Person: Cabieses, Báltica
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Publication Barriers and facilitators to access sexual and reproductive health services among young migrants in Tarapacá, Chile: a qualitative study(2024) Obach, Alexandra; Blukacz, Alice; Sadler, Michelle; Carreño Calderón, Alejandra; Cabieses, Báltica; Carolina DíazBackground: Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile. Methods: A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22). Results: Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions. Conclusions: This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.Publication Acceso a servicios de salud para personas migrantes internacionales durante la pandemia por COVID-19: estudio cualitativo(2023) Obach, Alexandra; Blukacz, Alice; Cabieses, Báltica; Carreño Calderón, Alejandra; Stefoni, Carolina; Pérez, ClaudiaObjective: To explore the experience and perception of international migrants in Chile regarding access to health services during the pandemic. Method: Collective case study following the qualitative paradigm. Forty semi-structured interviews were carried out with 30 migrants from different countries in Latin America and the Caribbean and 10 key actors from the health or social sector in November and December 2020. The interviews were analyzed thematically. Results: Perceived facilitators for general access to health services are related to formal work, support networks, and good treatment, while barriers are linked to immigration status, information gaps, discrimination, lack of cross-cultural skills, and personal limits of the system. In the context of access to COVID-19 diagnosis and treatment, the main barriers identified are: cultural approach to the disease, communication gaps, experiences of discrimination, costs, and lack of support networks. Conclusion: Access to health services is related to social vulnerability and violation of international migrants rights.Publication Desafíos para el abordaje de la salud de los migrantes en Chile durante la pandemia por Covid-19: una revisión de alcance(2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Rada, Isabel; Carreño Calderón, Alejandra; Mezones, EdwardObjetivo.Indagar sobre los principales desafíos reportados en el marco de la emergencia sanitaria de SARS-CoV-2 según la evidencia científica disponible a la fecha en esta materia en Chile. Material y métodos. Revisión de alcance con base en tres búsquedas en Web of Science, PubMed y Google Scholar de publicaciones en inglés y español publicadas entre 2020 y 2023. Resultados. Se identificaron tres áreas clave: desafíos de acceso y uso efectivo del sistema de salud, desafíos más allá del sistema de salud, incluyendo aquellas relaciones con determinantes sociales de la salud, autocuidado e información y, finalmente, desafíos de integración de los enfoques de interculturalidad, género y cooperación internacional. Conclusiones. Se evidencian oportunidades de mejorar el abordaje de la salud de personas migrantes internacionales en Chile a raíz de la pandemia por Covid-19, de cara a futuras crisis sanitarias y para reducir brechas e inequidades que impactan la salud poblacional. Objective. To investigate the main challenges in the context of the SARS-CoV-2 health emergency according to the scientific evidence available to date in this area in Chile. Materials and methods. Scoping review based on three searches in Web of Science, PubMed and Google Scholar of publications in English and Spanish published between 2020 and 2023. Results. Three key areas were identified: the challenges of access and effective use of the health system, the challenges beyond the health system, including those related to social determinants of health, self-care and information, and finally, the challenges of integrating intercultural, gender and international cooperation approaches. Conclusions. There are opportunities to better address the health of international migrants in Chile in the wake of the Covid-19 pandemic, anticipating future health crises and to reduce gaps and inequities that impact population health.Publication Emergency preparedness and response sensitive of migrant populations in Chile: post-pandemic perspectives(2024) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Carreño Calderón, Alejandra; Mezones, EdwardOn August 31, 2023, the Chilean government ended the health alert for COVID-19. This milestone invites us to reflect on lessons learned in emergency preparedness and response regarding migrant populations in the country. In this context, three perspectives are presented. The first focuses on avoiding pointing to individual responsibility for non-compliance with prevention measures, as this approach ignores structural and historical inequities. Emergency recommendations should be constructed considering a collective approach and diverse sociocultural and political contexts. The second perspective calls for considering and addressing migration as a social determinant of health. During the pandemic, changes in the governance of migration around the world made migration processes more precarious, with risks to the physical and mental health of migrants, which needs better planning and evidence-based decision-making in future pandemics. The third perspective focuses on promoting intercultural health, as effective communication of contagion risks and preventive measures were hampered among migrant populations with diverse worldviews and interpretations of health and disease processes. Responding to the needs of historically marginalized communities requires establishing ways of life that respect diversity in narratives and everyday practices. Governments and health systems must incorporate migration into their emergency preparedness and response strategies, creating the conditions for optimal compliance.Publication Mental health and the healthy immigrant effect in Chile: a comparative cross-sectional study with international migrants and locals(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Madrid, Paula; Obach, AlexandraIntroduction: The question of whether international migrants appear to be in better health than the locals, and whether this "healthy immigrant effect" declines over time is a highly relevant one, especially with regards to mental health. Based on a community-based survey conducted in Santiago, Chile, this study compares the mental health outcomes of international migrants versus local populations and examines differences within the international migrant group of respondents. Methods: Observational cross-sectional study. Data was collected with international migrants and Chilean participants in 2021-2022 through a structured questionnaire. The study examined self-reported stress and mood disorders in relation to demographic, socioeconomic, health, and migration-related factors. Descriptive analyses were conducted for all variables overall and stratified by perceived stress, mood disorders, and migration status. Associations were assessed using Chi-square or Fisher's exact tests, with Cramer's V used to evaluate effect size. Multiple imputation (m = 5) addressed missing data using the mice package in R, followed by generalised logistic regression models fitted across imputed datasets and combined using Rubin's rules; stepwise selection based on AIC was used for variable reduction, and models were run for the full sample and separately for the migrant population. Results: The sample included 1,656 international migrants and 1,664 locals. Being a migrant was negatively associated with reporting stress and mood disorders in all analyses. Among migrants, the main risk factors for stress were perceiving a high number of migrants in the neighbourhood and having experienced abuse as a migrant and for mood disorders the main risk factor was reporting having experienced abuse as a migrant as well as a longer stay in Chile. Discussion: We found a healthy immigrant effect for mental health among international migrants in Chile, which declined over time in the case of mood disorders. Chilean participants reported very high levels of mental health issues, consistent with existing studies. However, results for international migrants highlight both risk and protective factors linked to migration processes, which are unique to them, warranting a specific approach to their mental health needs.