Impact of Displacement on Refugee Women's Sexual and Reproductive Health: A Participatory Study Using Photovoice.

Objective: To explore how displacement impacts the sexual and reproductive health (SRH) of refugee women.

Design: Participatory photovoice study integrating photography with qualitative inquiry.

Setting: Conducted online between February and May 2024.

Population: Six refugee women formerly residing in Moria Reception and Identification Centre or Mavrovouni Closed Controlled Access Centre on Lesbos, Greece, now seeking asylum across Europe and the United States.

Methods: During the participatory photovoice study, participants (N = 6) took photographs reflecting the impact of displacement on their SRH and mental health. Visual data were explored in three focus groups and five in-depth interviews. Participants grouped photographs into themes, with additional thematic coding by the academic researchers. An intersectional lens guided the analysis.

Results: Thirty-six photographs, many including nature symbolism, illustrated how displacement shaped SRH experiences, healthcare-seeking behaviour and access to care for gender-based violence, female genital mutilation/cutting, family planning and menstrual, maternal, and gynaecological health. Eight themes emerged: bodily autonomy, instability, living conditions, social support, celebrations, healthcare access, resilience, and finding purpose. While displacement exacerbated SRH needs and undermined bodily autonomy, the instability of the asylum process led to deprioritisation of healthcare-seeking. Illness was only experienced until a sense of safety was established. Access to healthcare was compromised by language barriers, undignified treatment, and financial constraints. Despite challenges, narratives highlighted resilience, community, and personal growth.

Conclusions: Trauma-informed, culturally sensitive healthcare is essential for SRH equity among refugee women. Refugee-led visual research offers a transformative tool for knowledge production and advocacy.