Beyond Borders: Exploring the Lived Experiences of International Migrant Women in Nigeria, a Deep Dive into Healthcare Realities and Utilization

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A qualitative case study-oriented research design was employed, involving in-depth interviews with 21 migrant women of reproductive age and 4 key informant interviews with healthcare workers in the Ayobo community of Lagos State, Nigeria. Data collection occurred from June to September 2018, and thematic analysis was used to interpret the findings. Three main themes emerged: living conditions, pattern of healthcare utilization, and factors influencing accessibility and utilization of healthcare facilities. Living conditions were characterized by housing instability, limited access to clean water and sanitation, and financial constraints. Migrant women demonstrated a preference for traditional remedies over formal healthcare due to cultural beliefs and perceived effectiveness. Recommendations from peers and family members influenced healthcare decisions. Targeted public health interventions are needed to address the multifaceted challenges faced by migrant women, including improving housing conditions, providing access to clean water and sanitation, and promoting culturally sensitive healthcare programs. Gender Studies Sociology Health Policy migrant women healthcare-seeking behaviors public health urban slum Nigeria Introduction The accessibility and utilization of modern healthcare services pose significant challenges for poor households in Sub-Saharan Africa, particularly in areas where affordable and high-quality healthcare is scarce, and access to health insurance is limited (Ackerson and Zielinksi, 2017; Alam et al., 2015; Kiwanuka et al., 2008). Studies have shown that residents of informal settlements in sub-Saharan Africa, as well as regions in Asia and Latin America, lack access to fundamental social infrastructure including clean water, electricity, well-maintained roads, sanitation facilities, high-quality education, healthcare services, and proper waste management systems (Satterthwaite et al., 2019; Zerbo et al., 2020). In Nigeria, the substantial majority of health expenditure, exceeding 70% of approximate $10 per capita health expenditure, is attributed to private out-of-pocket expenditure (Uzochukwu et al., 2015). Reliance on out-of-pocket expenditure significantly hinders the equitable access to high-quality healthcare services, particularly within urban slum areas (Owusu et al., 2008). Nigeria, as a third world nation, has been found to have areas characterized by slum settlements (Akinwale et al., 2014; Zubair et al., 2015). Numerous urban residents, unable to afford decent living accommodations due to factors such as the high costs associated with owning their own homes, steep rental prices, and exorbitant expenses related to acquiring urban land, had sought shelter in slums despite their challenging living conditions often likened to a “near-hell-status” (Pat-Mbano & Nwadiaro, 2012: 258). Urbanization often leads to the proliferation of slum areas and a concentration of vulnerable populations within these settlements (Tacoli et al., 2015; Zulu et al., 2011). In the Lagos megacity of Nigeria, a significant number of migrant women residing in slums belong to lower socioeconomic classes (Akpabio et al., 2021; Badmos et al., 2020). These women migrate to the city with hopes of improving their livelihoods (Owusu et al., 2008). However, limited education, skills, and work experience restrict employment opportunities for migrant women, confining them to low-paying jobs such as construction labor, domestic service, casual factory work, and petty trading (Adeosun et al., 2023). Due to minimal incomes, these women are often compelled to live in slum areas, enduring unsanitary and unhygienic conditions (Corburn & Hildebrand, 2015). They often navigate their daily lives with only the most essential resources and provisions (Soliman, 2023). Even those with some financial means are often reluctant to invest in home improvements due to the temporary nature of their residence or the illegal occupation of public lands, coupled with the constant threat of eviction (Popoola et al., 2020). Thus, the quality of housing in slum areas remains poor (Omole, 2010). The substandard living conditions, characterized by overcrowding, poor sanitation, and occupational hazards, adversely affect the health of slum dwellers (Malik et al., 2020). Globally, poor women, particularly those in developing countries, exhibit the highest rates of mortality and illness (World Health Organization, 2009). This trend is evident in the health status of women and children in these communities (Fink et al., 2014; Mberu et al., 2016; Unger, 2013). A significant concern is the indifferent attitude of migrant women towards their own health and its management (Dias et al., 2012). They typically seek medical treatment only when health issues cause severe physical discomfort or impede their work performance (Ikechukwu et al., 2020). This neglect exacerbates their health problems and highlights the urgent need for interventions to improve the living and health conditions of migrant women in Lagos slums. Oftentimes, women in slum areas overlook minor health concerns (Desmond, 2012), and this poses serious implications for their health and well-being. The significance of health as a crucial economic concern for residents of slum areas, particularly women, cannot be overstated. Research has shown that an unhealthy physical environment in slums can lead to illnesses requiring medical attention, resulting in a loss of workdays and economic productivity (Prüss-Ustün et al., 2017). Barua (2014) highlighted that women in slum areas often experience various health issues such as joint pain, mental stress, white discharge, and acute fatigue, with many resorting to self-medication for treatment. These health problems are commonly attributed to factors like excessive workload, inadequate nutrition, and poor living conditions (Abdi et al., 2021; Nangia & Thorat, 2000). Furthermore, studies indicate that slum residents tend to ignore minor ailments and avoid seeking medical help when unwell (Das et al., 2018; Ezeh et al., 2017; van der Heijden et al., 2019). One key factor influencing the healthcare-seeking behavior of slum dwellers is the limited availability of healthcare facilities, leading to reliance on informal providers, and sale of medications at unauthorized outlets (Krishna, 2010; Shukla et al., 2019). In these settings, only a limited range of low-cost medicines is typically accessible, often sold in grocery stores without proper licensing (Goswami, 2014). Research indicates that the migrant population residing in slums often face challenges in accessing healthcare services (Kusuma et al., 2010). Disparities have been observed in the access and utilization of healthcare services between the general urban population and migrants, with inequities existing in healthcare access (Owusu & Yeboah, 2018; Park et al., 2022). Migrants are typically of lower socioeconomic status, less likely to be employed, and may reside in less secure housing compared to non-migrants (Coates et al., 2013; Owuor, 2007). Many migrant women who relocate to slum areas in search of employment opportunities often have lower levels of education compared to non-migrants (African Population and Health Research Center, 2014). They frequently find themselves economically inactive or engaged in low-wage and irregular employment following migration (Emina et al., 2011). These circumstances can make it difficult for them to provide adequate support for their children due to challenges such as inadequate housing (Gulyani et al., 2012; Meth, 2013), the risk of eviction (Beyer et al., 2016; Gulyani et al., 2012; Meth, 2013), and food insecurity (Faye et al., 2011). In the bustling community of Ayobo in Nigeria, a diverse population of migrant women navigate a landscape marked by both opportunity and challenge. Drawn by the promise of a better life for themselves and their families, these women grapple with a myriad of issues that impact their daily existence, with access to and utilization of healthcare being a critical determinant of their well-being and quality of life. Limited research exists on healthcare utilization and accessibility among migrant women in Nigerian slums. In order to address this gap, this study drew on a qualitative study to understand the patterns of healthcare utilization and factors influencing accessibility among migrant women in urban slums in Nigeria. The aim of the current study was to examine the level of access to healthcare services and utilization of health facilities in urban slum communities in Nigeria. The study was guided by three research questions: What are the features of living conditions of international migrant women in urban slums? What are the patterns of healthcare utilization among migrant women in urban slums? What are the factors that influence accessibility and utilization of health care facilities by migrant women in urban slums? Methods The foundation of this study was built upon firsthand field observations and investigations. The research adopted a qualitative case study-oriented research design, focusing on migrant women of reproductive age. The case study design is important for three reasons. First, it allows for a concentrated focus on meticulous and thorough data collection from multiple sources within a specific locale and targeted group (Bryman, 2008 ). Second, it emphasizes the importance of preserving and analyzing the contextual backdrop, which is crucial for conducting in-depth analyses (Gerring, 2007 ). Third, it is more valuable compared to research endeavors that seek superficial knowledge from diverse contexts, as it avoids the risk of conceptual stretching (Schutt, 2018 ). The study aimed to recruit 25–30 female participants, which was similar to previous qualitative inquiries in relation to healthcare access and utilization among women (Ganle et al., 2014 ; Ntoimo et al., 2019 ; Udenigwe et al., 2022 ). To be included in the study, participants needed to be migrant women of reproductive age who lived in Ayobo community of Lagos State, Nigeria where the study was conducted. Secondary data were utilized through a comprehensive review of pertinent literature, including books, articles, and reputable internet sources. The study location was Ayobo, a high-density suburban district in Alimosho local government area of Lagos State, south-western Nigeria. Situated at the border of Aiyetoro, Ogun State, Ayobo shares the Local Council Development Area with Ipaja. According to the 2006 census, the population of Ayobo was approximately 633,009 people (National Population Census, 2006). The selection of Ayobo for this study is strategically justified by its diverse migrant population, representative urban slum characteristics, healthcare access challenges, and the influential role of community dynamics (Opoko et al., 2015 ). These factors collectively provide a robust foundation for exploring the lived experiences of international migrant women and developing informed interventions to enhance their healthcare access and utilization. Recruitment of participants in this study proved challenging due to factors such as sensitivity, security concerns, and a reluctance to disclose information on research issues. The snowballing technique was employed, involving the identification and contact of initial interviewees who subsequently referred and introduced the research team to additional participants capable of contributing to the research. To mitigate bias and encompass varied perspectives, in-depth interviews were conducted at the household level from June to September 2018. Semi-structured, audio-recorded interviews lasting ~ 45 min were conducted face-to-face by Authors One and Two. The interview guide used with participants focused on three themes: living conditions in slum settlements, the nature of existing healthcare, and factors that influence accessibility and utilization of healthcare facilities in slum settlements. The interviews with health officers focused on the same topics, however, it was more focused on the challenges facing healthcare utilization and accessibility among migrant women in the study area. Data collection ended when there was sufficient information from the interviews to answer the research questions (Malterud et al., 2016 ). The transcripts from the audio recordings of the face-to-face interviews were transcribed by Author One and Author Two. Braun & Clarke's (2021) reflexive thematic analysis framework, consisting of six phases, was employed to interpret and derive themes from the data. This interpretive process took place both during and after data collection. Detailed notes were taken after each interview to capture key topics discussed, and data familiarization was an ongoing process during transcription. Coding and theme development were centered on the research questions. The researchers engaged in regular meetings to discuss data interpretation, theme construction, and the implications of the study findings. Results The study included a total of 25 participants, comprising 21 migrant women and 4 healthcare workers. Among the participants, the majority were women, with the exception of one male, the sole Medical Doctor in the study area. Participants' ages ranged from 22 to 48 years. They hailed from Togo, Benin, and Niger - neighboring countries to Nigeria. The duration of residence in the study area varied, with some participants having lived there for many years, while others had only recently moved. The anonymity of all interviewees was carefully maintained throughout the study. Living Conditions of International Migrant Women The living conditions of migrant women in impoverished urban slums reflect the challenges posed by inadequate housing, with many residing in makeshift and incomplete buildings that underscore the precarious nature of their accommodation arrangements. Despite facing substandard housing conditions, participants in the study demonstrated resilience and adaptability in navigating these challenges, emphasizing the fundamental importance of having shelter, regardless of its quality. The narrative shared by the following participant shed light on their experience of housing instability and the gradual process of improvement within their living environments: When I arrived in Nigeria in 2015, I lived in Agege with my husband and his friend. Our living condition was challenging, as we struggled with poor housing and limited resources. However, in 2016, we decided to relocate in search of better opportunities. Since then, we had welcomed three children into our lives. Despite the initial hardships, we are gradually improving our situation. Through perseverance and hard work, we are determined to create a better future for ourselves and our children. — 24-year-old migrant from Benin Republic Access to clean water emerged as a pressing concern among participants in the study, highlighting the challenges faced by migrant women and their families in securing a reliable water supply. Many reported relying on neighbors or nearby sources to fetch water, often enduring long distances or incurring costs to meet their daily water needs. The following participant described her water-fetching routine, stating that she obtains water from a source located about three houses away from her residence: I fetch water from a street tap, located about three houses away from my residence. Unfortunately, where I live lacks any facility for water access, leaving us dependent on communal sources for our daily needs. This absence of basic amenities adds an extra burden to our daily lives, requiring us to travel a distance to fulfill a fundamental necessity. Despite these challenges, we persevere, making the journey each day to ensure our family's access to clean water. — 22-year-old migrant from Togo Another participant, a mother of four, shared her experience of accessing water from a neighbor located in close proximity to her home, as well as getting help from fellow church members: I fetch water from one of my neighbors close to where I live. Fortunately, she graciously helps me, understanding the challenges we face. Being the wife of a Pastor, I receive support not only from my neighbor but also from fellow church members. During the period of my childbirth, they generously assisted me in fetching water, alleviating some of the burdens of daily life . — 31-year-old migrant from Togo Access to adequate sanitation facilities posed a significant challenge for participants in this study. Many described using makeshift or communal toilets, often situated within incomplete structures, highlighting the lack of proper sanitation infrastructure in their living environments. Waste disposal methods were also characterized by makeshift practices, with burning being a common strategy employed during dry seasons. However, the arrival of rainy seasons posed additional obstacles to waste management, particularly affecting disposal practices and access to designated refuse dumpsites. For example, the following participant shared insights into their living conditions, expressing concerns about the quality of their toilet facilities: My toilet situation is less than ideal. It is a source of embarrassment, especially when visitors come around. The makeshift setup within an unfinished building lacks privacy and basic hygiene standards. To manage waste disposal, particularly during dry seasons when the risk of disease is higher, we take precautions by burning our refuse. Despite these challenges, we try our best to maintain cleanliness and sanitation as best as we can under the circumstances. — 41-year-old migrant from Benin Republic Another participant provided further perspective on sanitation challenges within their living space. She described using a pit latrine shared by all occupants of their “ face-me-I-face-you ” residence, a specific type of housing in Nigeria where multiple one- or two-room apartments face each other along a common walkway leading to the main entrance of the building: The toilet is a pit latrine shared by all the occupants of my "face me I face you" house, a common arrangement in our community. However, for the sake of my children's hygiene, we use a potty (chamber pot) for their needs. Currently, there's no proper method for waste disposal. During the dry season, I resort to burning waste, but during the rainy season, disposing of it becomes a significant challenge. Complicating matters further, the land where we used to dump our refuse has been sold to someone planning to build a house there. This leaves us in a difficult situation, grappling with sanitation issues with limited options for waste management. — 30-year-old migrant from Niger Republic The living conditions observed among migrant women and their families have significant health implications. The prevalence of various ailments was attributed to environmental factors such as stagnant water bodies, poorly maintained surroundings, and inadequate waste management practices. The following key informant emphasized the crucial role of the environment in influencing the prevalence of illnesses within the community: The environment plays a significant role in the prevalence of certain ailments despite efforts to address them with medication. In our area, the presence of swamps, overgrown bushes, and dirty drainage creates an ideal breeding ground for disease-carrying mosquitoes like the female anopheles. Despite our efforts to counsel the community on the importance of cleanliness and hygiene, the persistence of these environmental factors continues to contribute to the ongoing health challenges we face. — 29-year-old Medical Doctor Pattern of Healthcare Utilization A notable trend observed among participants in this study was their preference for traditional remedies, like herbs and consultations with traditional healers and auxiliary nurses, rather than seeking care at formal healthcare facilities. This inclination towards traditional medicine often stemmed from personal beliefs, cultural traditions, and the perceived efficacy of herbal treatments in addressing health issues. Some participants expressed a preference for herbal remedies as a first line of defense against illnesses, saving visits to hospitals or purchasing pharmaceutical drugs for more severe or persistent health concerns: I prefer starting with herbal remedies initially due to their natural properties and historical effectiveness in treating various ailments. The use of herbs align with my belief in holistic healing and the importance of traditional medicine in maintaining overall well-being. Assessing the severity of the illness is crucial in determining the appropriate course of action, and if the symptoms indicate a serious condition, I am open to purchasing medication or seeking professional medical care at a hospital. While herbs have been my go-to remedy and have provided relief in the past, I acknowledge the importance of timely and comprehensive healthcare interventions in managing severe or persistent health issues. — 36-year-old migrant from Niger Republic Financial limitations and a lack of awareness regarding the affordability of healthcare services were notable hurdles hindering participants from accessing formal medical care. For example, a Matron who supervises the nursing staff in a health center, highlighted how financial constraints deterred migrant women from seeking care at health centers, perceiving formal healthcare as unaffordable. She also stated a lack of information and knowledge about the cost of services at health facilities fostered misconceptions about healthcare affordability, leading some individuals to spend money on unnecessary medications from chemists (patent medicine vendors) instead of seeking appropriate medical attention: Financial constraints pose a significant challenge for many individuals in accessing healthcare services. When discussing this issue with them, a common refrain is "owo po lowo mi," a Yoruba saying meaning they lack the funds to afford health center services. The primary obstacle faced by these women is lack of information and knowledge regarding healthcare affordability. The primary challenge for these women lies in their lack of information and knowledge regarding healthcare affordability. Upon engaging them in conversations, they often express surprise upon learning that the health center offers services at minimal or no cost, contrary to their previous beliefs. This lack of awareness leads them to expend funds on unnecessary medications from local chemists, resulting in higher overall expenses. Although the health center typically imposes a nominal fee for services like injections and treatments, individuals may be unaware of these affordable options. Despite financial constraints, the health center is willing to provide subsidies for those in need, underscoring the importance of cost-effective healthcare access. — 48-year-old Matron at the Community HealthCare Center This study brought to light a prevailing pattern where participants often resort to self-care practices, including buying medications from patent medicine vendors (PMVs), commonly referred to as chemists . However, when it concerned their children, there was a distinct preference for seeking professional medical care at the health center. This preference indicates a heightened level of concern and a proactive approach to safeguarding their children's well-being, as articulated by one participant: I seldom visit the health center myself. As an adult, I feel confident in managing my own health issues. If traditional remedies don't suffice, I resort to purchasing medications from a chemist. However, when it comes to my children, I consistently prioritize their health. I always take them to the health center to ensure they receive thorough medical attention and accurate diagnoses. Their well-being is my utmost concern, and I place my trust in the health center's services for their treatment and immunizations. — 33-year-old migrant from Togo Likewise, another participant noted a prevalent pattern among migrant women where their own healthcare needs are frequently relegated to a lower priority compared to ensuring essential healthcare services, such as immunizations, for their children: The main reason I go there is for my children. I don't see myself as a regular patient at the health center. When I fall ill, I turn to herbs or visit a chemist instead of seeking care at the health center. However, when my children fall sick, I prioritize taking them to the health center to ensure they receive proper diagnoses and treatment. Their well-being is my utmost priority, and I have confidence in the health center's ability to provide the necessary care for them. Additionally, I rely on the health center for their immunizations and other preventive measures crucial for their overall health and well-being. — 36-year-old migrant from Benin The narratives shared by participants provided insight into the obstacles and perspectives regarding laboratory tests and the availability of prescribed medications at the health center, highlighting a larger concern about limited resources and healthcare infrastructure within the community under study. For instance, one participant noted that a lack of awareness or comprehension regarding the significance of laboratory tests in effectively diagnosing and monitoring health conditions contributed to a hesitancy to undergo such tests, particularly among migrant women who perceived they already grasp the nature of their health issue: The health center possesses some testing equipment, but I seldom utilize the laboratory facilities. Why should I undergo testing when I already have a good understanding of my children's ailments? I perceive it as unnecessary to undergo testing when the symptoms are familiar, and I can manage them effectively with the treatments I'm accustomed to. Moreover, I believe the time and expense associated with these tests would be better allocated to providing immediate care for my children. — 30-year-old migrant from Benin Republic Similarly, another participant expressed hesitation about undergoing laboratory tests, citing a mix of factors such as the perceived seriousness of the health concern, apprehension about receiving unfavorable results, and skepticism regarding the healthcare system's capacity to deliver precise diagnoses: God forbid! Why would I require tests? My issue isn't that grave; I'm solely focused on immunization. I don't concern myself with those laboratory tests because I rely on my intuition for health matters. Moreover, I prioritize preventive actions like immunization over unnecessary tests for minor ailments. — 23-year-old migrant from Niger Republic In addition to concerns about laboratory testing, participants also highlighted challenges related to access to prescribed medications at the health center. This observation underscores a common issue faced by many individuals in resource-constrained settings, where limited availability of essential medications at healthcare facilities necessitates out-of-pocket expenses to obtain prescribed drugs from external sources: The health center doesn't dispense medications; rather, they provide prescriptions that we must obtain from chemists and pharmacists independently. This places an additional strain on our already limited resources, requiring us to invest extra time and money in traveling to acquire the prescribed medications. — 28-year-old migrant from Niger Furthermore, another participant echoed similar sentiments: I rarely depend on the medications provided at the health center because they're not consistently available. Instead, after diagnosing our conditions, they prescribe treatments, leaving us to procure the necessary medications from a chemist or pharmacy elsewhere. This procedure can be burdensome and exacerbates the difficulties of accessing adequate healthcare . — 26-year-old migrant from Togo Factors Influencing Accessibility and Utilization of Health Care Facilities Migrant women exhibit a wide range of perceptions about healthcare personnel, reflecting both positive and negative experiences within the healthcare system. These varying perspectives illuminate the complex dynamics that influence their interactions with healthcare providers and their overall satisfaction with the care received. The following participant, who is a regular visitor to the health center, expressed a sense of contentment with the treatment provided by healthcare personnel: I can't lie, the health workers treat me well. Even when they scold me, I know it's for my own good. I can tolerate any insult because I need their help and believe it comes from a place of love. Their strictness shows they care about my health and want the best for me. This makes me feel more confident in the care I receive, knowing that they are genuinely invested in my well-being. — 30-year-old migrant from Niger In addition to the participant who expressed satisfaction with occasional scolding as a form of care and love, another participant highlighted the inconsistency in healthcare services experienced by migrant women. She noted that the provision of treatment often seemed to depend on personal relationships or financial incentives. Her sentiment underscores a critical issue within the healthcare system. The variability in service provision based on personal relationships and financial incentives reflects systemic inequities, which can lead to inconsistent care for migrant women. The reliance on informal exchanges suggests that the healthcare system may lack sufficient resources or structured protocols to ensure fair and timely access to care for all patients, regardless of their socio-economic status or personal connections: They make an effort, but sometimes you end up waiting a long time. If they like you, they might give you some medication when you're sick. If you have money, you can give them a small reward. It often feels like the quality of care you receive depends more on your personal relationship with the healthcare workers and your ability to provide financial incentives than on your actual medical needs. — 22-year-old migrant from Benin Republic Distance to healthcare facilities is a crucial factor influencing individuals' utilization of healthcare services. The proximity of health centers can significantly impact the choices people make regarding their healthcare. For instance, a 22-year-old participant highlighted that the distance to the health center influenced her decision to opt for more accessible herbal remedies instead of seeking conventional medical care. This demonstrates how geographical barriers can shape healthcare-seeking behavior, leading individuals to explore alternative options when faced with challenges in accessing traditional healthcare services. On the other hand, 21-year-old participant expressed a contrasting perspective, indicating that the distance to the health center was not a significant concern for them. She viewed walking long distances as a manageable aspect of their daily routine, suggesting a higher threshold for physical exertion or a different perception of accessibility to healthcare services. This divergence in experiences underscores the diverse ways in which individuals navigate and adapt to the challenges posed by geographical barriers in accessing healthcare. It highlights the need for a nuanced understanding of how distance and accessibility influence healthcare-seeking behaviors among different individuals and communities. Addressing these geographical barriers is essential for ensuring equitable access to healthcare services for all residents, particularly those in underserved areas. Financial constraints represent a significant barrier to accessing healthcare services for migrant women. The inability to afford necessary medications and healthcare services due to financial limitations poses a considerable challenge for those seeking medical treatment. This economic barrier not only impacts the ability to access essential healthcare but also influences the decision-making process regarding alternative healthcare options and coping strategies. The following key informant emphasized the impact of financial issues on healthcare access, noting that in the absence of sufficient funds, individuals often turn to religion or seek out less costly alternatives for managing their health needs: The financial aspect is the main issue; it hinders a lot of things. They can't afford to buy drugs, and distance and other factors become secondary concerns. They often turn to religion because they lack the necessary finances. Additionally, midwives are cheaper than hospitals, so the choice to seek care from them is driven by cost rather than distance or other logistical issues . — 29-year-old Medical Doctor Additionally, another participant pointed out that the cost of prescribed medications frequently acts as a deterrent to purchasing them. This observation sheds light on the direct impact of medication costs on treatment adherence and health outcomes, as individuals may forego or delay necessary medications due to financial constraints, potentially compromising their health and well-being. She stated thus: I buy drugs too, but it depends on the type and cost. If the health center do not have the medications, we have to purchase the prescribed drugs elsewhere. If the drugs are too expensive, I will not bother buying them. — 25-year-old migrant from Togo The influence of cultural, religious, and personal beliefs on healthcare decisions among migrant women is a critical aspect that shapes their health-seeking behaviors and treatment preferences. The study participants highlighted the significant role of cultural practices and familiarity in guiding their healthcare choices, with some individuals expressing a preference for herbal remedies based on traditional knowledge and experiences within their communities. The following participant shared her positive experience with herbal remedies, emphasizing how these traditional treatments have been effective for her and her family: It's more of a cultural tradition passed down through generations. Herbs worked for my mom, and they work for me too. My body has adjusted to them very well, so I usually don't consider going to the health center. I trust these remedies because they have been a part of my family's health practices for as long as I can remember. They are not only familiar but also accessible and affordable, which makes them a preferred choice for me and many others in my community. — 26-year-old migrant from Niger However, a key informant attributed the preference for herbal remedies to ignorance and a lack of education among migrant women. She emphasized that traditional practices and advice from older, uneducated women often dominate healthcare decision-making processes. This reliance on informal knowledge suggests a significant gap in health literacy and access to evidence-based information among certain segments of the migrant population. The participant noted that many migrant women trust the guidance of elderly women in their community over formal healthcare providers, often because these elderly women have successfully managed health issues in the past using traditional methods. This deep-rooted trust in cultural practices and a lack of exposure to modern medical information contribute to the persistence of using herbal remedies, even when formal healthcare might offer more effective solutions: The major issue is ignorance and lack of education. Many migrant women often take advice from older, uneducated women in their communities, as these elder women are perceived as knowledgeable and trustworthy. Their husbands also insist on trusting these women because they were the ones who assisted in their own births, reinforcing the belief that these elder women can be trusted to deliver their unborn children as well. This reliance on traditional knowledge over formal medical advice indicates a significant gap in health literacy and access to evidence-based healthcare information among the migrant population. This deep-seated trust in community elders and traditional practices highlights the urgent need for educational interventions and outreach programs to improve health literacy and encourage the adoption of safer, evidence-based healthcare practices. — 36-year-old Hospital Matron Religious beliefs hold a significant influence over healthcare decisions among migrant women, as highlighted by the experiences shared by participants in the study. The intersection of faith and healthcare practices shapes individuals' perspectives on treatment modalities and influences their approach to managing health issues. In particular, the role of religious beliefs in guiding healthcare decisions is exemplified by the account of a participant, a Pastor's wife, who provided insights into her personal views on the integration of spirituality and medical treatment: Some people avoid going to the clinic for various reasons, including religious beliefs. In certain denominations, the use of drugs is discouraged because there is a belief that only God, by His grace, heals us. However, I hold a different perspective. Even though I am a pastor's wife, I believe that God can use drugs as a medium to heal us. God doesn't need to come down to earth to heal us directly; instead, He has provided us with drugs. We must combine prayer with medical treatment, recognizing that God created both the leaves and the drugs for our benefit. — 35-year-old migrant from Benin Republic The utilization of health care facilities among migrant women is significantly influenced by recommendations from friends and family members, especially from fellow migrants within their social networks. The reliance on referrals and testimonials from trusted individuals plays a crucial role in shaping healthcare-seeking behaviors and decisions, highlighting the importance of interpersonal relationships and community support in accessing essential health services. The following participant, a Togolese food seller and mother of two, shared her experience on the impact of recommendations on her decision to visit a health center. She highlighted that the primary reason for seeking care at the health center was for immunization, a crucial aspect of child health: The primary reason for my visits to the health center is for immunization. Given the tender age of my children, a friend strongly recommended that I bring them here for their immunization shots, emphasizing the importance of safeguarding their health through this vital preventative measure. She explained how regular immunizations could prevent serious illnesses and protect their developing immune systems. Additionally, my friend shared personal experiences of witnessing the positive effects of immunization on her own children's health, instilling confidence in me regarding the efficacy of this healthcare practice. Her reassurances and firsthand accounts have been instrumental in my decision to prioritize immunizations, ensuring that my children receive the necessary protection to thrive in their early years . — 32-year-old migrant from Togo Similarly, another participant from Togo recounted the support and guidance received from family members regarding healthcare decisions for her child: Recommendations from others significantly influence my decisions. One of my sisters from Togo advised me to take my newborn baby to the health center for injections to ensure good health. Her recommendation carried weight, as she had experienced positive outcomes with her own children after receiving similar care at the facility. She shared stories of how her children thrived after receiving their immunizations, free from many common illnesses that unvaccinated children often suffer. Consequently, I didn't seek antenatal treatment at that facility, opting instead to prioritize my child's health based on trusted advice within my community. This guidance from my sister, who I deeply trust, reinforced my belief in the importance of following through with recommended health practices, underscoring the value of community support and shared knowledge in making healthcare decisions. — 28-year-old migrant from Togo Discussion This study explored how migrant women accessed and utilized health care facilities in urban slum communities in Nigeria. Three themes were constructed from the data relating to the level of access to healthcare services and utilization of health facilities among migrant women. There were three points of discussion that are particularly relevant to these findings within the context of public health approaches to addressing healthcare access and utilization. First, this study revealed that international migrant women living in impoverished urban slums face significant housing challenges. Majority of the women reside in makeshift and incomplete buildings, which underscores the precarious nature of their accommodation. Despite these substandard conditions, the resilience and adaptability demonstrated by the participants highlight a fundamental aspect of their experiences: the prioritization of shelter, irrespective of its quality. The lack of privacy and dignity associated with using communal or makeshift toilets can lead to feelings of shame, embarrassment, and vulnerability among women, impacting their overall well-being and sense of self-worth. This finding is consistent with research which found that migrants tend to be poorer, less likely to be employed, and may live in less stable housing compared to non-migrants (Malik et al., 2020 ; Omole, 2010 ). This study also demonstrated that access to clean water is a critical concern for migrant women. The findings from the study revealed that many migrant women rely on communal or nearby sources for water, which often entails long distances or additional costs. This reliance on external sources not only underscores the lack of basic amenities in their living conditions but also imposes an extra burden on these women. The reliance on communal or nearby water sources may raise concerns about the quality and safety of the water available to these women. Inadequate access to clean water can pose health risks, exposing individuals to waterborne diseases and contaminants that can further compromise their well-being. The study highlighted the prevalence of ailments linked to environmental factors such as stagnant water, poor waste management, and overgrown vegetation, which create ideal conditions for disease vectors like mosquitoes. Previous research has shown that access to clean water is a critical issue in many urban slums, leading to contracting communicable diseases such as diarrhea (Zwane & Kremer, 2007 ). Sanitation facilities pose another significant challenge for many migrant women. The study demonstrated a severe lack of proper sanitation infrastructure, exposing migrant women to various health and safety risks. Researchers have previously recognized that overcrowding and poor environmental sanitation are issues faced by women in slum settlements (Akinwale et al., 2014 ). The shared nature of these facilities can lead to overcrowding, long wait times, and discomfort, further exacerbating the challenges faced by migrant women. Second, this study demonstrated that a notable trend among migrant women is the preference for traditional remedies, such as herbal treatments and consultations with traditional healers and auxiliary nurses, over seeking care at formal healthcare facilities. This inclination is deeply rooted in personal beliefs, cultural practices, and the perceived effectiveness of herbal treatments in managing health conditions. Similar research had shown that in instances of minor ailments, herbal-based remedies are favored over allopathic treatments due to their cost-effectiveness among many migrant women (Li et al., 2020 ). This approach aligned with her belief in holistic healing and the importance of traditional medicine. Financial constraints and a lack of awareness about the affordability of healthcare services emerged as significant barriers to accessing formal medical care among migrant women in this study. Many migrant women perceived formal healthcare as unaffordable due to financial limitations and a lack of information about the cost of services. This is consistent with the study by Chuah et al ( 2018 ) who identified health illiteracy and lack of awareness as barriers to health care access among migrants. This misconception leads them to spend money on unnecessary medications from PMVs (also known as chemists ), resulting in higher overall expenses and delayed professional medical intervention. Studies have previously recognized that financial support may not be easily accessible to international migrants as they may lack access to stable sources of income (Anderloni & Vandone, 2008 ; Solheim et al., 2022 ). The study brought to light a significant trend among participants, indicating a reliance on self-care practices for addressing their health needs, through the purchase of medications from PMVs or chemists . This preference for self-care methods underscores a practical approach to managing minor ailments and health concerns among the participants themselves. However, a distinct pattern emerges when it comes to the healthcare decisions regarding their children, revealing a clear preference for seeking professional medical care at health centers. Truly, PMVs frequently serve as the initial point of contact within many urban slums, with a greater proportion of visits to these PMVs attributed to new conditions rather than pre-existing ones (Onuegbu et al., 2023 ; Onwujekwe et al., 2022 ). The participants' inclination towards self-care for themselves may stem from factors such as religion, convenience, familiarity with traditional remedies, or cost considerations associated with over-the-counter medications obtained from PMVs or chemists . In contrast, the prioritization of professional medical care for their children suggests a heightened level of concern and a proactive stance towards safeguarding their children's well-being. A final point for discussion arising from this research relates to factors that influence accessibility and utilization of healthcare facilities among migrant women. Migrant women residing in urban slums demonstrate a range of perceptions towards healthcare personnel, reflecting a spectrum of experiences encompassing both positive and negative encounters within the healthcare system. Some expressed contentment with the treatment provided by healthcare personnel, interpreting occasional scolding from healthcare providers as a demonstration of care and affection, indicating a high level of tolerance and a profound need for support despite encountering what may be perceived as harsh interactions. Others suggested that the quality of treatment received often relied on personal relationships with healthcare providers or financial incentives, indicating potential biases or informal practices that could influence the care provided to migrant women. The identification of a spectrum of perceptions towards healthcare personnel among migrant women extends previous research by highlighting the complexity of dynamics that influence individuals' interactions with healthcare providers (Braithwaite et al., 2017 ; Khan et al., 2018 ). This underscores the need for a nuanced understanding of healthcare experiences to address the diverse needs and preferences of migrant populations effectively. The recognition of potential influence of informal practices within the healthcare system on treatment quality expands on existing literature that discusses systemic issues affecting healthcare delivery to migrant populations (Acquadro-Pacera et al., 2024 ). This emphasizes the importance of addressing structural factors and promoting transparency in service provision to enhance the overall healthcare experiences of migrant women. Distance to healthcare facilities plays a pivotal role in shaping healthcare utilization patterns among migrant women, as evidenced by the experiences shared by participants in the study. As a result, many migrant women opt for more accessible herbal remedies instead of seeking care at a health center. This finding aligns with previous studies that highlights geographical barriers as significant determinants of access to healthcare services (Lankila et al., 2016 ; Okwaraji et al., 2015 ). Financial constraints represent a significant barrier to accessing healthcare services for the women. The inability to afford necessary medications and healthcare services due to financial limitations poses a considerable challenge. This economic barrier often acts as a deterrent to purchasing prescribed medications, potentially compromising health outcomes. As the study showed, this is yet another reason the women turned to midwives or traditional herbs for remedies. Truly, past studies have identified economic factors as key determinants of healthcare access for vulnerable populations, including migrants (Jayeweera, 2021; Lebano et al., 2020 ). Cultural and religious beliefs significantly shape healthcare decisions among migrant women. Some participants expressed a strong preference for herbal remedies based on traditional knowledge and community experiences. This perspective illustrates the nuanced interplay between faith and healthcare practices among migrant women. Similarly, previous studies have emphasized the impact of cultural beliefs on healthcare decisions among migrant populations (Levin-Zamir et al., 2017 ). The utilization of healthcare facilities among migrant women is significantly influenced by recommendations from friends and family members within their social networks. The reliance on referrals highlights the importance of interpersonal relationships and community support in accessing health services and demonstrates the critical role of social networks in shaping healthcare-seeking behaviors and decisions. This aligns with various studies that point that social networks exists as an effective way to influencing health seeking behavior of migrants (Kim et al., 2015 ; Ryan, 2011 ). Social networks serve as channels for information dissemination and guidance on healthcare services. Recommendations from peers and family members can provide valuable insights into available healthcare options, quality of services, and the overall patient experience, influencing individuals' decisions to seek care Limitations There are three limitations associated with this study. First, language barrier posed a significant challenge, as most participants were not proficient in English. To facilitate communication, researchers conducted interviews in Pidgin , an English-based creole language widely spoken across Nigeria. However, even Pidgin was not universally understood by all participants. For those unable to communicate in Pidgin , interviews were conducted in Yoruba, the predominant local language in the study area. This language barrier primarily arose because the participants originated from French-speaking countries, necessitating their learning of Pidgin English or Yoruba to communicate more effectively upon arriving in Nigeria. The need to use multiple languages for effective communication underscores the importance of linguistic adaptability in research involving diverse migrant populations and highlights the challenges faced by migrants in adapting to new linguistic environments. Second, many participants were initially reluctant to engage in the study, fearing that the researchers might be government officials. This apprehension stemmed from concerns about their immigration status, as many were either undocumented or had unresolved legal issues related to their residency in the country. This mistrust posed a significant barrier to data collection, as it limited the openness and willingness of participants to share their experiences and challenges. Overcoming this barrier required building trust and ensuring participants of the confidentiality and non-governmental nature of the research. Addressing these concerns is crucial in future studies to facilitate more comprehensive and candid participation, thereby yielding richer and more accurate data on the healthcare experiences of migrant women. Third, this study was limited to a single location in Lagos due to funding constraints. Conducting research in additional locations across Nigeria, where there are also significant populations of migrant women, would have provided a more comprehensive understanding of their healthcare experiences and challenges. Expanding the study to include diverse regions would have captured a wider range of cultural, social, and economic factors influencing healthcare access and utilization among migrant women in Nigeria. This broader scope would have enriched the data and potentially revealed regional variations and commonalities in healthcare needs and barriers faced by migrant women throughout the country. Conclusion This study highlighted the complex interplay of factors influencing the access to and utilization of healthcare facilities among migrant women in urban slum communities in Nigeria. Housing instability, lack of access to clean water and sanitation facilities, cultural beliefs, financial constraints, and social networks all play crucial roles in shaping healthcare-seeking behaviors among this vulnerable population. The findings underscore the urgent need for targeted public health interventions to address the structural determinants of healthcare access and utilization among migrant women. Improving housing conditions, providing access to clean water and sanitation infrastructure, and addressing economic barriers to healthcare access are paramount. Culturally sensitive healthcare programs that respect traditional healing practices while promoting evidence-based medical care can help bridge the gap between migrant women's healthcare needs and available services. Furthermore, community-based interventions that leverage social networks and peer support systems can enhance health literacy and facilitate access to healthcare services. By empowering migrant women to make informed healthcare decisions and providing them with the necessary resources and support, we can work towards achieving health equity and improving the overall well-being of migrant populations in urban slum communities. The implications for public health are clear: Addressing the multifaceted challenges faced by migrant women requires a comprehensive and holistic approach that takes into account their unique social, cultural, and economic contexts. By addressing these barriers and promoting equitable access to healthcare, we can strive towards achieving the goal of health for all, regardless of socioeconomic status or migration status. Declarations Statement of Ethics Approval The Ethics Committee of the University of Ibadan/University College Hospital Research Ethics Committee (UI/EC/17/0396) provided ethical approval for this study. Adherence to ethical considerations, including confidentiality, anonymity, and autonomy, was observed throughout the study. Due respect was accorded to participants who opted to withdraw from the research. Prior to their involvement, the authors explained the study to potential participants, answering any questions they had. Each participant then signed a consent form indicating their willingness to participate. This written consent process ensured that participants fully understood their involvement in the study and that their participation was entirely voluntary. References Abdi, F., Rahnemaei, F. A., Shojaei, P., Afsahi, F., & Mahmoodi, Z. (2021). Social determinants of mental health of women living in slum: a systematic review. Obstetrics & Gynecology Science , 64(2), 143. https://doi.org/10.5468/ogs.20264 Ackerson, K., & Zielinski, R. (2017). Factors influencing use of family planning in women living in crisis affected areas of Sub-Saharan Africa: A review of the literature. Midwifery , 54 , 35-60. https://doi.org/10.1016/j.midw.2017.07.021 Acquadro-Pacera, G., Valente, M., Facci, G., Molla Kiros, B., Della Corte, F., Barone-Adesi, F., ... & Trentin, M. (2024). Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review. BMC Public Health, 24(1), 963. https://doi.org/10.1186/s12889-024-18472-3 Adeosun, O. T., Owolabi, K. E., Eshiet, I. C., & Owolabi, T. J. (2023). Exploring the transition from informal to formal jobs and its consequent impacts on the livelihood of migrant youths in Lagos metropolis. Journal of Enterprising Communities: People and Places in the Global Economy , 17 (6), 1135-1153. https://doi.org/10.1108/JEC-02-2022-0020 African Population and Health Research Center. (2014). Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012. Nairobi: APHRC. Akinwale, O. P., Adeneye, A. K., Musa, A. Z., Oyedeji, K. S., Sulyman, M. A., Oyefara, J. O., ... & Adeneye, A. A. (2014). Living conditions and public health status in three urban slums of Lagos, Nigeria. South East Asia Journal of Public Health , 3 (1), 36-41. https://doi.org/10.3329/seajph.v3i1.17709 Akpabio, E. M., Wilson, N. A. U., Essien, K. A., Ansa, I. E., & Odum, P. N. (2021). Slums, women and sanitary living in South-South Nigeria. Journal of Housing and the Built Environment , 36 , 1229-1248. https://doi.org/10.1007/s10901-020-09802-z Alam, N., Hajizadeh, M., Dumont, A., & Fournier, P. (2015). Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis. PloS one , 10 (4), e0120922. https://doi.org/10.1371/journal.pone.0120922 Anderloni, L., & Vandone, D. (2008). Migrants and financial services: which opportunities for financial innovation?. In Frontiers of banks in a global economy (pp. 149-185). London: Palgrave Macmillan UK. https://doi.org/10.1057/9780230590663_7 Badmos, O. S., Callo-Concha, D., Agbola, B., Rienow, A., Badmos, B., Greve, K., & Jürgens, C. (2020). Determinants of residential location choices by slum dwellers in Lagos megacity. Cities , 98 , 102589. https://doi.org/10.1016/j.cities.2019.102589 Barua, N. (2014). Medical pluralism in a slum in Delhi: Global medicine in a local garb. Medical Pluralism and Homeopathy in India and Germany (1810-2010). A Comparison of Practices , 203-216. Beyer, L. I., Chaudhuri, J., & Kagima, B. (2016). Kenya's focus on urban vulnerability and resilience in the midst of urban transitions in Nairobi. Development Southern Africa , 33 (1), 3-22. https://doi.org/10.1080/0376835X.2015.1115739 Braithwaite, J., Churruca, K., Ellis, L. A., Long, J., Clay-Williams, R., Damen, N., ... & Ludlow, K. (2017). Complexity science in healthcare. Sydney: Australian Institute of Health Innovation, Macquarie University . Braun, V., & Clarke, V. (2021). Thematic Analysis: A Practical Guide . SAGE Publications, London, England. Bryman, A. (2008). Why do researchers integrate/combine/mesh/blend/mix/merge/fuse quantitative and qualitative research. Advances in mixed methods research , 21 (8), 87-100. https://doi.org/10.4135/9780857024329.d9 Chuah, F. L. H., Tan, S. T., Yeo, J., & Legido-Quigley, H. (2018). The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study. International journal for equity in health , 17 , 1-15. https://doi.org/10.1186/s12939-018-0833-x Coates, D., Anand, P., & Norris, M. (2013). Housing and quality of life for migrant communities in Western Europe: A capabilities approach. Journal on Migration and Human Security , 1(4), 163-209. https://doi.org/10.1177/233150241300100403 Corburn, J., & Hildebrand, C. (2015). Slum sanitation and the social determinants of women’s health in Nairobi, Kenya. Journal of environmental and public health , 2015 . https://doi.org/10.1155/2015/209505 Das, M., Angeli, F., Krumeich, A. J., & Van Schayck, O. C. (2018). Patterns of illness disclosure among Indian slum dwellers: a qualitative study. BMC international health and human rights , 18, 1-17. https://doi.org/10.1186/s12914-018-0142-x Desmond, M. (2012). Eviction and the reproduction of urban poverty. American journal of sociology , 118 (1), 88-133. https://doi.org/10.1086/666082 Dias, S., Gama, A., Cargaleiro, H., & Martins, M. O. (2012). Health workers’ attitudes toward immigrant patients: a cross-sectional survey in primary health care services. Human Resources for Health , 10 , 1-6. https://doi.org/10.1186/1478-4491-10-14 Emina, J., Beguy, D., Zulu, E. M., Ezeh, A. C., Muindi, K., Elung’ata, P., ... & Yé, Y. (2011). Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System. Journal of Urban Health , 88 , 200-218. https://doi.org/10.1007/s11524-011-9594-1 Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., ... & Lilford, R. J. (2017). The history, geography, and sociology of slums and the health problems of people who live in slums. The lancet , 389(10068), 547-558. https://doi.org/10.1016/S0140-6736(16)31650-6 Faye, O., Baschieri, A., Falkingham, J., & Muindi, K. (2011). Hunger and food insecurity in Nairobi’s slums: an assessment using IRT models. Journal of Urban Health , 88 , 235-255. https://doi.org/10.1007/s11524-010-9521-x Fink, G., Günther, I., & Hill, K. (2014). Slum residence and child health in developing countries. Demography , 51 (4), 1175-1197. https://doi.org/10.1007/s13524-014-0302-0 Ganle, J. K., Parker, M., Fitzpatrick, R., & Otupiri, E. (2014). A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC pregnancy and childbirth , 14 , 1-17. https://doi.org/10.1186/s12884-014-0425-8 Gerring, J. (2007). Case study research: Principles and practices . Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511803123 Goswami, S. (2014). A study on women’s healthcare practice in urban slums: Indian scenario. Journal of Evidence-Based Women’s Health Journal Society , 4 (4), 201-207. https://doi.org/10.1097/01.EBX.0000456499.60072.56 Gulyani, S., Bassett, E. M., & Talukdar, D. (2012). Living conditions, rents, and their determinants in the slums of Nairobi and Dakar. Land Economics , 88 (2), 251-274. http://www.population.gov.ng/index.php/publication/140-popn-distri-by-sex-state-jgas-and-senatorial-distr-2006. Ikechukwu, H. U., Ofonime, N. U., Kofoworola, O., & Asukwo, D. E. (2020). Influence of cultural and traditional beliefs on maternal and child health practices in rural and urban communities in Cross River State, Nigeria. Annals of Medical Research and Practice , 1 (4), 1. https://doi.org/10.25259/ANMRP_4_2019 Jayaweera, H. (2021). Migrant diversity and determinants of health care access and use. Journal of Health Services Research & Policy , 26 (1), 1-2. https://doi.org/10.1177/1355819620976272 Khan, S., Vandermorris, A., Shepherd, J., Begun, J. W., Lanham, H. J., Uhl-Bien, M., & Berta, W. (2018). Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems. BMC health services research, 18, 1-8. https://doi.org/10.1186/s12913-018-2994-0 Kim, W., Kreps, G. L., & Shin, C. N. (2015). The role of social support and social networks in health information–seeking behavior among Korean Americans: a qualitative study . International journal for equity in health , 14, 1-10. https://doi.org/10.1186/s12939-015-0169-8 Kiwanuka, S. N., Ekirapa, E. K., Peterson, S., Okui, O., Rahman, M. H., Peters, D., & Pariyo, G. W. (2008). Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Transactions of the Royal Society of Tropical Medicine and Hygiene , 102 (11), 1067-1074. https://doi.org/10.1016/j.trstmh.2008.04.023 Kusuma, Y. S., Kumari, R., Pandav, C. S., & Gupta, S. K. (2010). Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India. Tropical Medicine & International Health , 15 (11), 1326-1332. https://doi.org/10.1111/j.1365-3156.2010.02628.x Lankila, T., Näyhä, S., Rautio, A., Rusanen, J., Taanila, A., & Koiranen, M. (2016). Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland. Public health , 131 , 82-91. https://doi.org/10.1016/j.puhe.2015.10.020 Lebano, A., Hamed, S., Bradby, H., Gil-Salmerón, A., Durá-Ferrandis, E., Garcés-Ferrer, J., ... & Linos, A. (2020). Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review. BMC public health , 20 , 1-22. https://doi.org/10.1186/s12889-020-08749-8 Levin-Zamir, D., Leung, A. Y. M., Dodson, S., & Rowlands, G. (2017). Health literacy in selected populations: Individuals, families, and communities from the international and cultural perspective. Information Services & Use , 37 (2), 131-151. https://doi.org/10.3233/ISU-170834 Li, S., Odedina, S., Agwai, I., Ojengbede, O., Huo, D., & Olopade, O. I. (2020). Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC complementary medicine and therapies , 20, 1-7. https://doi.org/10.1186/s12906-020-02881-z Malik, S., Roosli, R., & Tariq, F. (2020). Investigation of informal housing challenges and issues: experiences from slum and squatter of Lahore. Journal of Housing and the Built Environment , 35 (1), 143-170. https://doi.org/10.1007/s10901-019-09669-9 Malterud, K., Siersma, V.D. and Guassora, A.D. (2016). Sample size in qualitative interview studies: guided by information power. Qualitative Health Research, 6, 1753-1760. https://doi.org/10.1177/1049732315617444 Mberu, B. U., Haregu, T. N., Kyobutungi, C., & Ezeh, A. C. (2016). Health and health-related indicators in slum, rural, and urban communities: a comparative analysis. Global health action , 9 (1), 33163. https://doi.org/10.3402/gha.v9.33163 Meth, P. (2013). ‘I Don't Like My Children to Grow up in this Bad Area’: Parental Anxieties about Living in Informal Settlements. International journal of urban and regional research , 37 (2), 537-555. https://doi.org/10.1111/j.1468-2427.2012.01199.x National Population Commission (2006) Nigeria National Census: Population Distribution by Sex, State, LGAs and Senatorial District: 2006 Census Priority Tables (Vol. 3). Ntoimo, L. F. C., Okonofua, F. E., Igboin, B., Ekwo, C., Imongan, W., & Yaya, S. (2019). Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria. BMC Pregnancy and Childbirth , 19 , 1-13. https://doi.org/10.1186/s12884-019-2433-1 Okwaraji, Y. B., Webb, E. L., & Edmond, K. M. (2015). Barriers in physical access to maternal health services in rural Ethiopia. BMC health services research , 15 , 1-8. https://doi.org/10.1186/s12913-015-1161-0 Omole, K. F. (2010). An assessment of housing condition and socio-economic life styles of slum dwellers in Akure, Nigeria. Contemporary Management Research , 6 (4). https://doi.org/10.7903/cmr.2980 Onuegbu, C., Harlock, J., & Griffiths, F. (2023). Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria: a cross-sectional survey. BMJ open , 13 (5), e065152. https://doi.org/10.1136/bmjopen-2022-065152 Onwujekwe, O., Mbachu, C., Onyebueke, V., Ogbozor, P., Arize, I., Okeke, C., ... & Ensor, T. (2022). Stakeholders’ perspectives and willingness to institutionalize linkages between the formal health system and informal healthcare providers in urban slums in southeast, Nigeria. BMC health services research , 22 (1), 583. https://doi.org/10.1186/s12913-022-08005-2 Opoko, A. P., Ibem, E. O., & Adeyemi, E. A. (2015). Housing aspiration in an informal urban settlement: A case study. Urbani izziv , 26 (2), 117-131. https://doi.org/10.5379/urbani-izziv-2015-en-26-02-003 Owuor, S. O. (2007). Migrants, urban poverty and the changing nature of urban–rural linkages in Kenya. Development Southern Africa , 24 (1), 109-122. https://doi.org/10.1080/03768350601165926 Owusu, L., & Yeboah, T. (2018). Living conditions and social determinants of healthcare inequities affecting female migrants in Ghana. GeoJournal, 83, 1005-1017. https://doi.org/10.1007/s10708-017-9817-4 Park, J. E., Kibe, P., Yeboah, G., Oyebode, O., Harris, B., Ajisola, M. M., ... & Chen, Y. F. (2022). Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. BMJ open , 12(5), e055415. https://doi.org/10.1136/bmjopen-2021-055415 Pat-Mbano, E., & Nwadiaro, E. C. C. (2012). The rise of urban slum in Nigeria: implications on the urban landscape. International Journal of Development and Management Review , 7 (1). Popoola, A., Olatunde, M. O., Magidimisha, H. H., Amuda, A., Adeleye, B. M., & Chipungu, L. (2020). Urban forced eviction: Experiences in the metropolitan city of Lagos, Nigeria. https://doi.org/10.22146/ijg.40555 Prüss-Ustün, A., Wolf, J., Corvalán, C., Neville, T., Bos, R., & Neira, M. (2017). Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. Journal of public health , 39 (3), 464-475. https://doi.org/10.1093/pubmed/fdw085 Ryan, L. (2011). Migrants' social networks and weak ties: accessing resources and constructing relationships post-migration. The Sociological Review , 59(4), 707-724. https://doi.org/10.1111/j.1467-954X.2011.02030.x Satterthwaite, D., Sverdlik, A., & Brown, D. (2019). Revealing and responding to multiple health risks in informal settlements in sub-Saharan African cities. Journal of urban health , 96 , 112-122. https://doi.org/10.1007/s11524-018-0264-4 Schutt, R. K. (2018). Investigating the social world: The process and practice of research . Sage publications. Shukla, N., Toppo, N. A., Thakur, A., Kasar, P. K., & Sharma, B. (2019). Study of health care seeking behaviour for illnesses among malnourished children of age 06-59 months in rural and urban areas of Jabalpur district, Madhya Pradesh. International Journal of Community Medicine and Public Health , 6 (10), 4478. https://doi.org/10.18203/2394-6040.ijcmph20194515 Solheim, C. A., Ballard, J., Fatiha, N., Dini, Z., Buchanan, G., & Song, S. (2022). Immigrant family financial and relationship stress from the COVID-19 pandemic. Journal of Family and Economic Issues , 43 (2), 282-295. https://doi.org/10.1007/s10834-022-09819-2 Soliman, N. (2023). Exploring slum life and urban poverty in Lagos: the politics of everyday resistance in Chris Abani's Graceland. Journal of Humanities and Applied Social Sciences , 5 (5), 467-482. https://doi.org/10.1108/JHASS-01-2023-0017 Tacoli, C., McGranahan, G., & Satterthwaite, D. (2015). Urbanisation, rural-urban migration and urban poverty . London, UK: Human Settlements Group, International Institute for Environment and Development. Udenigwe, O., Okonofua, F. E., Ntoimo, L. F., & Yaya, S. (2022). Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study. PLoS one , 17 (8), e0272523. https://doi.org/10.1371/journal.pone.0272523 Unger, A. (2013). Children's health in slum settings. Archives of disease in childhood , 98 (10), 799-805. https://doi.org/10.1136/archdischild-2011-301621 Uzochukwu, B. S., Ughasoro, M. D., Etiaba, E. A., Okwuosa, C., Envuladu, E., & Onwujekwe, O. E. (2015). Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian journal of clinical practice , 18 (4), 437-444. https://doi.org/10.4103/1119-3077.154196 van der Heijden, J., Gray, N., Stringer, B., Rahman, A., Akhter, S., Kalon, S., ... & Biswas, A. (2019). ‘Working to stay healthy’, health-seeking behaviour in Bangladesh’s urban slums: a qualitative study. BMC Public Health , 19 , 1-13. https://doi.org/10.1186/s12889-019-6750-0 World Health Organization. (2009). Global health risks: mortality and burden of disease attributable to selected major risks . World Health Organization. Zerbo, A., Delgado, R. C., & González, P. A. (2020). Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa. Global Health Journal , 4 (2), 46-50. https://doi.org/10.1016/j.glohj.2020.04.003 Zubair, O. A., Ojigi, L. M., & Mbih, R. A. (2015). Urbanization: A catalyst for the emergence of squatter settlements and squalor in the vicinities of the federal capital city of Nigeria. Journal of sustainable Development , 8 (2), 134. https://doi.org/10.5539/jsd.v8n2p134 Zulu, E. M., Beguy, D., Ezeh, A. C., Bocquier, P., Madise, N. J., Cleland, J., & Falkingham, J. (2011). Overview of migration, poverty and health dynamics in Nairobi City's slum settlements. Journal of Urban Health , 88 , 185-199. https://doi.org/10.1007/s11524-011-9595-0 Zwane, A. P., & Kremer, M. (2007). What works in fighting diarrheal diseases in developing countries? A critical review. The World Bank Research Observer , 22 (1), 1-24. https://doi.org/10.1093/wbro/lkm002 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4671466","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":321504278,"identity":"f879b3a8-b992-40be-9314-123428929775","order_by":0,"name":"Juliet Nwafor","email":"","orcid":"","institution":"Heriot-Watt University, Edinburgh, Scotland","correspondingAuthor":false,"prefix":"","firstName":"Juliet","middleName":"","lastName":"Nwafor","suffix":""},{"id":321504279,"identity":"fe37d8cd-7aaf-468e-a4b6-f048ebf9acc1","order_by":1,"name":"Rowland Edet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYHACAwaGChsGBnYgk4doLQfOpDEwMJOk5WDbYRK0mLc3b3z8ge184nZmBsYHb9uI0CJz5lixwQGe24k7mxmYDecSo0VCIsdM4oDE7cQNhxnYpHmJ0iL/xvzHAYNzIC3sv4nTIsFjxnAg4QDYFmbitPCkFUucOZBsvOEwY7PknHPEaGE/vPFD5T872Q3Hmw9+eFNGhBYkwNhAmvpRMApGwSgYBbgBANqZNlsA9MT6AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0009-3188-6477","institution":"University of Nebraska-Lincoln, United States","correspondingAuthor":true,"prefix":"","firstName":"Rowland","middleName":"","lastName":"Edet","suffix":""},{"id":321504280,"identity":"7852dfee-a8fc-4f8b-be79-7b15797457f1","order_by":2,"name":"Ezebunwa Nwokoch","email":"","orcid":"","institution":"University of Ibadan, Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Ezebunwa","middleName":"","lastName":"Nwokoch","suffix":""}],"badges":[],"createdAt":"2024-07-02 04:56:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4671466/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4671466/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60275813,"identity":"52b76398-d657-4e4e-af4b-36df507b4fb8","added_by":"auto","created_at":"2024-07-15 05:07:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":437685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4671466/v1/1afad08d-9384-4786-bc67-5fe4a51ef183.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBeyond Borders: Exploring the Lived Experiences of International Migrant Women in Nigeria, a Deep Dive into Healthcare Realities and Utilization\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe accessibility and utilization of modern healthcare services pose significant challenges for poor households in Sub-Saharan Africa, particularly in areas where affordable and high-quality healthcare is scarce, and access to health insurance is limited (Ackerson and Zielinksi, 2017; Alam et al., 2015; Kiwanuka et al., 2008). Studies have shown that residents of informal settlements in sub-Saharan Africa, as well as regions in Asia and Latin America, lack access to fundamental social infrastructure including clean water, electricity, well-maintained roads, sanitation facilities, high-quality education, healthcare services, and proper waste management systems (Satterthwaite et al., 2019; Zerbo et al., 2020). In Nigeria, the substantial majority of health expenditure, exceeding 70% of approximate $10 per capita health expenditure, is attributed to private out-of-pocket expenditure (Uzochukwu et al., 2015). Reliance on out-of-pocket expenditure significantly hinders the equitable access to high-quality healthcare services, particularly within urban slum areas (Owusu et al., 2008).\u003c/p\u003e\n\u003cp\u003eNigeria, as a third world nation, has been found to have areas characterized by slum settlements (Akinwale et al., 2014; Zubair et al., 2015). Numerous urban residents, unable to afford decent living accommodations due to factors such as the high costs associated with owning their own homes, steep rental prices, and exorbitant expenses related to acquiring urban land, had sought shelter in slums despite their challenging living conditions often likened to a “near-hell-status” (Pat-Mbano \u0026amp; Nwadiaro, 2012: 258). Urbanization often leads to the proliferation of slum areas and a concentration of vulnerable populations within these settlements (Tacoli et al., 2015; Zulu et al., 2011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the Lagos megacity of Nigeria, a significant number of migrant women residing in slums belong to lower socioeconomic classes (Akpabio et al., 2021; Badmos et al., 2020).\u0026nbsp;These women migrate to the city with hopes of improving their livelihoods (Owusu et al., 2008). However, limited education, skills, and work experience restrict employment opportunities for migrant women, confining them to low-paying jobs such as construction labor, domestic service, casual factory work, and petty trading (Adeosun et al., 2023). Due to minimal incomes, these women are often compelled to live in slum areas, enduring unsanitary and unhygienic conditions (Corburn \u0026amp; Hildebrand, 2015). They often navigate their daily lives with only the most essential resources and provisions (Soliman, 2023). Even those with some financial means are often reluctant to invest in home improvements due to the temporary nature of their residence or the illegal occupation of public lands, coupled with the constant threat of eviction (Popoola et al., 2020). Thus, the quality of housing in slum areas remains poor (Omole, 2010). The substandard living conditions, characterized by overcrowding, poor sanitation, and occupational hazards, adversely affect the health of slum dwellers (Malik et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGlobally, poor women, particularly those in developing countries, exhibit the highest rates of mortality and illness (World Health Organization, 2009). This trend is evident in the health status of women and children in these communities (Fink et al., 2014; Mberu et al., 2016; Unger, 2013). A significant concern is the indifferent attitude of migrant women towards their own health and its management (Dias et al., 2012). They typically seek medical treatment only when health issues cause severe physical discomfort or impede their work performance (Ikechukwu et al., 2020). This neglect exacerbates their health problems and highlights the urgent need for interventions to improve the living and health conditions of migrant women in Lagos slums.\u003c/p\u003e\n\u003cp\u003eOftentimes, women in slum areas overlook minor health concerns (Desmond, 2012), and this poses serious implications for their health and well-being. The significance of health as a crucial economic concern for residents of slum areas, particularly women, cannot be overstated. Research has shown that an unhealthy physical environment in slums can lead to illnesses requiring medical attention, resulting in a loss of workdays and economic productivity (Prüss-Ustün et al., 2017). Barua (2014) highlighted that women in slum areas often experience various health issues such as joint pain, mental stress, white discharge, and acute fatigue, with many resorting to self-medication for treatment. These health problems are commonly attributed to factors like excessive workload, inadequate nutrition, and poor living conditions (Abdi et al., 2021; Nangia \u0026amp; Thorat, 2000). Furthermore, studies indicate that slum residents tend to ignore minor ailments and avoid seeking medical help when unwell (Das et al., 2018; Ezeh et al., 2017; van der Heijden et al., 2019). One key factor influencing the healthcare-seeking behavior of slum dwellers is the limited availability of healthcare facilities, leading to reliance on informal providers, and sale of medications at unauthorized outlets (Krishna, 2010; Shukla et al., 2019). In these settings, only a limited range of low-cost medicines is typically accessible, often sold in grocery stores without proper licensing (Goswami, 2014).\u003c/p\u003e\n\u003cp\u003eResearch indicates that the migrant population residing in slums often face challenges in accessing healthcare services (Kusuma et al., 2010). Disparities have been observed in the access and utilization of healthcare services between the general urban population and migrants, with inequities existing in healthcare access (Owusu \u0026amp; Yeboah, 2018; Park et al., 2022). Migrants are typically of lower socioeconomic status, less likely to be employed, and may reside in less secure housing compared to non-migrants (Coates et al., 2013; Owuor, 2007). Many migrant women who relocate to slum areas in search of employment opportunities often have lower levels of education compared to non-migrants (African Population and Health Research Center, 2014). They frequently find themselves economically inactive or engaged in low-wage and irregular employment following migration (Emina et al., 2011). These circumstances can make it difficult for them to provide adequate support for their children due to challenges such as inadequate housing (Gulyani et al., 2012; Meth, 2013), the risk of eviction (Beyer et al., 2016; Gulyani et al., 2012; Meth, 2013), and food insecurity (Faye et al., 2011).\u003c/p\u003e\n\u003cp\u003eIn the bustling community of Ayobo in Nigeria, a diverse population of migrant women navigate a landscape marked by both opportunity and challenge. Drawn by the promise of a better life for themselves and their families, these women grapple with a myriad of issues that impact their daily existence, with access to and utilization of healthcare being a critical determinant of their well-being and quality of life. Limited research exists on healthcare utilization and accessibility among migrant women in Nigerian slums. In order to address this gap, this study drew on a qualitative study to understand the patterns of healthcare utilization and factors influencing accessibility among migrant women in urban slums in Nigeria. The aim of the current study was to examine the level of access to healthcare services and utilization of health facilities in urban slum communities in Nigeria. The study was guided by three research questions:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWhat are the features of living conditions of international migrant women in urban slums?\u003c/li\u003e\n \u003cli\u003eWhat are the patterns of healthcare utilization among migrant women in urban slums?\u003c/li\u003e\n \u003cli\u003eWhat are the factors that influence accessibility and utilization of health care facilities by migrant women in urban slums?\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003cp\u003eThe foundation of this study was built upon firsthand field observations and investigations. The research adopted a qualitative case study-oriented research design, focusing on migrant women of reproductive age. The case study design is important for three reasons. First, it allows for a concentrated focus on meticulous and thorough data collection from multiple sources within a specific locale and targeted group (Bryman, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Second, it emphasizes the importance of preserving and analyzing the contextual backdrop, which is crucial for conducting in-depth analyses (Gerring, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Third, it is more valuable compared to research endeavors that seek superficial knowledge from diverse contexts, as it avoids the risk of conceptual stretching (Schutt, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study aimed to recruit 25\u0026ndash;30 female participants, which was similar to previous qualitative inquiries in relation to healthcare access and utilization among women (Ganle et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ntoimo et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Udenigwe et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). To be included in the study, participants needed to be migrant women of reproductive age who lived in Ayobo community of Lagos State, Nigeria where the study was conducted. Secondary data were utilized through a comprehensive review of pertinent literature, including books, articles, and reputable internet sources.\u003c/p\u003e \u003cp\u003eThe study location was Ayobo, a high-density suburban district in Alimosho local government area of Lagos State, south-western Nigeria. Situated at the border of Aiyetoro, Ogun State, Ayobo shares the Local Council Development Area with Ipaja. According to the 2006 census, the population of Ayobo was approximately 633,009 people (National Population Census, 2006). The selection of Ayobo for this study is strategically justified by its diverse migrant population, representative urban slum characteristics, healthcare access challenges, and the influential role of community dynamics (Opoko et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These factors collectively provide a robust foundation for exploring the lived experiences of international migrant women and developing informed interventions to enhance their healthcare access and utilization.\u003c/p\u003e \u003cp\u003eRecruitment of participants in this study proved challenging due to factors such as sensitivity, security concerns, and a reluctance to disclose information on research issues. The snowballing technique was employed, involving the identification and contact of initial interviewees who subsequently referred and introduced the research team to additional participants capable of contributing to the research. To mitigate bias and encompass varied perspectives, in-depth interviews were conducted at the household level from June to September 2018.\u003c/p\u003e \u003cp\u003eSemi-structured, audio-recorded interviews lasting\u0026thinsp;~\u0026thinsp;45 min were conducted face-to-face by Authors One and Two. The interview guide used with participants focused on three themes: living conditions in slum settlements, the nature of existing healthcare, and factors that influence accessibility and utilization of healthcare facilities in slum settlements. The interviews with health officers focused on the same topics, however, it was more focused on the challenges facing healthcare utilization and accessibility among migrant women in the study area. Data collection ended when there was sufficient information from the interviews to answer the research questions (Malterud et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe transcripts from the audio recordings of the face-to-face interviews were transcribed by Author One and Author Two. Braun \u0026amp; Clarke's (2021) reflexive thematic analysis framework, consisting of six phases, was employed to interpret and derive themes from the data. This interpretive process took place both during and after data collection. Detailed notes were taken after each interview to capture key topics discussed, and data familiarization was an ongoing process during transcription. Coding and theme development were centered on the research questions. The researchers engaged in regular meetings to discuss data interpretation, theme construction, and the implications of the study findings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included a total of 25 participants, comprising 21 migrant women and 4 healthcare workers. Among the participants, the majority were women, with the exception of one male, the sole Medical Doctor in the study area. Participants' ages ranged from 22 to 48 years. They hailed from Togo, Benin, and Niger - neighboring countries to Nigeria. The duration of residence in the study area varied, with some participants having lived there for many years, while others had only recently moved. The anonymity of all interviewees was carefully maintained throughout the study.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eLiving Conditions of International Migrant Women\u003c/h2\u003e \u003cp\u003eThe living conditions of migrant women in impoverished urban slums reflect the challenges posed by inadequate housing, with many residing in makeshift and incomplete buildings that underscore the precarious nature of their accommodation arrangements. Despite facing substandard housing conditions, participants in the study demonstrated resilience and adaptability in navigating these challenges, emphasizing the fundamental importance of having shelter, regardless of its quality. The narrative shared by the following participant shed light on their experience of housing instability and the gradual process of improvement within their living environments:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWhen I arrived in Nigeria in 2015, I lived in Agege with my husband and his friend. Our living condition was challenging, as we struggled with poor housing and limited resources. However, in 2016, we decided to relocate in search of better opportunities. Since then, we had welcomed three children into our lives. Despite the initial hardships, we are gradually improving our situation. Through perseverance and hard work, we are determined to create a better future for ourselves and our children. \u0026mdash;\u003c/em\u003e 24-year-old migrant from Benin Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAccess to clean water emerged as a pressing concern among participants in the study, highlighting the challenges faced by migrant women and their families in securing a reliable water supply. Many reported relying on neighbors or nearby sources to fetch water, often enduring long distances or incurring costs to meet their daily water needs. The following participant described her water-fetching routine, stating that she obtains water from a source located about three houses away from her residence:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI fetch water from a street tap, located about three houses away from my residence. Unfortunately, where I live lacks any facility for water access, leaving us dependent on communal sources for our daily needs. This absence of basic amenities adds an extra burden to our daily lives, requiring us to travel a distance to fulfill a fundamental necessity. Despite these challenges, we persevere, making the journey each day to ensure our family's access to clean water.\u003c/em\u003e \u0026mdash; 22-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant, a mother of four, shared her experience of accessing water from a neighbor located in close proximity to her home, as well as getting help from fellow church members:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI fetch water from one of my neighbors close to where I live. Fortunately, she graciously helps me, understanding the challenges we face. Being the wife of a Pastor, I receive support not only from my neighbor but also from fellow church members. During the period of my childbirth, they generously assisted me in fetching water, alleviating some of the burdens of daily life\u003c/em\u003e. \u0026mdash; 31-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAccess to adequate sanitation facilities posed a significant challenge for participants in this study. Many described using makeshift or communal toilets, often situated within incomplete structures, highlighting the lack of proper sanitation infrastructure in their living environments. Waste disposal methods were also characterized by makeshift practices, with burning being a common strategy employed during dry seasons. However, the arrival of rainy seasons posed additional obstacles to waste management, particularly affecting disposal practices and access to designated refuse dumpsites. For example, the following participant shared insights into their living conditions, expressing concerns about the quality of their toilet facilities:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMy toilet situation is less than ideal. It is a source of embarrassment, especially when visitors come around. The makeshift setup within an unfinished building lacks privacy and basic hygiene standards. To manage waste disposal, particularly during dry seasons when the risk of disease is higher, we take precautions by burning our refuse. Despite these challenges, we try our best to maintain cleanliness and sanitation as best as we can under the circumstances.\u003c/em\u003e \u0026mdash; 41-year-old migrant from Benin Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother participant provided further perspective on sanitation challenges within their living space. She described using a pit latrine shared by all occupants of their \u0026ldquo;\u003cem\u003eface-me-I-face-you\u003c/em\u003e\u0026rdquo; residence, a specific type of housing in Nigeria where multiple one- or two-room apartments face each other along a common walkway leading to the main entrance of the building:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe toilet is a pit latrine shared by all the occupants of my \"face me I face you\" house, a common arrangement in our community. However, for the sake of my children's hygiene, we use a potty (chamber pot) for their needs. Currently, there's no proper method for waste disposal. During the dry season, I resort to burning waste, but during the rainy season, disposing of it becomes a significant challenge. Complicating matters further, the land where we used to dump our refuse has been sold to someone planning to build a house there. This leaves us in a difficult situation, grappling with sanitation issues with limited options for waste management.\u003c/em\u003e \u0026mdash; 30-year-old migrant from Niger Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe living conditions observed among migrant women and their families have significant health implications. The prevalence of various ailments was attributed to environmental factors such as stagnant water bodies, poorly maintained surroundings, and inadequate waste management practices. The following key informant emphasized the crucial role of the environment in influencing the prevalence of illnesses within the community:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe environment plays a significant role in the prevalence of certain ailments despite efforts to address them with medication. In our area, the presence of swamps, overgrown bushes, and dirty drainage creates an ideal breeding ground for disease-carrying mosquitoes like the female anopheles. Despite our efforts to counsel the community on the importance of cleanliness and hygiene, the persistence of these environmental factors continues to contribute to the ongoing health challenges we face.\u003c/em\u003e \u0026mdash; 29-year-old Medical Doctor\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePattern of Healthcare Utilization\u003c/h2\u003e \u003cp\u003eA notable trend observed among participants in this study was their preference for traditional remedies, like herbs and consultations with traditional healers and auxiliary nurses, rather than seeking care at formal healthcare facilities. This inclination towards traditional medicine often stemmed from personal beliefs, cultural traditions, and the perceived efficacy of herbal treatments in addressing health issues. Some participants expressed a preference for herbal remedies as a first line of defense against illnesses, saving visits to hospitals or purchasing pharmaceutical drugs for more severe or persistent health concerns:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI prefer starting with herbal remedies initially due to their natural properties and historical effectiveness in treating various ailments. The use of herbs align with my belief in holistic healing and the importance of traditional medicine in maintaining overall well-being. Assessing the severity of the illness is crucial in determining the appropriate course of action, and if the symptoms indicate a serious condition, I am open to purchasing medication or seeking professional medical care at a hospital. While herbs have been my go-to remedy and have provided relief in the past, I acknowledge the importance of timely and comprehensive healthcare interventions in managing severe or persistent health issues.\u003c/em\u003e \u0026mdash; 36-year-old migrant from Niger Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinancial limitations and a lack of awareness regarding the affordability of healthcare services were notable hurdles hindering participants from accessing formal medical care. For example, a Matron who supervises the nursing staff in a health center, highlighted how financial constraints deterred migrant women from seeking care at health centers, perceiving formal healthcare as unaffordable. She also stated a lack of information and knowledge about the cost of services at health facilities fostered misconceptions about healthcare affordability, leading some individuals to spend money on unnecessary medications from \u003cem\u003echemists\u003c/em\u003e (patent medicine vendors) instead of seeking appropriate medical attention:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eFinancial constraints pose a significant challenge for many individuals in accessing healthcare services. When discussing this issue with them, a common refrain is \"owo po lowo mi,\" a Yoruba saying meaning they lack the funds to afford health center services. The primary obstacle faced by these women is lack of information and knowledge regarding healthcare affordability. The primary challenge for these women lies in their lack of information and knowledge regarding healthcare affordability. Upon engaging them in conversations, they often express surprise upon learning that the health center offers services at minimal or no cost, contrary to their previous beliefs. This lack of awareness leads them to expend funds on unnecessary medications from local chemists, resulting in higher overall expenses. Although the health center typically imposes a nominal fee for services like injections and treatments, individuals may be unaware of these affordable options. Despite financial constraints, the health center is willing to provide subsidies for those in need, underscoring the importance of cost-effective healthcare access.\u003c/em\u003e \u0026mdash; 48-year-old Matron at the Community HealthCare Center\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis study brought to light a prevailing pattern where participants often resort to self-care practices, including buying medications from patent medicine vendors (PMVs), commonly referred to as \u003cem\u003echemists\u003c/em\u003e. However, when it concerned their children, there was a distinct preference for seeking professional medical care at the health center. This preference indicates a heightened level of concern and a proactive approach to safeguarding their children's well-being, as articulated by one participant:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI seldom visit the health center myself. As an adult, I feel confident in managing my own health issues. If traditional remedies don't suffice, I resort to purchasing medications from a chemist. However, when it comes to my children, I consistently prioritize their health. I always take them to the health center to ensure they receive thorough medical attention and accurate diagnoses. Their well-being is my utmost concern, and I place my trust in the health center's services for their treatment and immunizations.\u003c/em\u003e \u0026mdash; 33-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eLikewise, another participant noted a prevalent pattern among migrant women where their own healthcare needs are frequently relegated to a lower priority compared to ensuring essential healthcare services, such as immunizations, for their children:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe main reason I go there is for my children. I don't see myself as a regular patient at the health center. When I fall ill, I turn to herbs or visit a chemist instead of seeking care at the health center. However, when my children fall sick, I prioritize taking them to the health center to ensure they receive proper diagnoses and treatment. Their well-being is my utmost priority, and I have confidence in the health center's ability to provide the necessary care for them. Additionally, I rely on the health center for their immunizations and other preventive measures crucial for their overall health and well-being.\u003c/em\u003e \u0026mdash; 36-year-old migrant from Benin\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe narratives shared by participants provided insight into the obstacles and perspectives regarding laboratory tests and the availability of prescribed medications at the health center, highlighting a larger concern about limited resources and healthcare infrastructure within the community under study. For instance, one participant noted that a lack of awareness or comprehension regarding the significance of laboratory tests in effectively diagnosing and monitoring health conditions contributed to a hesitancy to undergo such tests, particularly among migrant women who perceived they already grasp the nature of their health issue:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe health center possesses some testing equipment, but I seldom utilize the laboratory facilities. Why should I undergo testing when I already have a good understanding of my children's ailments? I perceive it as unnecessary to undergo testing when the symptoms are familiar, and I can manage them effectively with the treatments I'm accustomed to. Moreover, I believe the time and expense associated with these tests would be better allocated to providing immediate care for my children.\u003c/em\u003e \u0026mdash; 30-year-old migrant from Benin Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another participant expressed hesitation about undergoing laboratory tests, citing a mix of factors such as the perceived seriousness of the health concern, apprehension about receiving unfavorable results, and skepticism regarding the healthcare system's capacity to deliver precise diagnoses:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eGod forbid! Why would I require tests? My issue isn't that grave; I'm solely focused on immunization. I don't concern myself with those laboratory tests because I rely on my intuition for health matters. Moreover, I prioritize preventive actions like immunization over unnecessary tests for minor ailments.\u003c/em\u003e \u0026mdash; 23-year-old migrant from Niger Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition to concerns about laboratory testing, participants also highlighted challenges related to access to prescribed medications at the health center. This observation underscores a common issue faced by many individuals in resource-constrained settings, where limited availability of essential medications at healthcare facilities necessitates out-of-pocket expenses to obtain prescribed drugs from external sources:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe health center doesn't dispense medications; rather, they provide prescriptions that we must obtain from chemists and pharmacists independently. This places an additional strain on our already limited resources, requiring us to invest extra time and money in traveling to acquire the prescribed medications.\u003c/em\u003e \u0026mdash; 28-year-old migrant from Niger\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, another participant echoed similar sentiments:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI rarely depend on the medications provided at the health center because they're not consistently available. Instead, after diagnosing our conditions, they prescribe treatments, leaving us to procure the necessary medications from a chemist or pharmacy elsewhere. This procedure can be burdensome and exacerbates the difficulties of accessing adequate healthcare\u003c/em\u003e. \u0026mdash; 26-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Accessibility and Utilization of Health Care Facilities\u003c/h2\u003e \u003cp\u003eMigrant women exhibit a wide range of perceptions about healthcare personnel, reflecting both positive and negative experiences within the healthcare system. These varying perspectives illuminate the complex dynamics that influence their interactions with healthcare providers and their overall satisfaction with the care received. The following participant, who is a regular visitor to the health center, expressed a sense of contentment with the treatment provided by healthcare personnel:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI can't lie, the health workers treat me well. Even when they scold me, I know it's for my own good. I can tolerate any insult because I need their help and believe it comes from a place of love. Their strictness shows they care about my health and want the best for me. This makes me feel more confident in the care I receive, knowing that they are genuinely invested in my well-being.\u003c/em\u003e \u0026mdash; 30-year-old migrant from Niger\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition to the participant who expressed satisfaction with occasional scolding as a form of care and love, another participant highlighted the inconsistency in healthcare services experienced by migrant women. She noted that the provision of treatment often seemed to depend on personal relationships or financial incentives. Her sentiment underscores a critical issue within the healthcare system. The variability in service provision based on personal relationships and financial incentives reflects systemic inequities, which can lead to inconsistent care for migrant women. The reliance on informal exchanges suggests that the healthcare system may lack sufficient resources or structured protocols to ensure fair and timely access to care for all patients, regardless of their socio-economic status or personal connections:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThey make an effort, but sometimes you end up waiting a long time. If they like you, they might give you some medication when you're sick. If you have money, you can give them a small reward. It often feels like the quality of care you receive depends more on your personal relationship with the healthcare workers and your ability to provide financial incentives than on your actual medical needs.\u003c/em\u003e \u0026mdash; 22-year-old migrant from Benin Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDistance to healthcare facilities is a crucial factor influencing individuals' utilization of healthcare services. The proximity of health centers can significantly impact the choices people make regarding their healthcare. For instance, a 22-year-old participant highlighted that the distance to the health center influenced her decision to opt for more accessible herbal remedies instead of seeking conventional medical care. This demonstrates how geographical barriers can shape healthcare-seeking behavior, leading individuals to explore alternative options when faced with challenges in accessing traditional healthcare services. On the other hand, 21-year-old participant expressed a contrasting perspective, indicating that the distance to the health center was not a significant concern for them. She viewed walking long distances as a manageable aspect of their daily routine, suggesting a higher threshold for physical exertion or a different perception of accessibility to healthcare services. This divergence in experiences underscores the diverse ways in which individuals navigate and adapt to the challenges posed by geographical barriers in accessing healthcare. It highlights the need for a nuanced understanding of how distance and accessibility influence healthcare-seeking behaviors among different individuals and communities. Addressing these geographical barriers is essential for ensuring equitable access to healthcare services for all residents, particularly those in underserved areas.\u003c/p\u003e \u003cp\u003eFinancial constraints represent a significant barrier to accessing healthcare services for migrant women. The inability to afford necessary medications and healthcare services due to financial limitations poses a considerable challenge for those seeking medical treatment. This economic barrier not only impacts the ability to access essential healthcare but also influences the decision-making process regarding alternative healthcare options and coping strategies. The following key informant emphasized the impact of financial issues on healthcare access, noting that in the absence of sufficient funds, individuals often turn to religion or seek out less costly alternatives for managing their health needs:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe financial aspect is the main issue; it hinders a lot of things. They can't afford to buy drugs, and distance and other factors become secondary concerns. They often turn to religion because they lack the necessary finances. Additionally, midwives are cheaper than hospitals, so the choice to seek care from them is driven by cost rather than distance or other logistical issues\u003c/em\u003e. \u0026mdash; 29-year-old Medical Doctor\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAdditionally, another participant pointed out that the cost of prescribed medications frequently acts as a deterrent to purchasing them. This observation sheds light on the direct impact of medication costs on treatment adherence and health outcomes, as individuals may forego or delay necessary medications due to financial constraints, potentially compromising their health and well-being. She stated thus:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI buy drugs too, but it depends on the type and cost. If the health center do not have the medications, we have to purchase the prescribed drugs elsewhere. If the drugs are too expensive, I will not bother buying them.\u003c/em\u003e \u0026mdash; 25-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe influence of cultural, religious, and personal beliefs on healthcare decisions among migrant women is a critical aspect that shapes their health-seeking behaviors and treatment preferences. The study participants highlighted the significant role of cultural practices and familiarity in guiding their healthcare choices, with some individuals expressing a preference for herbal remedies based on traditional knowledge and experiences within their communities. The following participant shared her positive experience with herbal remedies, emphasizing how these traditional treatments have been effective for her and her family:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt's more of a cultural tradition passed down through generations. Herbs worked for my mom, and they work for me too. My body has adjusted to them very well, so I usually don't consider going to the health center. I trust these remedies because they have been a part of my family's health practices for as long as I can remember. They are not only familiar but also accessible and affordable, which makes them a preferred choice for me and many others in my community.\u003c/em\u003e \u0026mdash; 26-year-old migrant from Niger\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, a key informant attributed the preference for herbal remedies to ignorance and a lack of education among migrant women. She emphasized that traditional practices and advice from older, uneducated women often dominate healthcare decision-making processes. This reliance on informal knowledge suggests a significant gap in health literacy and access to evidence-based information among certain segments of the migrant population. The participant noted that many migrant women trust the guidance of elderly women in their community over formal healthcare providers, often because these elderly women have successfully managed health issues in the past using traditional methods. This deep-rooted trust in cultural practices and a lack of exposure to modern medical information contribute to the persistence of using herbal remedies, even when formal healthcare might offer more effective solutions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe major issue is ignorance and lack of education. Many migrant women often take advice from older, uneducated women in their communities, as these elder women are perceived as knowledgeable and trustworthy. Their husbands also insist on trusting these women because they were the ones who assisted in their own births, reinforcing the belief that these elder women can be trusted to deliver their unborn children as well. This reliance on traditional knowledge over formal medical advice indicates a significant gap in health literacy and access to evidence-based healthcare information among the migrant population. This deep-seated trust in community elders and traditional practices highlights the urgent need for educational interventions and outreach programs to improve health literacy and encourage the adoption of safer, evidence-based healthcare practices.\u003c/em\u003e \u0026mdash; 36-year-old Hospital Matron\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eReligious beliefs hold a significant influence over healthcare decisions among migrant women, as highlighted by the experiences shared by participants in the study. The intersection of faith and healthcare practices shapes individuals' perspectives on treatment modalities and influences their approach to managing health issues. In particular, the role of religious beliefs in guiding healthcare decisions is exemplified by the account of a participant, a Pastor's wife, who provided insights into her personal views on the integration of spirituality and medical treatment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSome people avoid going to the clinic for various reasons, including religious beliefs. In certain denominations, the use of drugs is discouraged because there is a belief that only God, by His grace, heals us. However, I hold a different perspective. Even though I am a pastor's wife, I believe that God can use drugs as a medium to heal us. God doesn't need to come down to earth to heal us directly; instead, He has provided us with drugs. We must combine prayer with medical treatment, recognizing that God created both the leaves and the drugs for our benefit.\u003c/em\u003e \u0026mdash; 35-year-old migrant from Benin Republic\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe utilization of health care facilities among migrant women is significantly influenced by recommendations from friends and family members, especially from fellow migrants within their social networks. The reliance on referrals and testimonials from trusted individuals plays a crucial role in shaping healthcare-seeking behaviors and decisions, highlighting the importance of interpersonal relationships and community support in accessing essential health services. The following participant, a Togolese food seller and mother of two, shared her experience on the impact of recommendations on her decision to visit a health center. She highlighted that the primary reason for seeking care at the health center was for immunization, a crucial aspect of child health:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe primary reason for my visits to the health center is for immunization. Given the tender age of my children, a friend strongly recommended that I bring them here for their immunization shots, emphasizing the importance of safeguarding their health through this vital preventative measure. She explained how regular immunizations could prevent serious illnesses and protect their developing immune systems. Additionally, my friend shared personal experiences of witnessing the positive effects of immunization on her own children's health, instilling confidence in me regarding the efficacy of this healthcare practice. Her reassurances and firsthand accounts have been instrumental in my decision to prioritize immunizations, ensuring that my children receive the necessary protection to thrive in their early years\u003c/em\u003e. \u0026mdash; 32-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another participant from Togo recounted the support and guidance received from family members regarding healthcare decisions for her child:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eRecommendations from others significantly influence my decisions. One of my sisters from Togo advised me to take my newborn baby to the health center for injections to ensure good health. Her recommendation carried weight, as she had experienced positive outcomes with her own children after receiving similar care at the facility. She shared stories of how her children thrived after receiving their immunizations, free from many common illnesses that unvaccinated children often suffer. Consequently, I didn't seek antenatal treatment at that facility, opting instead to prioritize my child's health based on trusted advice within my community. This guidance from my sister, who I deeply trust, reinforced my belief in the importance of following through with recommended health practices, underscoring the value of community support and shared knowledge in making healthcare decisions.\u003c/em\u003e \u0026mdash; 28-year-old migrant from Togo\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored how migrant women accessed and utilized health care facilities in urban slum communities in Nigeria. Three themes were constructed from the data relating to the level of access to healthcare services and utilization of health facilities among migrant women. There were three points of discussion that are particularly relevant to these findings within the context of public health approaches to addressing healthcare access and utilization.\u003c/p\u003e \u003cp\u003eFirst, this study revealed that international migrant women living in impoverished urban slums face significant housing challenges. Majority of the women reside in makeshift and incomplete buildings, which underscores the precarious nature of their accommodation. Despite these substandard conditions, the resilience and adaptability demonstrated by the participants highlight a fundamental aspect of their experiences: the prioritization of shelter, irrespective of its quality. The lack of privacy and dignity associated with using communal or makeshift toilets can lead to feelings of shame, embarrassment, and vulnerability among women, impacting their overall well-being and sense of self-worth. This finding is consistent with research which found that migrants tend to be poorer, less likely to be employed, and may live in less stable housing compared to non-migrants (Malik et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Omole, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). This study also demonstrated that access to clean water is a critical concern for migrant women. The findings from the study revealed that many migrant women rely on communal or nearby sources for water, which often entails long distances or additional costs. This reliance on external sources not only underscores the lack of basic amenities in their living conditions but also imposes an extra burden on these women. The reliance on communal or nearby water sources may raise concerns about the quality and safety of the water available to these women. Inadequate access to clean water can pose health risks, exposing individuals to waterborne diseases and contaminants that can further compromise their well-being. The study highlighted the prevalence of ailments linked to environmental factors such as stagnant water, poor waste management, and overgrown vegetation, which create ideal conditions for disease vectors like mosquitoes. Previous research has shown that access to clean water is a critical issue in many urban slums, leading to contracting communicable diseases such as diarrhea (Zwane \u0026amp; Kremer, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Sanitation facilities pose another significant challenge for many migrant women. The study demonstrated a severe lack of proper sanitation infrastructure, exposing migrant women to various health and safety risks. Researchers have previously recognized that overcrowding and poor environmental sanitation are issues faced by women in slum settlements (Akinwale et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The shared nature of these facilities can lead to overcrowding, long wait times, and discomfort, further exacerbating the challenges faced by migrant women.\u003c/p\u003e \u003cp\u003eSecond, this study demonstrated that a notable trend among migrant women is the preference for traditional remedies, such as herbal treatments and consultations with traditional healers and auxiliary nurses, over seeking care at formal healthcare facilities. This inclination is deeply rooted in personal beliefs, cultural practices, and the perceived effectiveness of herbal treatments in managing health conditions. Similar research had shown that in instances of minor ailments, herbal-based remedies are favored over allopathic treatments due to their cost-effectiveness among many migrant women (Li et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This approach aligned with her belief in holistic healing and the importance of traditional medicine. Financial constraints and a lack of awareness about the affordability of healthcare services emerged as significant barriers to accessing formal medical care among migrant women in this study. Many migrant women perceived formal healthcare as unaffordable due to financial limitations and a lack of information about the cost of services. This is consistent with the study by Chuah et al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) who identified health illiteracy and lack of awareness as barriers to health care access among migrants. This misconception leads them to spend money on unnecessary medications from PMVs (also known as \u003cem\u003echemists\u003c/em\u003e), resulting in higher overall expenses and delayed professional medical intervention. Studies have previously recognized that financial support may not be easily accessible to international migrants as they may lack access to stable sources of income (Anderloni \u0026amp; Vandone, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Solheim et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The study brought to light a significant trend among participants, indicating a reliance on self-care practices for addressing their health needs, through the purchase of medications from PMVs or \u003cem\u003echemists\u003c/em\u003e. This preference for self-care methods underscores a practical approach to managing minor ailments and health concerns among the participants themselves. However, a distinct pattern emerges when it comes to the healthcare decisions regarding their children, revealing a clear preference for seeking professional medical care at health centers. Truly, PMVs frequently serve as the initial point of contact within many urban slums, with a greater proportion of visits to these PMVs attributed to new conditions rather than pre-existing ones (Onuegbu et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Onwujekwe et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The participants' inclination towards self-care for themselves may stem from factors such as religion, convenience, familiarity with traditional remedies, or cost considerations associated with over-the-counter medications obtained from PMVs or \u003cem\u003echemists\u003c/em\u003e. In contrast, the prioritization of professional medical care for their children suggests a heightened level of concern and a proactive stance towards safeguarding their children's well-being.\u003c/p\u003e \u003cp\u003eA final point for discussion arising from this research relates to factors that influence accessibility and utilization of healthcare facilities among migrant women. Migrant women residing in urban slums demonstrate a range of perceptions towards healthcare personnel, reflecting a spectrum of experiences encompassing both positive and negative encounters within the healthcare system. Some expressed contentment with the treatment provided by healthcare personnel, interpreting occasional scolding from healthcare providers as a demonstration of care and affection, indicating a high level of tolerance and a profound need for support despite encountering what may be perceived as harsh interactions. Others suggested that the quality of treatment received often relied on personal relationships with healthcare providers or financial incentives, indicating potential biases or informal practices that could influence the care provided to migrant women. The identification of a spectrum of perceptions towards healthcare personnel among migrant women extends previous research by highlighting the complexity of dynamics that influence individuals' interactions with healthcare providers (Braithwaite et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Khan et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This underscores the need for a nuanced understanding of healthcare experiences to address the diverse needs and preferences of migrant populations effectively. The recognition of potential influence of informal practices within the healthcare system on treatment quality expands on existing literature that discusses systemic issues affecting healthcare delivery to migrant populations (Acquadro-Pacera et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This emphasizes the importance of addressing structural factors and promoting transparency in service provision to enhance the overall healthcare experiences of migrant women. Distance to healthcare facilities plays a pivotal role in shaping healthcare utilization patterns among migrant women, as evidenced by the experiences shared by participants in the study. As a result, many migrant women opt for more accessible herbal remedies instead of seeking care at a health center. This finding aligns with previous studies that highlights geographical barriers as significant determinants of access to healthcare services (Lankila et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Okwaraji et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Financial constraints represent a significant barrier to accessing healthcare services for the women. The inability to afford necessary medications and healthcare services due to financial limitations poses a considerable challenge. This economic barrier often acts as a deterrent to purchasing prescribed medications, potentially compromising health outcomes. As the study showed, this is yet another reason the women turned to midwives or traditional herbs for remedies. Truly, past studies have identified economic factors as key determinants of healthcare access for vulnerable populations, including migrants (Jayeweera, 2021; Lebano et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Cultural and religious beliefs significantly shape healthcare decisions among migrant women. Some participants expressed a strong preference for herbal remedies based on traditional knowledge and community experiences. This perspective illustrates the nuanced interplay between faith and healthcare practices among migrant women. Similarly, previous studies have emphasized the impact of cultural beliefs on healthcare decisions among migrant populations (Levin-Zamir et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The utilization of healthcare facilities among migrant women is significantly influenced by recommendations from friends and family members within their social networks. The reliance on referrals highlights the importance of interpersonal relationships and community support in accessing health services and demonstrates the critical role of social networks in shaping healthcare-seeking behaviors and decisions. This aligns with various studies that point that social networks exists as an effective way to influencing health seeking behavior of migrants (Kim et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ryan, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Social networks serve as channels for information dissemination and guidance on healthcare services. Recommendations from peers and family members can provide valuable insights into available healthcare options, quality of services, and the overall patient experience, influencing individuals' decisions to seek care\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThere are three limitations associated with this study. First, language barrier posed a significant challenge, as most participants were not proficient in English. To facilitate communication, researchers conducted interviews in \u003cem\u003ePidgin\u003c/em\u003e, an English-based creole language widely spoken across Nigeria. However, even \u003cem\u003ePidgin\u003c/em\u003e was not universally understood by all participants. For those unable to communicate in \u003cem\u003ePidgin\u003c/em\u003e, interviews were conducted in Yoruba, the predominant local language in the study area. This language barrier primarily arose because the participants originated from French-speaking countries, necessitating their learning of \u003cem\u003ePidgin\u003c/em\u003e English or Yoruba to communicate more effectively upon arriving in Nigeria. The need to use multiple languages for effective communication underscores the importance of linguistic adaptability in research involving diverse migrant populations and highlights the challenges faced by migrants in adapting to new linguistic environments.\u003c/p\u003e \u003cp\u003eSecond, many participants were initially reluctant to engage in the study, fearing that the researchers might be government officials. This apprehension stemmed from concerns about their immigration status, as many were either undocumented or had unresolved legal issues related to their residency in the country. This mistrust posed a significant barrier to data collection, as it limited the openness and willingness of participants to share their experiences and challenges. Overcoming this barrier required building trust and ensuring participants of the confidentiality and non-governmental nature of the research. Addressing these concerns is crucial in future studies to facilitate more comprehensive and candid participation, thereby yielding richer and more accurate data on the healthcare experiences of migrant women.\u003c/p\u003e \u003cp\u003eThird, this study was limited to a single location in Lagos due to funding constraints. Conducting research in additional locations across Nigeria, where there are also significant populations of migrant women, would have provided a more comprehensive understanding of their healthcare experiences and challenges. Expanding the study to include diverse regions would have captured a wider range of cultural, social, and economic factors influencing healthcare access and utilization among migrant women in Nigeria. This broader scope would have enriched the data and potentially revealed regional variations and commonalities in healthcare needs and barriers faced by migrant women throughout the country.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlighted the complex interplay of factors influencing the access to and utilization of healthcare facilities among migrant women in urban slum communities in Nigeria. Housing instability, lack of access to clean water and sanitation facilities, cultural beliefs, financial constraints, and social networks all play crucial roles in shaping healthcare-seeking behaviors among this vulnerable population. The findings underscore the urgent need for targeted public health interventions to address the structural determinants of healthcare access and utilization among migrant women. Improving housing conditions, providing access to clean water and sanitation infrastructure, and addressing economic barriers to healthcare access are paramount. Culturally sensitive healthcare programs that respect traditional healing practices while promoting evidence-based medical care can help bridge the gap between migrant women's healthcare needs and available services. Furthermore, community-based interventions that leverage social networks and peer support systems can enhance health literacy and facilitate access to healthcare services. By empowering migrant women to make informed healthcare decisions and providing them with the necessary resources and support, we can work towards achieving health equity and improving the overall well-being of migrant populations in urban slum communities. The implications for public health are clear: Addressing the multifaceted challenges faced by migrant women requires a comprehensive and holistic approach that takes into account their unique social, cultural, and economic contexts. By addressing these barriers and promoting equitable access to healthcare, we can strive towards achieving the goal of health for all, regardless of socioeconomic status or migration status.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatement of Ethics Approval\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the University of Ibadan/University College Hospital Research Ethics Committee (UI/EC/17/0396) provided ethical approval for this study. Adherence to ethical considerations, including confidentiality, anonymity, and autonomy, was observed throughout the study. Due respect was accorded to participants who opted to withdraw from the research. Prior to their involvement, the authors explained the study to potential participants, answering any questions they had. Each participant then signed a consent form indicating their willingness to participate. This written consent process ensured that participants fully understood their involvement in the study and that their participation was entirely voluntary.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdi, F., Rahnemaei, F. A., Shojaei, P., Afsahi, F., \u0026amp; Mahmoodi, Z. (2021). Social determinants of mental health of women living in slum: a systematic review. \u003cem\u003eObstetrics \u0026amp; Gynecology Science\u003c/em\u003e, 64(2), 143. https://doi.org/10.5468/ogs.20264 \u003c/li\u003e\n\u003cli\u003eAckerson, K., \u0026amp; Zielinski, R. (2017). Factors influencing use of family planning in women living in crisis affected areas of Sub-Saharan Africa: A review of the literature. \u003cem\u003eMidwifery\u003c/em\u003e, \u003cem\u003e54\u003c/em\u003e, 35-60. https://doi.org/10.1016/j.midw.2017.07.021 \u003c/li\u003e\n\u003cli\u003eAcquadro-Pacera, G., Valente, M., Facci, G., Molla Kiros, B., Della Corte, F., Barone-Adesi, F., ... \u0026amp; Trentin, M. (2024). Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review. BMC Public Health, 24(1), 963. https://doi.org/10.1186/s12889-024-18472-3 \u003c/li\u003e\n\u003cli\u003eAdeosun, O. T., Owolabi, K. E., Eshiet, I. C., \u0026amp; Owolabi, T. J. (2023). Exploring the transition from informal to formal jobs and its consequent impacts on the livelihood of migrant youths in Lagos metropolis. \u003cem\u003eJournal of Enterprising Communities: People and Places in the Global Economy\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(6), 1135-1153. https://doi.org/10.1108/JEC-02-2022-0020 \u003c/li\u003e\n\u003cli\u003eAfrican Population and Health Research Center. (2014). Population and Health Dynamics in Nairobi\u0026rsquo;s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012. Nairobi: APHRC.\u003c/li\u003e\n\u003cli\u003eAkinwale, O. P., Adeneye, A. K., Musa, A. Z., Oyedeji, K. S., Sulyman, M. A., Oyefara, J. O., ... \u0026amp; Adeneye, A. A. (2014). Living conditions and public health status in three urban slums of Lagos, Nigeria. \u003cem\u003eSouth East Asia Journal of Public Health\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 36-41. https://doi.org/10.3329/seajph.v3i1.17709 \u003c/li\u003e\n\u003cli\u003eAkpabio, E. M., Wilson, N. A. U., Essien, K. A., Ansa, I. E., \u0026amp; Odum, P. N. (2021). Slums, women and sanitary living in South-South Nigeria. \u003cem\u003eJournal of Housing and the Built Environment\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e, 1229-1248. https://doi.org/10.1007/s10901-020-09802-z \u003c/li\u003e\n\u003cli\u003eAlam, N., Hajizadeh, M., Dumont, A., \u0026amp; Fournier, P. (2015). Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(4), e0120922. https://doi.org/10.1371/journal.pone.0120922 \u003c/li\u003e\n\u003cli\u003eAnderloni, L., \u0026amp; Vandone, D. (2008). Migrants and financial services: which opportunities for financial innovation?. In \u003cem\u003eFrontiers of banks in a global economy\u003c/em\u003e (pp. 149-185). London: Palgrave Macmillan UK. https://doi.org/10.1057/9780230590663_7 \u003c/li\u003e\n\u003cli\u003eBadmos, O. S., Callo-Concha, D., Agbola, B., Rienow, A., Badmos, B., Greve, K., \u0026amp; J\u0026uuml;rgens, C. (2020). Determinants of residential location choices by slum dwellers in Lagos megacity. \u003cem\u003eCities\u003c/em\u003e, \u003cem\u003e98\u003c/em\u003e, 102589. https://doi.org/10.1016/j.cities.2019.102589 \u003c/li\u003e\n\u003cli\u003eBarua, N. (2014). Medical pluralism in a slum in Delhi: Global medicine in a local garb. Medical Pluralism and Homeopathy in India and Germany (1810-2010). \u003cem\u003eA Comparison of Practices\u003c/em\u003e, 203-216.\u003c/li\u003e\n\u003cli\u003eBeyer, L. I., Chaudhuri, J., \u0026amp; Kagima, B. (2016). Kenya\u0026apos;s focus on urban vulnerability and resilience in the midst of urban transitions in Nairobi. \u003cem\u003eDevelopment Southern Africa\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(1), 3-22. https://doi.org/10.1080/0376835X.2015.1115739 \u003c/li\u003e\n\u003cli\u003eBraithwaite, J., Churruca, K., Ellis, L. A., Long, J., Clay-Williams, R., Damen, N., ... \u0026amp; Ludlow, K. (2017). Complexity science in healthcare. \u003cem\u003eSydney: Australian Institute of Health Innovation, Macquarie University\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2021). \u003cem\u003eThematic Analysis: A Practical Guide\u003c/em\u003e. SAGE Publications, London, England.\u003c/li\u003e\n\u003cli\u003eBryman, A. (2008). Why do researchers integrate/combine/mesh/blend/mix/merge/fuse quantitative and qualitative research. \u003cem\u003eAdvances in mixed methods research\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(8), 87-100. https://doi.org/10.4135/9780857024329.d9 \u003c/li\u003e\n\u003cli\u003eChuah, F. L. H., Tan, S. T., Yeo, J., \u0026amp; Legido-Quigley, H. (2018). The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study. \u003cem\u003eInternational journal for equity in health\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e, 1-15. https://doi.org/10.1186/s12939-018-0833-x \u003c/li\u003e\n\u003cli\u003eCoates, D., Anand, P., \u0026amp; Norris, M. (2013). Housing and quality of life for migrant communities in Western Europe: A capabilities approach. \u003cem\u003eJournal on Migration and Human Security\u003c/em\u003e, 1(4), 163-209. https://doi.org/10.1177/233150241300100403 \u003c/li\u003e\n\u003cli\u003eCorburn, J., \u0026amp; Hildebrand, C. (2015). Slum sanitation and the social determinants of women\u0026rsquo;s health in Nairobi, Kenya. \u003cem\u003eJournal of environmental and public health\u003c/em\u003e, \u003cem\u003e2015\u003c/em\u003e. https://doi.org/10.1155/2015/209505 \u003c/li\u003e\n\u003cli\u003eDas, M., Angeli, F., Krumeich, A. J., \u0026amp; Van Schayck, O. C. (2018). Patterns of illness disclosure among Indian slum dwellers: a qualitative study. \u003cem\u003eBMC international health and human rights\u003c/em\u003e, 18, 1-17. https://doi.org/10.1186/s12914-018-0142-x \u003c/li\u003e\n\u003cli\u003eDesmond, M. (2012). Eviction and the reproduction of urban poverty. \u003cem\u003eAmerican journal of sociology\u003c/em\u003e, \u003cem\u003e118\u003c/em\u003e(1), 88-133. https://doi.org/10.1086/666082 \u003c/li\u003e\n\u003cli\u003eDias, S., Gama, A., Cargaleiro, H., \u0026amp; Martins, M. O. (2012). Health workers\u0026rsquo; attitudes toward immigrant patients: a cross-sectional survey in primary health care services. \u003cem\u003eHuman Resources for Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 1-6. https://doi.org/10.1186/1478-4491-10-14 \u003c/li\u003e\n\u003cli\u003eEmina, J., Beguy, D., Zulu, E. M., Ezeh, A. C., Muindi, K., Elung\u0026rsquo;ata, P., ... \u0026amp; Y\u0026eacute;, Y. (2011). Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System. \u003cem\u003eJournal of Urban Health\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e, 200-218. https://doi.org/10.1007/s11524-011-9594-1 \u003c/li\u003e\n\u003cli\u003eEzeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., ... \u0026amp; Lilford, R. J. (2017). The history, geography, and sociology of slums and the health problems of people who live in slums. \u003cem\u003eThe lancet\u003c/em\u003e, 389(10068), 547-558. https://doi.org/10.1016/S0140-6736(16)31650-6 \u003c/li\u003e\n\u003cli\u003eFaye, O., Baschieri, A., Falkingham, J., \u0026amp; Muindi, K. (2011). Hunger and food insecurity in Nairobi\u0026rsquo;s slums: an assessment using IRT models. \u003cem\u003eJournal of Urban Health\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e, 235-255. https://doi.org/10.1007/s11524-010-9521-x \u003c/li\u003e\n\u003cli\u003eFink, G., G\u0026uuml;nther, I., \u0026amp; Hill, K. (2014). Slum residence and child health in developing countries. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(4), 1175-1197. https://doi.org/10.1007/s13524-014-0302-0 \u003c/li\u003e\n\u003cli\u003eGanle, J. K., Parker, M., Fitzpatrick, R., \u0026amp; Otupiri, E. (2014). A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. \u003cem\u003eBMC pregnancy and childbirth\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e, 1-17. https://doi.org/10.1186/s12884-014-0425-8 \u003c/li\u003e\n\u003cli\u003eGerring, J. (2007). \u003cem\u003eCase study research: Principles and practices\u003c/em\u003e. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511803123 \u003c/li\u003e\n\u003cli\u003eGoswami, S. (2014). A study on women\u0026rsquo;s healthcare practice in urban slums: Indian scenario. \u003cem\u003eJournal of Evidence-Based Women\u0026rsquo;s Health Journal Society\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(4), 201-207. https://doi.org/10.1097/01.EBX.0000456499.60072.56 \u003c/li\u003e\n\u003cli\u003eGulyani, S., Bassett, E. M., \u0026amp; Talukdar, D. (2012). Living conditions, rents, and their determinants in the slums of Nairobi and Dakar. \u003cem\u003eLand Economics\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e(2), 251-274. http://www.population.gov.ng/index.php/publication/140-popn-distri-by-sex-state-jgas-and-senatorial-distr-2006.\u003c/li\u003e\n\u003cli\u003eIkechukwu, H. U., Ofonime, N. U., Kofoworola, O., \u0026amp; Asukwo, D. E. (2020). Influence of cultural and traditional beliefs on maternal and child health practices in rural and urban communities in Cross River State, Nigeria. \u003cem\u003eAnnals of Medical Research and Practice\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(4), 1. https://doi.org/10.25259/ANMRP_4_2019 \u003c/li\u003e\n\u003cli\u003eJayaweera, H. (2021). Migrant diversity and determinants of health care access and use. \u003cem\u003eJournal of Health Services Research \u0026amp; Policy\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(1), 1-2. https://doi.org/10.1177/1355819620976272 \u003c/li\u003e\n\u003cli\u003eKhan, S., Vandermorris, A., Shepherd, J., Begun, J. W., Lanham, H. J., Uhl-Bien, M., \u0026amp; Berta, W. (2018). Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems. BMC health services research, 18, 1-8. https://doi.org/10.1186/s12913-018-2994-0 \u003c/li\u003e\n\u003cli\u003eKim, W., Kreps, G. L., \u0026amp; Shin, C. N. (2015). The role of social support and social networks in health information\u0026ndash;seeking behavior among Korean Americans: a qualitative study\u003cem\u003e. International journal for equity in health\u003c/em\u003e, 14, 1-10. https://doi.org/10.1186/s12939-015-0169-8 \u003c/li\u003e\n\u003cli\u003eKiwanuka, S. N., Ekirapa, E. K., Peterson, S., Okui, O., Rahman, M. H., Peters, D., \u0026amp; Pariyo, G. W. (2008). Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. \u003cem\u003eTransactions of the Royal Society of Tropical Medicine and Hygiene\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(11), 1067-1074. https://doi.org/10.1016/j.trstmh.2008.04.023 \u003c/li\u003e\n\u003cli\u003eKusuma, Y. S., Kumari, R., Pandav, C. S., \u0026amp; Gupta, S. K. (2010). Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India. \u003cem\u003eTropical Medicine \u0026amp; International Health\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(11), 1326-1332. https://doi.org/10.1111/j.1365-3156.2010.02628.x \u003c/li\u003e\n\u003cli\u003eLankila, T., N\u0026auml;yh\u0026auml;, S., Rautio, A., Rusanen, J., Taanila, A., \u0026amp; Koiranen, M. (2016). Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland. \u003cem\u003ePublic health\u003c/em\u003e, \u003cem\u003e131\u003c/em\u003e, 82-91. https://doi.org/10.1016/j.puhe.2015.10.020 \u003c/li\u003e\n\u003cli\u003eLebano, A., Hamed, S., Bradby, H., Gil-Salmer\u0026oacute;n, A., Dur\u0026aacute;-Ferrandis, E., Garc\u0026eacute;s-Ferrer, J., ... \u0026amp; Linos, A. (2020). Migrants\u0026rsquo; and refugees\u0026rsquo; health status and healthcare in Europe: a scoping literature review. \u003cem\u003eBMC public health\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e, 1-22. https://doi.org/10.1186/s12889-020-08749-8 \u003c/li\u003e\n\u003cli\u003eLevin-Zamir, D., Leung, A. Y. M., Dodson, S., \u0026amp; Rowlands, G. (2017). Health literacy in selected populations: Individuals, families, and communities from the international and cultural perspective. \u003cem\u003eInformation Services \u0026amp; Use\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(2), 131-151. https://doi.org/10.3233/ISU-170834 \u003c/li\u003e\n\u003cli\u003eLi, S., Odedina, S., Agwai, I., Ojengbede, O., Huo, D., \u0026amp; Olopade, O. I. (2020). Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. \u003cem\u003eBMC complementary medicine and therapies\u003c/em\u003e, 20, 1-7. https://doi.org/10.1186/s12906-020-02881-z \u003c/li\u003e\n\u003cli\u003eMalik, S., Roosli, R., \u0026amp; Tariq, F. (2020). Investigation of informal housing challenges and issues: experiences from slum and squatter of Lahore. \u003cem\u003eJournal of Housing and the Built Environment\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(1), 143-170. https://doi.org/10.1007/s10901-019-09669-9 \u003c/li\u003e\n\u003cli\u003eMalterud, K., Siersma, V.D. and Guassora, A.D. (2016). Sample size in qualitative interview studies: guided by information power. Qualitative Health Research, 6, 1753-1760. https://doi.org/10.1177/1049732315617444 \u003c/li\u003e\n\u003cli\u003eMberu, B. U., Haregu, T. N., Kyobutungi, C., \u0026amp; Ezeh, A. C. (2016). Health and health-related indicators in slum, rural, and urban communities: a comparative analysis. \u003cem\u003eGlobal health action\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(1), 33163. https://doi.org/10.3402/gha.v9.33163 \u003c/li\u003e\n\u003cli\u003eMeth, P. (2013). \u0026lsquo;I Don\u0026apos;t Like My Children to Grow up in this Bad Area\u0026rsquo;: Parental Anxieties about Living in Informal Settlements. \u003cem\u003eInternational journal of urban and regional research\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(2), 537-555. https://doi.org/10.1111/j.1468-2427.2012.01199.x \u003c/li\u003e\n\u003cli\u003eNational Population Commission (2006) Nigeria National Census: Population Distribution by Sex, State, LGAs and Senatorial District: 2006 Census Priority Tables (Vol. 3).\u003c/li\u003e\n\u003cli\u003eNtoimo, L. F. C., Okonofua, F. E., Igboin, B., Ekwo, C., Imongan, W., \u0026amp; Yaya, S. (2019). Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria. \u003cem\u003eBMC Pregnancy and Childbirth\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 1-13. https://doi.org/10.1186/s12884-019-2433-1 \u003c/li\u003e\n\u003cli\u003eOkwaraji, Y. B., Webb, E. L., \u0026amp; Edmond, K. M. (2015). Barriers in physical access to maternal health services in rural Ethiopia. \u003cem\u003eBMC health services research\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e, 1-8. https://doi.org/10.1186/s12913-015-1161-0 \u003c/li\u003e\n\u003cli\u003eOmole, K. F. (2010). An assessment of housing condition and socio-economic life styles of slum dwellers in Akure, Nigeria. \u003cem\u003eContemporary Management Research\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(4). https://doi.org/10.7903/cmr.2980 \u003c/li\u003e\n\u003cli\u003eOnuegbu, C., Harlock, J., \u0026amp; Griffiths, F. (2023). Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria: a cross-sectional survey. \u003cem\u003eBMJ open\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(5), e065152. https://doi.org/10.1136/bmjopen-2022-065152 \u003c/li\u003e\n\u003cli\u003eOnwujekwe, O., Mbachu, C., Onyebueke, V., Ogbozor, P., Arize, I., Okeke, C., ... \u0026amp; Ensor, T. (2022). Stakeholders\u0026rsquo; perspectives and willingness to institutionalize linkages between the formal health system and informal healthcare providers in urban slums in southeast, Nigeria. \u003cem\u003eBMC health services research\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 583. https://doi.org/10.1186/s12913-022-08005-2 \u003c/li\u003e\n\u003cli\u003eOpoko, A. P., Ibem, E. O., \u0026amp; Adeyemi, E. A. (2015). Housing aspiration in an informal urban settlement: A case study. \u003cem\u003eUrbani izziv\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(2), 117-131. https://doi.org/10.5379/urbani-izziv-2015-en-26-02-003 \u003c/li\u003e\n\u003cli\u003eOwuor, S. O. (2007). Migrants, urban poverty and the changing nature of urban\u0026ndash;rural linkages in Kenya. \u003cem\u003eDevelopment Southern Africa\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(1), 109-122. https://doi.org/10.1080/03768350601165926 \u003c/li\u003e\n\u003cli\u003eOwusu, L., \u0026amp; Yeboah, T. (2018). Living conditions and social determinants of healthcare inequities affecting female migrants in Ghana. \u003cem\u003eGeoJournal,\u003c/em\u003e 83, 1005-1017. https://doi.org/10.1007/s10708-017-9817-4 \u003c/li\u003e\n\u003cli\u003ePark, J. E., Kibe, P., Yeboah, G., Oyebode, O., Harris, B., Ajisola, M. M., ... \u0026amp; Chen, Y. F. (2022). Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. \u003cem\u003eBMJ open\u003c/em\u003e, 12(5), e055415. https://doi.org/10.1136/bmjopen-2021-055415 \u003c/li\u003e\n\u003cli\u003ePat-Mbano, E., \u0026amp; Nwadiaro, E. C. C. (2012). The rise of urban slum in Nigeria: implications on the urban landscape. \u003cem\u003eInternational Journal of Development and Management Review\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(1).\u003c/li\u003e\n\u003cli\u003ePopoola, A., Olatunde, M. O., Magidimisha, H. H., Amuda, A., Adeleye, B. M., \u0026amp; Chipungu, L. (2020). Urban forced eviction: Experiences in the metropolitan city of Lagos, Nigeria. https://doi.org/10.22146/ijg.40555 \u003c/li\u003e\n\u003cli\u003ePr\u0026uuml;ss-Ust\u0026uuml;n, A., Wolf, J., Corval\u0026aacute;n, C., Neville, T., Bos, R., \u0026amp; Neira, M. (2017). Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. \u003cem\u003eJournal of public health\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(3), 464-475. https://doi.org/10.1093/pubmed/fdw085 \u003c/li\u003e\n\u003cli\u003eRyan, L. (2011). Migrants\u0026apos; social networks and weak ties: accessing resources and constructing relationships post-migration. \u003cem\u003eThe Sociological Review\u003c/em\u003e, 59(4), 707-724. https://doi.org/10.1111/j.1467-954X.2011.02030.x \u003c/li\u003e\n\u003cli\u003eSatterthwaite, D., Sverdlik, A., \u0026amp; Brown, D. (2019). Revealing and responding to multiple health risks in informal settlements in sub-Saharan African cities. \u003cem\u003eJournal of urban health\u003c/em\u003e, \u003cem\u003e96\u003c/em\u003e, 112-122. https://doi.org/10.1007/s11524-018-0264-4 \u003c/li\u003e\n\u003cli\u003eSchutt, R. K. (2018). \u003cem\u003eInvestigating the social world: The process and practice of research\u003c/em\u003e. Sage publications.\u003c/li\u003e\n\u003cli\u003eShukla, N., Toppo, N. A., Thakur, A., Kasar, P. K., \u0026amp; Sharma, B. (2019). Study of health care seeking behaviour for illnesses among malnourished children of age 06-59 months in rural and urban areas of Jabalpur district, Madhya Pradesh. \u003cem\u003eInternational Journal of Community Medicine and Public Health\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(10), 4478. https://doi.org/10.18203/2394-6040.ijcmph20194515 \u003c/li\u003e\n\u003cli\u003eSolheim, C. A., Ballard, J., Fatiha, N., Dini, Z., Buchanan, G., \u0026amp; Song, S. (2022). Immigrant family financial and relationship stress from the COVID-19 pandemic. \u003cem\u003eJournal of Family and Economic Issues\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(2), 282-295. https://doi.org/10.1007/s10834-022-09819-2 \u003c/li\u003e\n\u003cli\u003eSoliman, N. (2023). Exploring slum life and urban poverty in Lagos: the politics of everyday resistance in Chris Abani\u0026apos;s Graceland. \u003cem\u003eJournal of Humanities and Applied Social Sciences\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(5), 467-482. https://doi.org/10.1108/JHASS-01-2023-0017\u003c/li\u003e\n\u003cli\u003eTacoli, C., McGranahan, G., \u0026amp; Satterthwaite, D. (2015). \u003cem\u003eUrbanisation, rural-urban migration and urban poverty\u003c/em\u003e. London, UK: Human Settlements Group, International Institute for Environment and Development.\u003c/li\u003e\n\u003cli\u003eUdenigwe, O., Okonofua, F. E., Ntoimo, L. F., \u0026amp; Yaya, S. (2022). Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study. \u003cem\u003ePLoS one\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(8), e0272523. https://doi.org/10.1371/journal.pone.0272523 \u003c/li\u003e\n\u003cli\u003eUnger, A. (2013). Children\u0026apos;s health in slum settings. \u003cem\u003eArchives of disease in childhood\u003c/em\u003e, \u003cem\u003e98\u003c/em\u003e(10), 799-805. https://doi.org/10.1136/archdischild-2011-301621 \u003c/li\u003e\n\u003cli\u003eUzochukwu, B. S., Ughasoro, M. D., Etiaba, E. A., Okwuosa, C., Envuladu, E., \u0026amp; Onwujekwe, O. E. (2015). Health care financing in Nigeria: Implications for achieving universal health coverage. \u003cem\u003eNigerian journal of clinical practice\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(4), 437-444. https://doi.org/10.4103/1119-3077.154196 \u003c/li\u003e\n\u003cli\u003evan der Heijden, J., Gray, N., Stringer, B., Rahman, A., Akhter, S., Kalon, S., ... \u0026amp; Biswas, A. (2019). \u0026lsquo;Working to stay healthy\u0026rsquo;, health-seeking behaviour in Bangladesh\u0026rsquo;s urban slums: a qualitative study. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 1-13. https://doi.org/10.1186/s12889-019-6750-0 \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2009). \u003cem\u003eGlobal health risks: mortality and burden of disease attributable to selected major risks\u003c/em\u003e. World Health Organization.\u003c/li\u003e\n\u003cli\u003eZerbo, A., Delgado, R. C., \u0026amp; Gonz\u0026aacute;lez, P. A. (2020). Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa. \u003cem\u003eGlobal Health Journal\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(2), 46-50. https://doi.org/10.1016/j.glohj.2020.04.003 \u003c/li\u003e\n\u003cli\u003eZubair, O. A., Ojigi, L. M., \u0026amp; Mbih, R. A. (2015). Urbanization: A catalyst for the emergence of squatter settlements and squalor in the vicinities of the federal capital city of Nigeria. \u003cem\u003eJournal of sustainable Development\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(2), 134. https://doi.org/10.5539/jsd.v8n2p134 \u003c/li\u003e\n\u003cli\u003eZulu, E. M., Beguy, D., Ezeh, A. C., Bocquier, P., Madise, N. J., Cleland, J., \u0026amp; Falkingham, J. (2011). Overview of migration, poverty and health dynamics in Nairobi City\u0026apos;s slum settlements. \u003cem\u003eJournal of Urban Health\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e, 185-199. https://doi.org/10.1007/s11524-011-9595-0 \u003c/li\u003e\n\u003cli\u003eZwane, A. P., \u0026amp; Kremer, M. (2007). What works in fighting diarrheal diseases in developing countries? A critical review. \u003cem\u003eThe World Bank Research Observer\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 1-24. https://doi.org/10.1093/wbro/lkm002 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Nebraska–Lincoln","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"migrant women, healthcare-seeking behaviors, public health, urban slum, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-4671466/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4671466/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study explored access to and utilization of healthcare facilities among migrant women in an urban slum community in Nigeria, focusing on factors influencing healthcare-seeking behaviors and the implications for public health interventions. A qualitative case study-oriented research design was employed, involving in-depth interviews with 21 migrant women of reproductive age and 4 key informant interviews with healthcare workers in the Ayobo community of Lagos State, Nigeria. Data collection occurred from June to September 2018, and thematic analysis was used to interpret the findings. Three main themes emerged: living conditions, pattern of healthcare utilization, and factors influencing accessibility and utilization of healthcare facilities. Living conditions were characterized by housing instability, limited access to clean water and sanitation, and financial constraints. Migrant women demonstrated a preference for traditional remedies over formal healthcare due to cultural beliefs and perceived effectiveness. Recommendations from peers and family members influenced healthcare decisions. Targeted public health interventions are needed to address the multifaceted challenges faced by migrant women, including improving housing conditions, providing access to clean water and sanitation, and promoting culturally sensitive healthcare programs.\u003c/p\u003e","manuscriptTitle":"Beyond Borders: Exploring the Lived Experiences of International Migrant Women in Nigeria, a Deep Dive into Healthcare Realities and Utilization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 04:59:11","doi":"10.21203/rs.3.rs-4671466/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1c98a880-8af3-4f99-baf8-07545cd0d6d5","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33989507,"name":"Gender Studies"},{"id":33989508,"name":"Sociology"},{"id":33989509,"name":"Health Policy"}],"tags":[],"updatedAt":"2024-07-15T04:59:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 04:59:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4671466","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4671466","identity":"rs-4671466","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}