Healthcare providers' approaches to sexual function in women with migration histories: a qualitative study using...

Sexual function (SF) remains a critically neglected dimension of Sexual and Reproductive Health (SRH), particularly for Women with Migration Histories (WMH), who face intersecting cultural, institutional, and systemic barriers to care. Despite global health frameworks positioning sexual wellbeing as integral to holistic health, SF is rarely integrated into routine SRH practice. This study examines healthcare providers' approaches to SF in the clinical care of WMH in South Australia (SA).

An exploratory qualitative design was employed, using semi-structured interviews with ten SRH providers in SA, including nurses, allied health professionals, and a gynaecologist. Participants were purposively sampled for their experience in caring for WMH. Data were analysed thematically using NVivo. An adapted version of the Andersen Behavioural Model of Health Services Use (ABMHSU) was applied to guide the development of the interview guide and structure the analysis across three domains: predisposing factors, enabling resources, and need-related factors.

Providers described limited engagement with SF in routine clinical care, which remained focused on reproductive control. They identified predisposing barriers operating within the clinical encounter, including taboos and stigma surrounding sexual health, marginalisation, mistrust, and communication difficulties shaped by cultural and linguistic distance. Enabling resources were undermined by Medicare ineligibility, financial hardship, interpreter-related concerns, and fragmented care pathways. Need-related barriers included system strain limiting timely responses and restricted access to culturally appropriate sexual therapy. Together, these interconnected barriers were perceived to reinforce the marginalisation of SF in SRH care for WMH.

Incorporating SF into routine SRH care for WMH requires coordinated improvements at both the service and provider levels. At the service level, modifiable strategies include culturally tailored SRH literacy, interpreter-sensitive communication, system navigation support, and Medicare-funded, culturally adapted sexual therapy. At the provider level, addressing personal discomfort, insufficient training, and concerns about cultural appropriateness requires comprehensive, mandatory training in trauma-informed and culturally safe care, supported by centralised and accessible resources. Together, these interventions are critical to improving SRH service provision and utilisation, sexual autonomy, health literacy, consumer satisfaction, and overall quality of life for WMH.