Immigrant experiences of harm in sexual and reproductive healthcare in Spain

The medical encounter represents a site where patients may be harmed, with intersecting vulnerabilities shaping the risk and nature of this harm. Sexual and reproductive healthcare is an important site for exploring this dynamic. Questions concerning how immigrant women experience sexual and reproductive healthcare abound, with researchers and practitioners calling for greater attention to a population whose experiences are underrepresented in existing literature. As a case site, Spain is a high migration country with a stressed healthcare system where 'good' biomedical outcomes are complicated by institutional and routinised failures in patient care. Semi-structured interviews were conducted with 121 respondents concerning health experiences since immigrating to Spain. This paper draws from 69 respondents, primarily from the Philippines, the Americas, and Europe. Overarching themes included: 1) practitioners expressing dismissive attitudes; 2) practitioners behaving inappropriately and with prejudice; 3) practitioners failing to respect patient autonomy and consent; 4) practitioners mistreating patients during procedures. These issues recurred across treatment contexts, including diagnosis, routine examinations, preventative care, pre-natal care, abortion, pregnancy loss, and childbirth. Consequences include delayed and missed care, physical and psychological harm, and implications regarding migratory, medical, and reproductive futures. Informed by feminist scholarship, this study considers the identities, relations, and practices which contour this institutionally produced harm. The study provides recommendations for improvements in medical training and clinical practice based on identified failures in the care of immigrant patients.