often it is traditionally seen as God’s will… [T]hat’s over quite a range of countries throughout the world.” (p. 377)
	Sri Lankan Tamil community leaders and im/migrants, assisting im/migrant women’s access to formal support for abuse N = 16	Lack of knowledge of available services due to language barriers limited access to intimate partner violence support [70]	“Maybe the woman has language issues. If she is a woman who has contacts outside, who’s going outside, and being able to talk to someone, she will know about services. Other women have no way to know who does what and what helps.” (p. 72)
	Latin American im/migrant women N = 25 [permanent residents (N = 11), refugee status claimants (N = 10)]	Language barriers and a lack of appropriate translation services created challenges in HIV/STI services [69]	“Health centres sometimes offered translating services but when unavailable, women had to find someone who could accompany them to their appointments, which created confidentiality issues. Moreover, many women felt uncomfortable talking about sexual and reproductive health matters in the presence of a translator.” (p. 421)
	Muslim, West and South Asian im/migrant women N = 30	Different religious and cultural beliefs, language barriers and a preference for female physicians negatively shaped cervical cancer screening experiences [67]	“Health Care Connect program only ask for location preference, where you live, and then they will try to match in your area. You couldn’t set up for any other preferences. We usually have to find female doctors through friends and family.” (p. 7)
			“There are GP’s who, I guess there are less culturally sensitive. I guess that’s what it is—we go to the doctor with our moms, and I’m not married and I’m not comfortable when my GP says “are you sexually active?” and my mom is sitting beside me. No I’m not!! (Laughs). So, that’s why it’s nice for a lot of us to choose a GP that’s are from our own culture because they won’t ask questions like, “are you sexually active?” (p. 7)
	New im/migrant women N = 11	Embarrassment, preference for female clinicians, and language barriers limited cervical cancer screening [68]	“..and besides there are also the language barrier in this country right? ….how will I make the appointment? … and then when I have the appointment I don’t have someone who will translate for me, and I go looking and there are all these barriers… so someone really needs to have the desire to get it (Pap) done and realize that it’s necessary for her to do so.” (Sp/Sp) (p. 232)
			“Some cultural things affected,…big difference here. Back home, culturally… women is not married, she can’t talk about it like this.” (Ar/Eng) (p. 232)
	HCPs N = 63	Communication challenges due to background and social conditions negatively influenced access to maternity care for newly-arrived women [74]	“Maybe it’s me, but I think that the sociocultural beliefs are the toughest ones because you may need proper language to ask for the appointments and you may count or not on some family or friends to explain to you how to get into the health care system, unknown to you, that’s true. But now, when it comes to sociocultural issues it’s really hard for them because in addition to not having the language and feeling isolated, the only way you have to be emotionally linked to your family is by means of your rituals, your traditions, your beliefs. And for different reasons, usually genuine reasons, we have a hard time to respect them.” (p. 5)
	Immigrant and refugee women N = 30	Limited understandings of PPD and community beliefs around mental illness limited access to postpartum care and treatment of PPD [28]	“We don’t have all the circumstances that lead to this. Some of the women will get depressed, but you have your family support, everyone around you, you don’t feel lonely. So it’s really different, here you’re alone and struggling with the baby and don’t know how to seek help … we don’t know all the sources for help, that’s the difference.” (p. 306)
	Im/migrant women from 9 different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Cultural shock and communication barriers hindered access to maternity health care [61]	“… sometimes when we get into hospital … they speak very, like very fast English, and being new to the country you don’t—you are not really used to the accent, you know. And so, and they are scared to ask questions. (IW-FGI-Urban Town)” (p. 8)
			“It’s usually more on the gut feel that this person has no idea what you are talking about, no matter how slowly and simple you explain it. It’s just not getting through … I had someone send one of my patients for a triple screen which came back nicely with a positive for Down Syndrome and I couldn’t explain that in Arabic. (HCP-Rural Town)” (p. 8)
	Newcomer Chinese women N = 15	Limited linguistically and culturally sensitive health services presented barriers to accessing maternity care [54]	“I am worried about the process of delivery. I feel safe if someone can explain to me what’s going on using the language I understand.” (p. 4)
	HCPs N = 10	Expectations around culturally appropriate translation, interpretation services, and cultural awareness negatively impacted prenatal care experiences [75]	“Care is also compromised by people simply not understanding what the words mean and understand…so, sometimes, with people who don’t understand English words, so it is hard, so they can’t translate. And even if they can translate, sometimes they still don’t understand the word. That can be very difficult.” (HCP)(p. 565)
			“Many Muslim women… [will assume] that they can be guaranteed a female [provider]. And some of them also don’t want any learners, and we are a teaching site, so they don’t want any medical students or residents… sometimes they will settle: ‘Okay, I will have the male doctor if need be for my delivery, if that is who is on, but no male learners.’ And so, some of them will be… really forceful in that regard, trying to insist, thinking we will call in one of the female physicians.” (HCP) (p. 566)
	HCPs N = 10	Preference for female providers, differences in medical practices, and language barriers influenced access to maternity care [55]	“P2: I think probably the biggest challenge is no male physician for the delivery, and we cannot guarantee that. It’s not the way it works in Canada […] if she goes into hospital and there’s an emergency, it may be a male OB doing the C-Section or you know, helping out with the shoulder dystocia right or whatever it might be.” (p. 7)
Social isolation and support	Chinese im/migrant women N = 13	Support from family members, friends and partners facilitated postpartum care experiences [52]	“If my family is around, I would not let them leave in such a short time. Instead, I would ask my mother-in- law to stay for at least three months. I will not tell her to go after only one month of “zuo yue zi” (P12) (p. 389)
			“If during “zuo yue zi”, couples are able to work together to survive and to take care of the baby, this may solidify the couple for the future… If two people are truly able to understand each other, this may be a help to their future, because the wife may not understand her hus- band’s expression of love but she can experience the process of re-shaping the family values” (P5) (p. 389)
	Im/migrant women N = 15 HCPs N = 5	Support from husbands and family members facilitated women’s perinatal experiences [53]	“My husband used to help me so I didn’t have a lot of pressure. After coming from my work, I used to make just the vegetables. Even vacuuming, he used to do and if there was need to clean the kitchen with the broom, he used to do that too. My husband used to say, “It’s not important to clean the house, I will take care of it. Just rest because you are tired from work.” If the woman has to do the outside work as well as the work at home, it can be very difficult.” (p. 296)
			“At the first baby, one doesn’t know what happens. If there is an elderly person in the house, that person can tell about the circumstances, as my mother-in- law [did], who recently came [to Canada] towards the end.” (p. 296)
	Chinese im/migrant women N = 13	Lack of social support posed problems in implementing traditional practices in postpartum care [52]	“[my husband] has to get up at six or seven and when he gets home from work around five or six in the evening, he has to help me take care of the baby so he is… quite exhausted” (P12). (p. 391)
	Recent im/migrant women (< 5 years) N = 5703 Non-recent im/migrant women (> 5 years) N = 12,355 Canadian-born women N = 57,805	Less perceived social support during pregnancy or postpartum for im/migrant women leading to higher rates of postpartum depression symptoms [51]		Im/migrant women more likely to report high levels of postpartum depression symptoms (13.2% vs. 6.0%), less likely to have access to social support (74.1% vs. 90% during pregnancy, 67.8% vs. 87.1% during postpartum). Recent and non-recent immigrant women had different experiences—duration of residence in Canada played a role in maternity experiences
	Domestic violence service providers N = 32 Advocates and social service professionals N = 24 Im/migrant women from four different communities N = 21	Lack of social support prevented women from leaving intimate partner violence [79]	“For me, I didn’t know what to do—afraid, but I was afraid. Still am. Sometimes they say you have to leave him. Leave him! Where would I go? I don’t know anyone else in Canada”. (Spanish Woman) (p. 338)
	South Asian im/migrant women N = 22	Loss of social support after migration delayed help seeking for intimate partner violence support [56]	“(after being abused by partner) Here we just stay inside of the house scared not even calling anyone. What we are thinking at that time is what can I do? Where can I go? I don’t have anyone of my own over here.” (FG3, p. 4) (p. 617)
			“When I first came here my in-laws were in the house… they used to lock the door on me so I could not get out… and they did something to the phone. We could get incoming calls but couldn’t make outgoing calls, [after a year of being beaten by her husband] I looked into my neighbours house from my window and told her… can you call 911… the police came and broke the lock of my door” (FG1, p. 6) (p. 617)
	Im/migrant women from nine different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Lack of social support and feelings of isolation as barriers to maternity health care [61]	“I was in my eighth month I was still working. You know why? Because I don’t have anyone in the house. I was actually worried that I might give birth here and then I don’t have anybody.” (p. 7)
Immigration-specific factors	Women at low-risk for unplanned caesareans Cases: unplanned caesareans N = 233 Controls: delivered vaginally N = 1615	Poor access to maternity care determined by various migration-related predictors of unplanned caesareans [81]		Predictors of unplanned caesarean: being from sub-Saharan Africa/Caribbean (AOR 2.37, 95% CI 1.02–5.51)
				Amongst women living in Canada less than 2 years (AOR 1.77, 95% CI 0.98–3.20), having a humanitarian migration classification increased risk (AOR 1.60, 95% CI 0.72–3.56)
	Immigrant women N = 22 Refugee women N = 8	Consequences of immigration policies and precarious immigration status hindered help-seeking for postpartum depression [26]	“In my heart I always worry that because my husband is still on a work visa and not a Canadian citizen it may affect our immigration application… that’s why I dare not seek any help. I really felt inferior and that’s why I had a feeling that we’re not supposed to get any help without a Canadian citizenship status. To be honest, my husband also faced a lot of unfair kind of treatment in work place. For the first year our lives were really bitter…we could not see any way out and each day was filled with worries and fearing we would be expelled from Canada.” (p. 719)
	HCPs N = 63	Barriers to maternity care influenced by migration journey and background, primarily precarious immigration status [74]	“…if you don’t have a Canadian status, well, you will have no rights at all, they have literally nothing, not even access to legal recourses because they cannot even claim for refugee status. These people, it’s sad what I am going to say, but they just live in the shadows, in all possible senses! And for migrant women who are pregnant, the ‘Canadian status’ is crucial because that opens or closes access to free health care. If you have a ‘Canadian status,’ no matter which one, you get access to care…” (p. 5)
	Uninsured refugee claimant and im/migrant women N = 175 Insured refugee claimant and im/migrant women N = 278	Most uninsured women received inadequate maternity care, with shorter lengths of hospital stays and higher rates of caesareans due to poor perinatal outcomes [63]		The number of prenatal visits reported for the uninsured group (mean = 6.04, t = −6.173, α = 0) was significantly lower, than for their insured peers (mean = 8.70). No difference was found between the uninsured and insured groups in health care service or treatment during delivery
	Domestic violence service providers (key informant interviews) N = 32 Advocates and social service professionals	Fear of immigration status repercussions and a reluctance of police intervention prevented women from leaving relationships with intimate partner violence [79]	“She is waiting for papers. That man knows she cannot go. That is why he always tortures her. She is afraid of everything”. (Bengali Woman)
	N = 24 Im/migrant women from four different communities N = 21		“Very frightening for women with little kids, involved with CAS, no status here. Trend coming up is that men are bringing their wives to Canada on a visitor visa, so they have no status, and the men have no plan on sponsoring them, dump them, no rights here, terrified, don’t know about legal aid, men withdraw sponsorship at last second” (Service Provider) (p. 339)
Stigma, discrimination and racism	Im/migrant women from nine different countries N = 33 Social service providers/stakeholders N = 18 HCPs N = 8	Perceived discrimination and stereotyping in maternity care led to negative patient experiences [61]	“When you are pregnant and if you are over 30… in the African community, the doctors scared to hell. You have to do this, you have to do that. You do this, we have to test this, we have to give you the amnio… so start talking to you about C-section.” (IW-FGI-Urban Town) (p. 10)
	Im/migrant Muslim women N = 6	Discrimination and insensitivity about religious practices acted as barriers to maternity health services [78]	“You see their faces. You feel it that they think you are stupid and you don’t know anything about this world.” (p. 107)
	Immigrant and refugee women N = 30	Workplace discrimination and stigma from HCPs negatively influenced postpartum depression experiences [28]	“I think it’s just in a square box and they don’t want to [look] beyond … there is no exception or consideration for people like me or other professionals that work and study. I did everything… to be honest I felt sometimes I have more capacity or eagerness to do things than Canadians living here. It is because everything is harder for us, twice or three times… so going through the process and having your credentials, it really bothered me, I think it is discrimination… (pp. 308–309)
	Sri Lankan Tamil community leaders and im/migrants, assisting im/migrant women’s access to formal support for abuse N = 16	Discriminatory and racist practices negatively shaped experiences and service delivery for intimate partner violence [70]	“I’ve heard many stereotypical ideas about visible minority people. The service providers’ way is to tell the women, “Do as I say.” If you don’t, the services are withheld or they don’t provide the services in the way the woman wants. Visible minorities are being treated differently…” (p. 75)
Gender inequities and power relations	HCPs N = 9	Unequal gender power dynamics limited family planning access [71]	“I have had lots of women when having a discussion about contraception say that they couldn’t possibly decide. They would have to talk to their husbands, or their husbands would be the ones to decide … That is just a difference in culture, the way that the families are organized. And sometimes it is an issue of power and control.” (p. 376)
	Latin American im/migrant women N = 25 [permanent residents (N = 11), refugee status claimants (N = 10)]	Unequal gendered power dynamics influenced women’s perceptions of HIV/STI risk and limited access to testing [69]	“The doctor told me: you have herpes. He told me it is a disease that I will have for life… I did not know what to do, I was left in shock. When I left to talk to Carlos, he made himself to be the victim. He made it seem like I was the one being needy, he treated me really poorly and made me feel ashamed.” (p. 420)
	Immigrant and refugee women N = 35 [immigrants (N = 22), refugees (N = 8)]	Gender roles, relationship dominance and control hindered access to postpartum mental health services [26]	“I was evicted by my husband. He pushed me out of the house. The police took me to the YWCA. He took away a lot of my things I really treasure. He wouldn’t let me learn new things or let people help me. My husband would teach me a lot of things the wrong way… like wrong ways of thinking and he made me sign papers. Only now I know it’s the wrong way…” (p. 720)
			“According to Indian culture, men are the wage-earners and women stay at home and take care of their kids. So if the man is earning good, and the woman is working, she’s looked down upon by some elderly people in the household. It’s the woman’s responsibility to take care of the baby completely. If I’m going to work and my baby is getting sick often, then the elderly family members expect I quit my job and take care of my baby. They don’t expect my husband to do the same. If your husband stays home and if the wife goes out for work, it’s kind of looked upon as weird. That’s not the norm, according to the culture.” (p. 721)
	South Asian im/migrant women N = 22	Rigid gender roles and familial expectations (e.g. marriage obligations, expected silence) limited help seeking for intimate partner violence [56]	“Oh, I was told that you are a woman, you can change your husband, you can change your kids, it’s in your hands. If you cannot do it that means you don’t have the quality of a woman, you’re not real woman (other women are agreeing).. You aren’t capable of doing, (participant is crying).as if everything is my fault you know?” (FG3, p. 8) (p. 617)