Exploring barriers to healthcare among internal and international female migrants in The Gambia

Abstract

Background: Existing research on female migration and healthcare in sub-Saharan Africa has predominantly focused on internal migration and maternal and child health, often overlooking broader healthcare access issues for (international) migrant women. Aim: This study aimed to quantitatively assess healthcare barriers faced by internal and international migrants relative to non-migrant women. Setting: The setting of this study was The Gambia. Methods: Using the 2019-2020 Gambia Demographic and Health Survey and overlap weighting, we compare healthcare access - based on reported usage and key barriers-between non-migrants and internal or international migrants. We distinguish between recent and settled migrants according to the duration of residence at the destination. Results: Financial barriers are reported by 26.46% - 28.09% of women, geographic barriers by 21.47%-26.02% and safety barriers by 11.85%-15.37%. Internal female migrants encounter significantly more geographic (odds ratio [OR] = 1.32, 95% confidence interval [CI] [1.19, 1.45]), permission (OR = 1.43, 95% CI [1.16, 1.76]), safety (OR = 1.16, 95% CI [1.03, 1.30]) and financial (OR = 1.21, 95% CI [1.10, 1.33]) barriers than non-migrants - differences that persist for settled migrants. Conversely, international migrants do not experience more barriers than non- migrants. In addition, migrants who have moved in the past 3 years used health services more than non-migrants, both for internal migrants (OR = 1.14, 95% CI [1.00, 1.31]) and for international migrants (OR = 1.42, 95% CI [1.02, 1.98]), but these differences disappear for settled migrants. Conclusion: Policy interventions should address disparities between internal migrants and non-migrants and improve healthcare access for all women. Contribution: This study highlights internal migration as a key factor shaping healthcare access.