The Who, What, Why and When of Gynaecological Referrals for Refugee Women

  • Sarah L. Silverberg
  • Lacey Harding
  • Rachel F. Spitzer
  • Meb Rashid
Original Paper


Refugees have health needs relating to unstable living situations and poor access to care. We examined the nature of health problems requiring gynaecological referrals for refugee women in Toronto. A retrospective cohort design was used to examine gynaecologic referrals of women at a refugee clinic between December, 2011 and June, 2016. The primary outcome measure was the indications for gynaecological referral. 125 out of 1040 women received a gynaecologic referral for 131 unique concerns. The most common referrals were for abnormal uterine bleeding and cervical dysplasia. Fibroids were prevalent amongst African patients, while referrals for LARCs/sterilization were absent from Middle Eastern patients. 26% of patients referred had a sexual violence history. Refugee women exhibit gynaecologic needs similar to the broader population. Needs vary by geographic origins. As global conflicts shift, so too will this population’s needs. High rates of sexual violence history reflect the need for further understanding and intervention.


Refugees Women’s health Gynaecology Primary health care 



We would like to thank the staff of the Crossroads Clinic at Women’s College Hospital.


  1. 1.
    Citizenship and Immigration Canada. Facts and figures 2013—immigration overview: permanent residents. Ottawa: Citizenship and Immigration Canada; 2014. Available at: Accessed 17 Sept 2016.
  2. 2.
    Citizenship and Immigration Canada. #WelcomeRefugees: key figures. Ottawa: Citizenship and Immigration Canada; 2016. Available at: Accessed 11 Nov 2016.
  3. 3.
    Beiser M. The health of immigrants and refugees in Canada. Can J Public Health. 2005;96(Suppl 2):S30–44.PubMedGoogle Scholar
  4. 4.
    Mckeary M, Newbold KB. Barriers to care: the challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523–45.CrossRefGoogle Scholar
  5. 5.
    Gushulak BD, Pottie K, Hatcher Roberts J, Torres S, DesMeules M. Canadian Collaboration for Immigrant and Refugee Health: Migration health in Canada: health in the global village. CMAJ. 2011;183(12):E952–8. Scholar
  6. 6.
    Johnson-Agbakwu CE, Allen J, Nizigiyimana JF, Ramirez G, Hollifield M. Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care. Psychol Serv. 2014;11(4):470.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    DesMeules M, Gold J, McDermott S, Cao Z, Payne J, Lafrance B, et al. Disparities in mortality patterns among Canadian immigrants and refugees, 1980–1998: results of a national cohort study. J Immigr Health. 2005;7(4):221–32.CrossRefPubMedGoogle Scholar
  8. 8.
    Kandasamy T, Cherniak R, Shah R, Yudin M, Spitzer R. Obstetric risks and outcomes of refugee women at a single centre in Toronto. J Obstet Gynaecol Can. 2014;36(4):296–302.CrossRefPubMedGoogle Scholar
  9. 9.
    Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824–925.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ng E, Wilkins R, Gendron F, Berthelot J-M. Dynamics of immigrants’ health in Canada: evidence from the National Population Health Survey. Healthy today, healthy tomorrow? Findings from the National Population Health Survey. Issue 2. Catalogue No. 82–618-MWE2005002. Ottawa: Statistics Canada; 2005.Google Scholar
  11. 11.
    Lesjak M, Hua M, Ward J. Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies. Aust NZ J Public Health. 1999;23(2):168–73.CrossRefGoogle Scholar
  12. 12.
    Taylor VM, Schwartz SM, Jackson JC, et al. Cervical cancer screening among Cambodian-American women. Cancer Epidemiol Biomarkers Prev. 1999;8(6):541–6.PubMedGoogle Scholar
  13. 13.
    Kerssens JJ, Bensing JM, Andela MG. Patient preference for gender of health professionals. Soc Sci Med. 1997;44:1531–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Delara M. Social determinants of immigrant women’s mental health. Adv Public Health. 2016. Scholar
  15. 15.
    Aptekman M, Rashid M, Wright V, Dunn S. Unmet contraceptive needs among refugees Crossroads Clinic experience. Can Fam Physician. 2014;60(12):e613–9.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, et al. Bridging the gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implement Sci. 2015;10(1):62.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Pottie K, Janakiram P, Topp P, McCarthy A. Prevalence of selected preventable and treatable diseases among government-assisted refugees: implications for primary care providers. Can Fam Physician. 2007;53(11):1928–34.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Wiedmeyer M, Lofters A, Rashid M. Cervical cancer screening among vulnerable women: factors affecting guideline adherence at a community health centre in Toronto, Ont. Can Fam Physician. 2012;58(9):e521–6.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R. Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada. Prev Med. 2007;44(6):536–42.CrossRefPubMedGoogle Scholar
  20. 20.
    United Nations High Commissioner for Refugees. Sexual and gender-based violence against refugees, returnees and internally displaced persons: guidelines for prevention and response. New York: United Nations; 2003.Google Scholar
  21. 21.
    Freedman J. Sexual and gender-based violence against refugee women: a hidden aspect of the refugee “crisis”. Reprod Health Matters. 2016;24(47):18–26.CrossRefPubMedGoogle Scholar
  22. 22.
    Benoit C, Shumka L, Phillips R, Kennedy M, Belle-Isle L. Issue brief: sexual violence against women in Canada. Ottawa: Federal-Provincial-Territorial Senior Officials for the Status of Women; 2015. Accessed 1 Oct 2016.
  23. 23.
    Government of Ontario. Changing attitudes, changing lives: Ontario’s sexual violence action plan. Toronto: Government of Ontario; 2011. Accessed 23 Sept 2016.
  24. 24.
    García-Moreno C. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization; 2013. Accessed 1 Oct 2016.
  25. 25.
    StataCorp. Stata statistical software: release 14. College Station: StataCorp LP; 2015.Google Scholar
  26. 26.
    Tiong AC, Patel MS, Gardiner J, Ryan R, Linton KS, Walker KA, Scopel J, Biggs BA. Health issues in newly arrived African refugees attending general practice clinics in Melbourne. Med J Aust. 2006;185(11–12):602–6.PubMedGoogle Scholar
  27. 27.
    Sami S, Williams HA, Krause S, Onyango MA, Burton A, Tomczyk B. Responding to the Syrian crisis: the needs of women and girls. Lancet. 2014;383(9923):1179–81.CrossRefPubMedGoogle Scholar
  28. 28.
    Adams KM, Gardiner LD, Assefi N. Healthcare challenges from the developing world: post-immigration refugee medicine. BMJ. 2004;328(7455):1548.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rousseau C, Pottie K, Thombs B, Munoz M, Jurcik T. Post traumatic stress disorder: evidence review for newly arriving immigrants and refugees. Can Med Assoc J. 2011:1–11.Google Scholar
  30. 30.
    Conry JA. Every woman, every time. Obstet Gynecol. 2013;122(1):3–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Massey Z, Rising SS, Ickovics J. Centering pregnancy group prenatal care: promoting relationship-centered care. J Obstet Gynecol Neonat Nurs. 2006;35:286–94.CrossRefGoogle Scholar
  32. 32.
    Cancer Care Ontario. Ontario cervical screening program 2012 report. Toronto: Cancer Care Ontario; 2014. Accessed 1 Oct 2016.
  33. 33.
    Society of Obstetricians and Gynaecologists of Canada. Position statement: federal budget cuts to interim federal health program. Ottawa: Society of Obstetricians and Gynaecologists of Canada; 2012.Google Scholar
  34. 34.
    Degni F, Koivusilta L, Ojanlatva A. Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland. Eur J Contracept Reprod Health Care. 2006;11(3):190–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Davidson AS, Fabiyi C, Demissie S, Getachew H, Gilliam ML. Is LARC for everyone? A qualitative study of sociocultural perceptions of family planning and contraception among refugees in Ethiopia. Matern Child Health J. 2017;21(9):1699–705.CrossRefPubMedGoogle Scholar
  36. 36.
    Gagnon AJ, Carnevale FA, Saucier JF, Clausen C, Jeannotte J, Oxman-Martinez J. Do referrals work? Responses of childbearing newcomers to referrals for care. J Immigr Minor Health. 2010;12(4):559–68.CrossRefPubMedGoogle Scholar
  37. 37.
    Kobeissi L, Araya R, El Kak F, Ghantous Z, Khawaja M, Khoury B, Mahfoud Z, Nakkash R, Peters T, Ramia S, Zurayk H. The relaxation exercise and social support trial-RESST: study protocol for a randomized community based trial. BMC Psychiatry. 2011;11:142.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Department of Obstetrics and GynaecologyUniversity of TorontoTorontoCanada
  3. 3.Department of Obstetrics and GynaecologyMount Sinai HospitalTorontoCanada
  4. 4.Department of Family and Community Medicine, Women’s College HospitalUniversity of TorontoTorontoCanada

Personalised recommendations