INTRODUCTION

In our country, the increase in Venezuelan migration has been occurring since 2017; it is estimated that by 2022 the migrant population in Peru is greater than 1.5 million Venezuelan migrants¹. Despite these approximately 7 years of migration, to date there is no adequate information on the reproductive health needs in the migrant population of Venezuelan origin in our country. In this context and within the framework of the project "Strengthening the quality of sexual and reproductive, maternal and child health care for Venezuelan migrants in Peru", developed by the Pan American Development Foundation (PADF) and the Institute of Popular Health (INSAP, for its acronym in English), a survey was conducted on sexual and reproductive health by interviewing migrant women of different ages in South Lima and Trujillo, in order to know what were the main problems in reproductive health they have been facing and some of the gaps in the response from the health sector.

METHODS

This is a descriptive, quantitative, non-experimental, cross-sectional research conducted between March 18 and July 31, 2021. The sample consisted of a total of 1,616 Venezuelan migrant women; 1,114 came from the districts of the southern cone of Lima (Villa María del Triunfo, Villa El Salvador and San Juan de Miraflores) and 502 from the province of Trujillo. The survey was designed by the team of the Instituto de Salud Popular (INSAP) and the Venezuelan associations of Lima and Trujillo and subsequently validated by expert judgment. The questionnaire included population characteristics, health service requirements, maternal health, cervical and breast cancer prevention, and sexually transmitted infections (STIs). The data were entered and coded in a database. The Statistical Package for the Social Sciences SPSS v26 was used for processing, generating the tables presented in the results section. With regard to ethical aspects, the survey form explained to the informants the nature of the document and the fact that they responded confirmed their voluntary acceptance.

RESULTS

During the study period, 1,616 migrant women of Venezuelan origin were selected for the research. Of these, 1,114 corresponded to the districts of Villa María del Triunfo, Villa El Salvador and San Juan de Miraflores and 502 women to the province of Trujillo in La Libertad.

Table 1 shows the age distribution according to life stages, with the highest frequency between 20-34 years of age, a range of 15-65 years and an average of 32 years.

Table 1 sociodemographic characteristics of the migrant population. 

* TRPC= temporary residence permit card; trpf= temporary residence permit for foreigners; nic=national identity card

The largest number of women surveyed had an identity card (66.8%); however, 60% did not have a valid document and more than 80% had not regularized their migratory status.

By marital status at the time of the survey, 46% were cohabitating and 20.8% were single. 56.7% indicated that they had secondary education, 22.6% had university studies and 13.1% had technical studies.

As can be seen in Table 2, 82.2% of migrants had a monthly family income of less than 900 soles. When relating monthly income to age, it is evident that when they approach 40 years of age, they do not receive a monthly payment, i.e., they are not working. Likewise, the lower the income, the higher the health requirements.

When asked if they had insurance, 75.1% in Lima and 94% in Trujillo reported not having any type of insurance.

Tabla 2 economic and health access characteristics. 

When asked about the number of pregnancies, all the women surveyed in Lima and Trujillo had had at least one pregnancy; the group of women who had had between 2-4 pregnancies was the most frequent, representing 88.3% (Table 3).

Table 3 maternal health. 

Of the women surveyed, 5.3% were pregnant at the time of the survey. Of these, 39.5% had not started any prenatal care. In response to the question "Where are you being monitored?", 61.4% said that they were being monitored at a primary care center (health center), 19.3% at a level III hospital and 8.8% in private practice.

Regarding family planning (Table 4), there was greater use of contraceptive methods in Lima (53%) than in Trujillo (38%). The most commonly used were long-acting contraceptive methods (LARC), such as subdermal implants (29.7%), intrauterine devices (19.3%), and bilateral uterine tubal ligation (14%).

Tabla 4 family planning. 

Table 5 shows that between 78%-85.1% did not use cancer prevention services in the last three years. Of the total respondents, 245 (22%) and 75 (14.9%) in Lima and Trujillo, respectively, had a cervical cancer screening test; of these, 18% in Lima and 16% in Trujillo had a pathological result.

Table 5 cervical cancer prevention. 

More than 90% did not use breast cancer prevention services.

Sexually transmitted infections (STIs) were present in 2-5% of the surveyed population, with human papillomavirus infection being the most frequent.

DISCUSSION

The political, social, and economic crisis in Venezuela has caused thousands of people to migrate to Peru since mid-2017^2). The Peruvian population grew by more than one million^3). Some studies that evaluate the needs and demands of populations in different countries point out that the greatest challenges stem from limited medical care^4), especially in reproductive health, with urban areas having the least access to these services. This situation is compounded by the problems faced by migrant populations in accessing services due to their migratory status^4).

Table 6 sexually transmitted infections (sti). 

The vulnerability of the migrant population has its own characteristics that cannot be compared with the vulnerability of the Peruvian population. The reason for this assessment has allowed us to draw and/or come closer to having a profile of Venezuelan migrant women in the study area:

Migrant women were between 20-34 years of age (reproductive age). However, there was a significant percentage of women over 35 years of age, and these are the ones who require SRH services, increasing their vulnerability. There was a significant percentage of adolescents requiring services.

The migrants were cohabiting and single, with 2-4 children, secondary and higher education, income of less than 900 soles and more than 80% did not have health insurance. A cross check of income and health requirements showed that the lower the income, the higher the health requirements.

Between 5-6% were pregnant, and the majority of pregnant women used health services. Pregnant migrant women in our country have immediate access to comprehensive health insurance; however, a significant percentage did not use public services (accessibility, barriers, stigmatization).

Regarding family planning, they recognized the importance of unwanted pregnancy and used long-acting methods and combined contraceptive methods. However, a good number did not access services because they were not available on days and times outside the workday.

They represented an unprotected population with regard to early detection of cervical and breast cancer, many of them without access to these services.

There was a high incidence of human papillomavirus, so it is essential to think about preventive measures, as well as vaccinating daughters.

The problems of access to services increase according to the migratory situation.

CONCLUSION

The sexual and reproductive health profile of the Venezuelan migrant population in the study areas has its own characteristics, not comparable to the vulnerability of the Peruvian population, and shows that their sexual and reproductive health needs may vary according to their situation and context^5). Migrants may face barriers in accessing health care services^6). It is essential that health systems in receiving countries recognize and address these reproductive health needs of migrant women and their children^7-10), providing culturally sensitive, accessible and quality services to ensure the well-being and reproductive autonomy of this population.