Sexual and Reproductive Health - Initial Assessment for Refugee Patients

Overview

Sexual and reproductive health discussions should be incorporated into the initial assessment of refugee patients using a culturally sensitive and trauma-informed approach. Always conduct sensitive conversations with the patient alone in the room.

Contraception

Ask all refugee women of reproductive age about contraception history and desire for a contraceptive method.

Preferred methods at Calgary Refugee Health Program:

*     Intrauterine devices (IUDs)

*     Medroxyprogesterone acetate injections (Depo-Provera)

These are preferred because they require less ongoing adherence. Counsel patients about the effect on menstruation before prescribing. All standard methods are valid options and patient preference should guide the decision.

Cervical Cancer Screening

Most newly arrived female refugee patients have never had a Pap test.

*     Discuss cervical cancer screening at the first or second visit

*     Screening recommendation: every 3 years for women aged 25-69

*     Do not perform a Pap test at the first visit unless the patient requests it

*     If the patient is not comfortable with a male physician, offer referral to a female practitioner

STI Screening

STI screening is recommended as part of the initial assessment:

*     Syphilis serology: all adult refugees

*     Urine chlamydia/gonorrhea NAAT: all adult refugees

*     HIV serology: all refugees (with consent)

See individual pages for management of positive results.

Female Genital Cutting (FGC)

Screen for FGC history in women from high-prevalence countries. See the FGM/C Clinical Management Guide for full guidance.

Intimate Partner Violence (IPV)

*     Routine screening for IPV is recommended for all prenatal refugee patients

*     Remain alert to signs of IPV in all refugee patients regardless of screening status

*     CCIS educates government-assisted refugees about Canadian laws regarding IPV and child maltreatment