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[ES] Objetivo Valorar la influencia de la precariedad laboral y la exclusión social en la salud de hombres y mujeres migrantes que trabajan en el sector agrícola en España. Método Se recogerán datos cualitativos y cuantitativos en cuatro comunidades autónomas (Cataluña, La Rioja, Murcia y Andalucía) entre 2021 y 2022. En una primera fase se realizarán entrevistas personales semiestructuradas, con un mínimo de 40 informantes clave profesionales o expertos (de ONG, asociaciones, sanidad, servicios sociales, sindicatos, cooperativas agrícolas, política y mediadores culturales). En una segunda fase se combinarán entrevistas personales con técnicas cualitativas participativas (body mapping y photovoice), con 40 hombres y mujeres migrantes jornaleros/as. En una tercera fase se realizará un estudio transversal con una muestra estimada de 400-500 migrantes jornaleros/as basada en la Encuesta Nacional de Salud y la Encuesta de Condiciones de Vida.

Background Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. Objective This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). Methods The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. Results No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. Conclusions For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women's possibility to access healthcare services and being undocumented led to restricted access entitlement and t

Although gender equality is a fundamental human right, there is no country which has achieved full and effective equality. Inequality between genders is reproduced through the patriarchal system, which in both public and private areas regulates the powers of relationship between genders in detriment for women, and systematically excludes women from determined social institutions. The purpose of this article is to bring into our immediate context, the factors of discrimination that involve the challenges of the 5. Goal of sustainable development, which is Achieving gender equality and empowering all women and girls. For this purpose, after selective search and critically reading of documents on the subject, a summary and an adjustment of the information was made. Presented gender discrimination factors include those to conduct at a more individual and more collective level, such as gender violence, harmful cultural practices, burden of caring, failure to fulfill sexual and reproductive rights, poor technological use and land ownership and predominantly in the political field, political discrimination, the scarce presence of policies promoting gender equality and empowerment and participation in high-level decision-making institutions. This work provides an explanation of the fundamental concepts of the goal of sustainable development. Then the challenges are examined individually, by examining the different discriminatory factors that are presented through their respective indications.; Genero-berdintasuna oinarrizko giza eskubide bat bada ere, ez dago berdintasun oso eta efektiboa lortu duen herrialderik. Generoen desberdintasuna sistema patriarkalaren bitartez erreproduzitzen da, eta sistema horrek, era berean, eremu publiko zein pribatuan emakumeen kalterako generoen arteko erlazio-botereak arautu, eta emakumeak sistematikoki uzten ditu gizarte-erakunde erabakitzaileetatik kanpo. Garapen Jasangarrirako 5. Helburua hizpide hartuta, hots, genero-berdintasuna lortzea

92 p., Tesi honek emakume inmigranteen Euskadiko osasun zerbitzuetarako sarbidea aztertzeko helburua dauka. Ikerketa kuantitatibo batean eta bi ikerketa kualitatibotan oinarritzen da. Lehenengo ikerketarako datu bilketa, kontsulta zenbakien kontaketaren bitartez egin zen. Bigarren eta hirugarren ikerketarako, elkarrizketen bidez egin zen. Lehenengo ikerketan, Euskadin 2012. urteko legearen aldaketak dohaineko klinika baten kontsulta kopuruan izan zezaken eragina ebaluatzeko, datuei erregresio analisi binomial negatiboa aplikatu genion. Bigarren eta hirugarren ikerketetan, edukiaren analisi kualitatiboaren metodologia aplikatu genuen. Hauen helburua, emakume inmigranteen sarbiderako oztopoak ezagutzeko nahian, dohaineko kliniketan lan egiten duten osasun profesionalen pertzepzioa ezagutzea eta Afrika Sub-Sahararreko emakume inmigranteen osasun sistemarekiko pertzepzioak eta esperientziak ezagutzea zen, hurrenez hurren. Lehenengo ikerketan, ez zen erlazio argirik aurkitu legearen aldaketa eta dohaineko klinikaren kontsulta kopuruaren artean. Bigarrenaren emaitzarik esanguratsuenek, sarbidean eragiten duten faktoreak, lau talde hauetan sailkatutako faktoreetan oinarritzen dela diote: 1) inmigranteen ezaugarri pertsonalak, haien jatorriarekin estu erlazionaturik daudenak; 2) osasun zentruetako langileen inmigranteenganako jokaera; 3) osasun sistemaren ezaugarriak eta funtzionamendua eta 4) eskakizun legalak. Hirugarren ikerketaren bitartez, aurreko faktoretaz aparte, arrazismo estrukturalaren eraginak ere inmigranteen osasun zerbitzuetarako oztopoa suposatzen duela aurkitu zen. Bitartean, legeei buruzko informazioa, akonpainamendua eta sostengua jasotzeak sarbiderako faktore erraztaileak kontsideratu ziren. Hauek, profesionalengandik, gizarte erakundengandik edo sare sozial pertsonalengandik jasotzen dituztelarik. Populazio zaurgarrienen osasun zerbitzuak jasotzeko eskubidea indartzeaz aparte, diskriminazioa ekiditeko, eskubideetan oinarritutako arretaren balioa indartu behar

BackgroundImmigrant populations face diverse barriers to accessing appropriate healthcare services on several levels. In the Basque Country, Sub-Saharan African women were identified as facing the largest barriers to access them. The aim of the study is to analyse Sub-Saharan African immigrant women's perceptions and experiences of access to appropriate healthcare in the public health system in the Basque Country, Spain.MethodsFourteen women from eight Sub-Saharan African countries who have used the Basque public healthcare services were interviewed. A qualitative content analysis was applied: meaning that units were identified, coded and the resulting codes were then organized into three categories.ResultsThe first category, Fearing to enter a health system perceived as not friendly for immigrants, included factors, mainly those related to legal conditions for accessing healthcare services and lack of lawful documentation, that made women avoid or discontinue seeking out healthcare.The second category, Being attended on professionals' own communication terms, comprised how the lack of effective communication compromised not only the access of the immigrant women to healthcare services, but also their health.Lastly, the third category, Is mistreatment based on racism or merely on bad luck? described how being an immigrant and black influenced the way they were (mis)treated in the health system.ConclusionFor Sub-Saharan African immigrant women, accessing appropriate healthcare in the Basque Country was perceived to be subject to institutional barriers. At the legal level, barriers included lack of entitlement, difficulties in fulfilling legal access conditions and lack of documentation. The lack of communication with health centre staff and their attitudes, guided by a stereotyped social image of immigrants and black people, also hindered their possibilities of receiving appropriate healthcare. Facilitators for accessing healthcare included strategies from individual

OBJECTIVES: Policies restricting healthcare access for immigrants were applied in times of reduced public funding for welfare in Spain. This study aimed to assess the impact of the implementation of a more restrictive health policy in the Basque Country region, Decree 114/2012, on the number of consultations attended at a free clinic, where the majority of patients are undocumented immigrants. STUDY DESIGN: Interrupted time series. METHODS: A negative binomial regression model was applied in two phases to the number of healthcare consultations during the period 2007-2017 (n = 9272) to estimate the level and trend changes associated with the implementation of the policy. Data were analysed separately by sex and adjusted for consultations' seasonality and unemployment rate and the sex-specific percentage of migrant population in Biscay province as confounding factors. RESULTS: Different trends of attendance between men and women were observed during the whole period, constituting 76.94% and 23.06% of all consultations, respectively. After the implementation of the decree, the number of consultations for women per trimester decreased and increased for men by 1%, although it was not statistically significant in either of the trends. CONCLUSIONS: No clear relationship between the implementation of the Basque Decree 114/2012 and an increase in the attendance of immigrants in a free clinic during the studied period was found.

Objetivo: Explorar la percepción de las profesionales sanitarias que trabajan en centros sanitarios alternativos sobre las barreras y los facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos generales y de salud sexual y reproductiva en el País Vasco. Emplazamiento: País Vasco. Diseño: Análisis de contenido cualitativo basado en 11 entrevistas individuales. Participantes: Profesionales sanitarias que trabajan en centros sanitarios alternativos de atención primaria y salud sexual y reproductiva. Método: La recolección de datos se realizó entre septiembre y diciembre de 2015 en cuatro centros sanitarios alternativos. Tras su transcripción, se identificaron unidades de significado, códigos y categorías. Resultados: Del análisis emergieron cuatro categorías que representan cómo las características de las mujeres inmigrantes (Dime cómo eres y te diré cómo accedes), la actitud del personal administrativo y sanitario («Cuando ya les atienden, estupendamente. El problema está con los administrativos»), el funcionamiento del sistema sanitario (Sistema de salud inflexible, pasivo y receptor de necesidades) y las políticas sanitarias («Si no cumples los requisitos, pues no entras. La ley es la ley») influyen en el acceso a los servicios sanitarios públicos de las mujeres inmigrantes. Conclusiones: Este estudio indica que hay un considerable número de barreras y pocos facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos y de salud sexual y reproductiva en el País Vasco. Los centros sanitarios alternativos se presentaron como favorecedores en la mejora de la salud de la población inmigrante y en su acceso., Objective: To determine the perception of health professionals working in alternative health centres on the barriers and facilitators in the access by immigrant women to general public health services and sexual and reproductive health in the Basque Country. Location: Basque Country. Design: Analysis of qualitative content based on 11 individual interviews. Participants: Health professionals working in alternative health centres of Primary Care and sexual and reproductive health. Method: Data collection was performed between September and December 2015 in four alternative health centres. After transcription, the units of meaning, codes and categories were identified. Results: Four categories emerged from the analysis, which represented how the characteristics of immigrant women (Tell me how you are and I will tell you how to access), the attitude of the administrative and health staff ("When they are already taken care of"), the functioning of the health system (Inflexible, passive and needs-responsive health system), and health policies ("If you do not meet the requirements, you do not go in. The law is the law") influence access to health services of immigrant women. Conclusions: This study shows that there are a considerable number of barriers and few facilitators to the access by immigrant women to public health and sexual and reproductive health services in the Basque Country. The alternative health centres were presented as favouring the improvement of the health of the immigrant population and in their access., Parallel title: How do immigrant women access health services in the Basque Country? Perceptions of health professionals

Background: Immigrant women face diverse barriers in order to access the public healthcare services in Spain. Furthermore, in 2012, a legislative change made the access conditions more difficult to fulfil for immigrants. Besides the public healthcare system, “free clinics” exist, which provide health attention to immigrant men and women who are not eligible for accessing it. Objective: To explore the perception of healthcare professionals working in free clinics in regards to the barriers and facilitators that immigrant women face to access the public healthcare general services and sexual and reproductive health services in the Basque Country (Spain). Methods: Qualitative study based on 11 individual interviews with healthcare professionals working in four different free clinics. A qualitative content analysis was done identifying meaning units, codes and categories. Results: Four categories emerged from the analysis that represent how the personal characteristics of the immigrant women (Tell me who you are and I will let you know how you will access); the attitude of the staff at the healthcare system (“Once they have been attended, everything is fine. The problem is with the administrative staff”); the organization of the healthcare system (The healthcare system is bureaucratic and passive), and health policies (“If you do not fulfil the requirements, you are just out. The law is the law”) influence the access of immigrant women to the public healthcare services. Conclusions: The results of this study show that there are a great number of barriers and few facilitators for the access of immigrant women to the public healthcare general services and sexual and reproductive health services in the Basque Country. The barriers based on the personal characteristics of the immigrant women, which vary based on their origin, were the most largely recognized, whereas the legal barriers were considered the most restrictive ones and difficult to overcome. Key messages: Immigr

Explorar la percepción de las profesionales sanitarias que trabajan en centros sani- tarios alternativos sobre las barreras y los facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos generales y de salud sexual y reproductiva en el País Vasco. Emplazamiento: País Vasco. Dise ̃ no: Análisis de contenido cualitativo basado en 11 entrevistas individuales. Participantes: Profesionales sanitarias que trabajan en centros sanitarios alternativos de aten- ción primaria y salud sexual y reproductiva. Método: La recolección de datos se realizó entre septiembre y diciembre de 2015 en cuatro centros sanitarios alternativos. Tras su transcripción, se identificaron unidades de significado, códigos y categorías. Resultados: Del análisis emergieron cuatro categorías que representan cómo las características de las mujeres inmigrantes (Dime cómo eres y te diré cómo accedes), la actitud del personal administrativo y sanitario ( « Cuando ya les atienden, estupendamente. El problema está con los administrativos » ), el funcionamiento del sistema sanitario (Sistema de salud inflexible, pasivo y receptor de necesidades) y las políticas sanitarias ( « Si no cumples los requisitos, pues no entras. La ley es la ley » ) influyen en el acceso a los servicios sanitarios públicos de las mujeres inmigrantes. Conclusiones: Este estudio indica que hay un considerable número de barreras y pocos facili- tadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos y de salud sexual y reproductiva en el País Vasco. Los centros sanitarios alternativos se presentaron como favorecedores en la mejora de la salud de la población inmigrante y en su acceso., To determine the perception of health professionals working in alternative health centres on the barriers and facilitators in the access by immigrant women to general public health services and sexual and reproductive health in the Basque Country. Location: Basque Country. Design: Analysis of qualitative content based on 11 individual interviews. Participants: Health professionals working in alternative health centres of Primary Care and sexual and reproductive health. Method: Data collection was performed between September and December 2015 in four alter- native health centres. After transcription, the units of meaning, codes and categories were identified. Results: Four categories emerged from the analysis, which represented how the characteristics of immigrant women (Tell me how you are and I will tell you how to access), the attitude of the administrative and health staff (‘‘When they are already taken care of’’), the functioning of the health system (Inflexible, passive and needs-responsive health system), and health policies (‘‘If you do not meet the requirements, you do not go in. The law is the law’’) influence access to health services of immigrant women. Conclusions: This study shows that there are a considerable number of barriers and few facili- tators to the access by immigrant women to public health and sexual and reproductive health services in the Basque Country. The alternative health centres were presented as favouring the improvement of the health of the immigrant population and in their access.