Access to sexual and reproductive services: Experiences of Venezuelan Migrants in Ecuador

Abstract Until 2023 approximately 7.2 million Venezuelans left their country due to political and economic crises. Ecuador was the third-largest recipient of Venezuelan migrants in the context of this ongoing human mobility crisis. Most people in this scenario experienced many vulnerabilities related to health services access, specifically Sexual and Reproductive Health, this represents risks on their health. The objective of this study was to understand the use of SRH services at the level of perceptions of access through the migratory journey; usage patterns and characteristics of SRH services; experiences of discrimination and mistreatment, and recommendations for improving access, aiming to improve the accessibility and utilization of SRH services by various populations experiencing situations of human mobility. To achieve this, we conducted focus groups with semi-structured interview guides with women, men, and people and those who self-identified as belonging to the LGBTQ+ community. We found that most participants encountered barriers to access SRH services throughout their migratory journey, while on Ecuador, men reported not using much SRH services, on the other hand women and teenage solicited mainly obstetric and contraceptive needs and the LGBTIQ+ community said that the services couldn’t meet their needs. The three groups of participants reported experiencing discrimination because of their nationality, however, women that had obstetric attention reported mistreatments because of bad medical practices that was directed to Ecuadorian women as well and the LGBTIQ+ reported being targeted mainly for their sexual/gender identity rather than their nationality. This study encompasses experiences along the migration route and in the destination country, helping to identify the underlying structural and contextual factors of these issues and suggests potential future actions to ensure unrestricted sexual and reproductive health rights. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was reviewed and approved by the following entities: The Institutional Review Board of the Pontificia Universidad Católica del Ecuador (PUCE) (Approval Codes: CEISH-878-2020, PV-01-2020). The Ethics Review Committee of the Pan American Health Organization (PAHOERC) (Reference Number: PAHOERC.0330.02). The Health Intelligence Directorate of the Ministry of Public Health of Ecuador (Approval Code: MSP-SNSG-2020-15725). Written informed consent was obtained from all participants prior to their enrollment in each focus group discussion and individual in-depth interview. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data supporting the findings of this study cannot be made publicly available due to ethical restrictions. Although the data are anonymized, they consist of sensitive qualitative information concerning sexual and reproductive health, and were collected from a socially vulnerable migrant population, which included minors. However, the data are available upon request for researchers who meet the criteria for access to confidential data. Requests should be directed to the Data Analysis Unit of the Institute of Public Health at the Pontificia Universidad Católica del Ecuador. Please contact isp{at}puce.edu.ec and cc the University's Ethics Committee at CEISH{at}puce.edu.ec.