By Xaviera Villarino, Research Dissemination Intern, PSI
The process of migrating to the United States is one that places people at an increased risk of experiencing abuse and threats to their sexual and reproductive health and rights (SRHR). For women and girls, the risk is even greater.
Migration experiences have an immediate effect on well-being, but also shape a person’s physical, emotional, and biological health long after their journey ends. There are few research studies that have explored the SRHR experiences of migrant women and girls during their journeys to the United States. Eliciting and capturing sensitive information related to migration and health from participants comes with the challenge of building trust and creating a space for conversation that is welcoming and safe.
A recently published study, conducted by PSI LAC and led by Paola Letona, Regional Research Advisor, sought to fill this gap in the literature through qualitative interviews with migrant women and girls of reproductive age from Honduras, El Salvador, and Guatemala who were at different stages of the migration process.
A Novel Method to Build Trust
To create a more friendly, inviting, and engaging atmosphere, interviewers used the type of open-ended interview questions that are typical in qualitative research, but also introduced the following activities that helped facilitate conversations on sensitive topics.
- Seven prompt cards related to SRHR were shown when starting to explore SRHR themes.
- The images allowed the interviewer to explore SRHR topics with participants and segue into discussing their own experiences or what they saw other women experience during their migration journeys.
- Towards the end of the interview, participants were asked to make a drawing of a stressful situation during their journey.
- The interviewer gave them 10 minutes to draw by themselves. When they were finished, they were then asked to describe their drawing in their own words.
Below is a drawing by a 17-year-old girl from El Salvador. It depicts a scene in which the girl had found herself managing her period a short distance away from a car, among other people, in an area with some grass and patches of water which she used to clean herself.
After drawing, the participants were asked to describe, in their own words, what the drawing shows.
“In my case it was about the menstrual pads. They ran out…I had to put on rags, there was very little water, meanwhile little grass. The car was not so far from where I was. There were other people, [it was] not as calm as one could say or I don’t know what to call it…that I’m not alone…that there are other people who can see me, that I was not able to bathe like one at home. Not always having that privilege, that one will be able to pour water every day…in some places there were…little buckets [of water], in other places there were like wells…There was dirt [in the water] because of the grass, but it wasn’t dirty enough to say, -I don’t want to bathe-. Although I haven’t bathed in days…” Salvadoran, 17 years old.
Through this interview and others, the research team found that on their migration journeys, many women and girls did not have access to clean water, which made managing their periods particularly difficult. In fact, many migrant women and girls did not have access to period products, instead resorting to the use of items such as toilet paper or pieces of their clothing. Additionally, because of a lack of privacy, women often had to change in front of other migrants, including men.
Another participant, a 36-year-old Salvadoran, created the image below when asked to draw a stressful situation she encountered during migration.
“This is something very sad that I almost don’t talk about it, actually I didn’t touch it right now [during the interview], but in the drawing perhaps I leave it captured, sometimes there are things that are better not to talk about and leave them there where they are, but through a drawing yes I dare to touch it. It was something very embarrassing for me, it was something very hard…the one who is kneeling is me, the two men standing are the two men who touched me… to this day my guts churn. I am not that type of women to think that or live like that. I have always believed in monogamy, I have always believed in having relationships with only one person, but this time…It was very difficult, honestly, because there were more people who were watching and either it was just with them two or it was with everyone and I don’t know if it was recorded, I don’t know if any of my videos are circulating on any pornographic page, I don’t know anything…I don’t know what they thought.” Salvadoran, 36 years old.
Further analysis of this interview and others like it shed light on transactional sex and how it was common among migrants. It often occurred when women were running low on money or when they felt like they, or their journey to their destination, might be in danger. Primary accounts of participants experiencing sexual violence were rare, possibly because of fear of repercussions by the aggressor. Yet, many participants shared stories of other women who they traveled with who experienced sexual violence, including rape, and were not able to access care or additional support afterwards.
The quote from this participant illustrates how the drawing activity encouraged her to share this experience that she was unlikely to have shared otherwise and shows how traditional qualitative interviewing techniques may fail to capture sensitive information.
Applications in Future Research
This novel approach to the interview process can help future studies investigate the unique experiences of participants from their perspectives. This method may be particularly useful for sensitive or stigmatized topics, such as those related to SRHR, that may be uncomfortable for study participants to discuss with an interviewer. Additionally, such approaches may help researchers build rapport with vulnerable or marginalized populations who may be hesitant to share their experiences.
Creating opportunities for research participants to fully express themselves by capturing their stories through words and images can allow organizations like PSI to more fully understand and effectively respond to the public health needs of the populations that we serve.
For more information contact Paola Letona ([email protected])