The research, led by Dixie Brea Larios of the Oral Health Centre of Expertise in Western Norway, together with Anne N. Åstrøm of the University of Bergen and Manal Mustafa of the University of Bergen and the Oral Health Centre of Expertise, set out to examine the oral health practices of parents with and without a migrant background. The motivation is grounded in a well-documented problem: the migration process itself often pushes oral health down the list of priorities, and the consequences can persist for years after resettlement. Dental problems accumulate quietly, and by the time they surface, they can affect nutrition, speech, employment, and self-confidence.

To capture a representative picture, the team used a cross-sectional survey of parents with children in either kindergarten or elementary school. The sample comprised 600 participants, evenly split between 300 migrants and 300 Norwegian-born parents. Respondents answered questions about how they perceived their own oral health, their sociodemographic circumstances, their history of dental visits, and their dietary habits. The mean age of participants was 39.11 years, with a standard deviation of 6.45 years, and women made up 62 percent of the study population. Self-rated oral health, the study’s central outcome measure, is a deceptively simple question with considerable scientific weight: decades of epidemiological work have shown that how people rate their own mouths correlates with clinically measured disease, dental attendance patterns, and even broader quality of life.

The statistical analysis yielded a result that cuts against common assumptions. Migrant status was not a significant predictor of self-reported oral health, with an odds ratio of 0.93 and a p-value of 0.667, meaning the difference between migrants and non-migrants could easily have arisen by chance. In plain terms, knowing whether a parent was a migrant told the researchers almost nothing about how that parent rated their teeth and gums. What did matter were two variables that applied to everyone in the sample. Participants who attended dental check-ups had dramatically lower odds of reporting poor oral health, with an odds ratio of 0.25 and a p-value below 0.001, translating to a 75 percent reduction in the odds of worse self-rated oral health compared with those who did not attend. Educational attainment also played a significant role, with an odds ratio of 1.64 and a p-value of 0.001, indicating that more educated parents were substantially more likely to report better oral health.

One subgroup finding added nuance to the picture. Participants originating from Asian regions had 57 percent lower odds of reporting worse oral health than the reference group. This kind of regional variation within the migrant population is itself instructive, because it demonstrates that migrants are not a homogeneous block. Aggregating all migrant groups into a single category can obscure real differences in oral health profiles, dietary patterns, and experiences with dental services. The Norwegian study’s ability to detect such variation reflects both its sample size and its analytical approach, which modeled multiple sociodemographic and behavioral factors simultaneously rather than examining migrant status in isolation.

The strength of the dental attendance association deserves particular attention. An odds ratio of 0.25 is a large effect by the standards of public health epidemiology, where behavioral predictors often hover near 1.0 and are celebrated when they reach 1.2 or 1.5. Regular dental visits are associated with early detection of caries, professional cleaning, fluoride application, and preventive counseling, all of which interrupt the trajectory of oral disease before it becomes painful or irreversible. Conversely, people who avoid dental care tend to present only when problems are acute, reinforcing negative experiences and deepening avoidance. The study’s cross-sectional design means the direction of this relationship cannot be definitively established, since people with healthy mouths may simply have less reason to visit the dentist, but the association aligns with a large body of clinical evidence on the benefits of consistent preventive care.

Education, the other strong predictor, operates through several plausible mechanisms. Higher educational attainment is consistently linked with greater oral health literacy, better understanding of preventive recommendations, more stable incomes that make dental fees manageable, and workplaces that accommodate time off for appointments. In Norway, where the public dental health service provides free care to children but adults generally pay out of pocket for treatment, the educational gradient in adult oral health reflects both knowledge and economic access. The finding that education mattered equally across migrant and Norwegian parents suggests that these mechanisms are not specific to any cultural group but are structural features of how societies distribute health resources.

The authors are careful about what their results do and do not imply. They do not claim that migration is irrelevant to oral health; rather, they conclude that being a migrant is not the primary factor affecting oral health outcomes in this population. Instead, it is the interplay of sociodemographic factors, health behaviors, and access to dental care that plays the significant role. This distinction matters for policy. Interventions designed around migrant status as the central risk factor may miss the levers that actually move outcomes, such as reducing barriers to dental attendance and addressing educational inequalities. At the same time, the researchers acknowledge that various barriers can influence parental oral health behaviors during the migration process, and that prioritizing oral health and access to dental services remains essential for everyone.

The study forms part of a broader research effort in Norway to build an evidence base for improving oral health services, oral health literacy, and responsiveness to migrant needs. It was conducted within the COP study, Caries and Obesity Prevention in Children with a Migrant Background, financed by the Norwegian Research Council under grant number 331782. The survey data came from the Folkehelseundersøkelse i Vestland 2022, the national public health survey in Vestland county, accessed through the Norwegian health data infrastructure. Ethical approval for data access and handling was obtained from the Regional Committee for Medical and Health Research Ethics and the Norwegian Agency for Shared Services in Education and Research. The work also received support from the Research Department at the Oral Health Centre of Expertise in Western Norway.

The practical implications reach beyond Norway’s fjords. Migrant populations across Europe and North America are growing, and health systems everywhere are grappling with how to serve them equitably. This study offers a deceptively simple lesson: the path to better oral health may run through the same channels for everyone, namely affordable and consistent dental care and the education that helps people value and navigate it. The authors recommend that health authorities strengthen family- and community-based strategies embedded within broader health promotion and preventive programs, and they call for further research measuring oral health behaviors and oral health literacy to illuminate the mechanisms at play. If the goal is to reduce disparities, the evidence from Western Norway suggests that the starting point is not where people come from, but whether they can and do get to a dental chair.

Subject of Research: Associations between sociodemographic factors, dental care utilization, dietary habits and self-rated oral health among parents with and without a migrant background in Western Norway

Article Title: Self-rated oral health among parents with and without a migrant background in Western Norway: associations with sociodemographic factors, dental care utilization, and dietary habits

Article References: Brea Larios, D., Åstrøm, A. N., & Mustafa, M. (2026). Self-rated oral health among parents with and without a migrant background in Western Norway: associations with sociodemographic factors, dental care utilization, and dietary habits. BMC Public Health. https://doi.org/10.1186/s12889-026-29789-6

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29789-6

Keywords: oral health, self-rated health, migrant health, dental attendance, dental care utilization, health inequalities, public health, Norway, parents, sociodemographic factors, dietary habits, dental epidemiology

The methodological design matters as much as the findings. The team used purposive sampling with maximum variation, deliberately recruiting participants across a spectrum of residency status, socioeconomic background, and prior experience with the health system, so that the analysis would capture the full range of circumstances rather than a single archetype of the migrant patient. Semi-structured, in-depth interviews allowed women to describe their own trajectories through pregnancy, contraception, and gynecological care in their own words, while key informants supplied the institutional perspective of providers and administrators. The researchers then applied directed content analysis, coding the transcripts against the WHO framework’s distinction between structural determinants, such as law, macroeconomic policy, and gender norms, and intermediary determinants, such as material living conditions, psychosocial stress, and health behaviors. Prolonged member checking, in which participants reviewed the emerging interpretation, and peer debriefing among the research team strengthened the credibility and confirmability of the final categorization.

What emerged was a picture of access shaped at three interconnected levels. At the structural level, the study identified a restrictive legal and macroeconomic context as the foundational barrier. Iranian policy toward Afghan migrants has shifted repeatedly over decades of conflict and economic sanctions, and a woman’s documentation status determines whether she can enroll in insurance schemes, obtain subsidized care, or even travel to a clinic without fear of detention. Undocumented status, the researchers found, operates less as a single obstacle than as a multiplier that raises the perceived cost and risk of every subsequent step in the care-seeking process.

Financial mechanics compound the legal ones. Even for women with papers, reproductive health services in Iran involve substantial out-of-pocket payments, and the study documented how banking barriers, including difficulties opening accounts or transferring money, intersect with communication barriers to make routine transactions fraught. For a household living on precarious daily wages, the calculus is stark: a consultation fee, transport costs, and a day of lost earnings can outweigh the perceived benefit of preventive care, pushing women to defer visits until symptoms become severe. The macroeconomic pressures of sanctions-era inflation amplify these trade-offs, particularly for families already remitting money to relatives in Afghanistan.

Layered over these structural forces are patriarchal norms that constrain women’s agency in deciding when and whether to seek care. Participants described needing male relatives’ permission or accompaniment for appointments, and informants noted that husbands and mothers-in-law often act as gatekeepers to contraception and maternal services. This is not unique to Afghan communities, but the study shows how migration intensifies it: displacement can strengthen household hierarchies as families cling to familiar norms under pressure, while the absence of extended female support networks leaves young mothers without the informal guidance that might otherwise encourage timely care-seeking.

At the intermediary level, the researchers documented poor material circumstances, crowded and unstable housing, unsafe neighborhoods, and unreliable access to transport, that translate directly into missed appointments and delayed antenatal care. Psychosocial stressors, including chronic legal insecurity, fear of deportation, and the accumulated trauma of displacement, emerged as a distinct pathway. The study describes bio-behavioral responses to these stressors: women under sustained threat of detention or eviction reported postponing care even when services were nominally available, a delay pattern the authors interpret as a rational response to legal insecurity rather than ignorance or indifference. In other words, the decision to skip a check-up is often a risk calculation, not a knowledge gap.

The health system itself contributes a third tier of barriers. The study found a lack of migrant-sensitive facilities, meaning clinics and hospitals that lack interpreters, culturally adapted counseling, or staff trained in the specific needs of Afghan patients. Linguistic mismatches between Dari-speaking patients and Persian-speaking providers, though the languages are related, still generate misunderstandings about dosing, follow-up schedules, and informed consent. More corrosive still is perceived discrimination: participants reported feeling judged or deprioritized in waiting rooms, an experience that erodes trust and deters return visits. Cross-cutting factors such as inconsistent documentation requirements across facilities mean that a woman registered at one clinic may find herself refused at another, fragmenting continuity of care precisely when continuity matters most, during pregnancy and childbirth.

Against this dense web of barriers, the study identifies two forces that reliably bridge women to care: social capital and non-governmental organizations. Informal networks of neighbors, relatives, and fellow migrants who share information about which clinics are welcoming, which providers speak Dari, and how to navigate registration function as a parallel navigation system. NGO-run health posts and outreach workers, meanwhile, reach women whom the formal system misses, offering services and referrals at low or no cost. The authors emphasize that these bridges, while vital, are compensatory: they mitigate the damage of structural barriers rather than removing them, and they remain fragile, dependent on short-term funding and volunteer labor.

The analytical payoff of the WHO framework is that it shows how the three levels interact to produce what the researchers call a compounded vulnerability. An undocumented woman facing patriarchal household constraints, living in precarious housing, encountering a clinic with no interpreter and a billing system she cannot use, does not experience these as separate obstacles but as a single cumulative weight that grows heavier with each step toward care. This interaction explains why piecemeal interventions, a translation service here, a fee waiver there, have historically produced disappointing results: each addresses one strand of a braid.

The policy implications are correspondingly systemic. The authors argue that migrant-sensitive services, including linguistic accommodation, simplified and consistent documentation requirements, and staff training to counter discrimination, would improve uptake of essential services, but that durable gains require addressing the structural layer: legal pathways to documentation, insurance coverage for migrants regardless of status, and recognition that reproductive health access is not merely a clinical issue but a matter of law, economics, and gender. They also note a fiscal argument that resonates with host-country policymakers: delayed care for preventable conditions ultimately raises long-term healthcare costs for both migrant populations and the Iranian health system, through emergency interventions, complications, and untreated disease. Framing equity as cost containment, the study suggests, may be the most persuasive route to reform in a constrained fiscal environment, and the findings offer a template for assessing similar barriers faced by migrant women in other host countries across the region.

Subject of Research: Social determinants of reproductive health service access among Afghan migrant women in Iran

Article Title: Social determinants of access to reproductive health services among Afghan migrant women in Iran: A qualitative study

Article References: Mirmolaei, S. T., Mahmoodi, Z., Takian, A., & Bayat Jozani, Z. (2026). Social determinants of access to reproductive health services among Afghan migrant women in Iran: A qualitative study. PLOS Global Public Health, 6(10), e0007406. https://doi.org/10.1371/journal.pgph.0007406

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007406

Keywords: Afghan migrants, reproductive health, Iran, social determinants of health, qualitative study, health equity, migrant health, maternal care, health policy, Tehran, undocumented migrants, health systems

The research team searched PubMed and Web of Science for peer-reviewed original studies published between March 2010 and March 2025, following the PRISMA guidelines for scoping reviews. From an initial pool of 2,463 papers, the screening process narrowed the field to just 31 studies that met the inclusion criteria. To qualify, studies had to report data on discrimination in medical settings as perceived by forcibly displaced people in LMICs, aim to investigate discrimination in healthcare or barriers to healthcare access, and be available in English. Studies were excluded if they reported discrimination from the perspective of healthcare workers rather than migrants, if results were not separated from other migrant or non-migrant groups, or if they were conducted in high-income countries.

The geographical footprint of the included studies was narrow. South Africa led with eight studies, followed by Lebanon with five, while Colombia, Ecuador, Peru, Türkiye and Uganda each contributed three. Brazil, Iran, Jordan and Kenya each had two studies, and Nepal, Pakistan, the Philippines and Rwanda each had one. Notably, when the researchers cross-referenced their findings against the UNHCR’s list of the top ten refugee-hosting countries between 2010 and 2024, only five of those countries—Colombia, Iran, Jordan, Pakistan and Türkiye—were represented in the literature. Major hosts such as Afghanistan, the Democratic Republic of Congo, Ethiopia, Iraq, Nigeria, Somalia, South Sudan, Sudan, Ukraine and Yemen had no studies meeting the inclusion criteria at all.

The populations studied were similarly concentrated. Refugees from Syria were the most frequently studied group, appearing in ten studies, followed by refugees from the Democratic Republic of Congo in eight. People displaced from Rwanda, Venezuela, Burundi, Somalia, Zimbabwe and Afghanistan also featured prominently, while refugees from countries including the Central African Republic, Myanmar and Yemen were entirely absent from the evidence base. Perhaps most strikingly, the review identified no studies at all on internally displaced people, even though they account for nearly 60 percent of all forcibly displaced people worldwide—a gap the authors describe as especially striking given the scale of internal displacement.

Methodologically, the evidence base is dominated by qualitative work. Twenty-six of the 31 studies used qualitative methods, primarily interviews and focus group discussions, and only five used quantitative approaches. None of the quantitative studies employed standardized instruments such as the Discrimination in Medical Settings Scale, which limits the comparability of findings across studies and settings. Only four studies had discrimination against forcibly displaced people in healthcare as their single main objective; the rest explored it as one barrier among many in broader investigations of healthcare access. This methodological imbalance means that robust, generalizable data on the prevalence and context of discrimination in LMICs remain scarce.

Despite these limitations, the quantitative findings that do exist are consistent in direction. Across the studies reporting numerical data, between 10 and 44 percent of refugees reported experiencing discrimination while seeking healthcare. In South Africa, Kibiribiri and colleagues found that 39.2 percent of African refugee women would not return to the same facility if pregnant again due to staff attitudes and neglect, 43.6 percent perceived xenophobia, and 42.3 percent reported carelessness. In Uganda, Rustad and colleagues found that the risk of perceived discrimination among Sudanese refugee mothers rose from 4 percent among host-community women to 10 percent among refugees, attributed mainly to refugee status or language barriers. In Colombia, Unternaher and colleagues found that 12 to 15 percent of displaced Venezuelan women reported experiencing or witnessing discrimination during prenatal care, which was associated with a 42.8 percent lower likelihood of completing at least four prenatal visits. In Jordan, Ay and colleagues found that 40.8 percent of non-camp Syrian refugees reported discrimination by health personnel as a barrier to access, and 29.1 percent expressed distrust in healthcare providers.

The qualitative evidence, while harder to aggregate, is often more visceral. Refugees across multiple studies described being yelled at, treated as though they were unintelligent, denied information, blamed for expressing pain, questioned about their right to bear children in the host country, threatened, accused of burdening the health system, or told to go back to their country of origin. Some reported physical abuse by healthcare providers. Discrimination was also perceived in subtler forms—in the tone and wording of questions about nationality, in longer waiting times, in exclusion from services, in neglect, misdiagnosis, inadequate pain management, and in higher healthcare costs charged on the basis of country of origin. These experiences were frequently identified as barriers to accessing care, leading refugees to delay seeking treatment until their condition had reached a critical stage, to avoid specific facilities altogether, or to disengage from care entirely.

The consequences extend beyond missed appointments. The review found that experiences of stigma and mistreatment contributed to mistrust of health systems and confidentiality concerns, and that refugees reported feelings of worthlessness, heightened stress and trauma, and compromised emotional wellbeing as a result of discriminatory treatment. These findings align with the broader literature on discrimination as a social determinant of health. As the authors note, drawing on the Lancet Series on Racism, Xenophobia, Discrimination and Health, discrimination adversely affects all key elements of adequate care—availability, acceptability, accessibility and quality—and is associated with poorer physical and mental health outcomes, increased mortality and reduced life expectancy.

Why does this discrimination occur? The review found that the underlying reasons often remain unclear in the existing literature. In many cases it was not possible to distinguish whether perceived unfair treatment reflected actual discrimination based on personal characteristics or a more general mistreatment affecting all patients, such as staff shortages or resource scarcity. Some studies that included healthcare providers’ perspectives pointed to contributing factors including resentment toward refugees, work overload, general scarcity of resources, discriminatory policies and language barriers. But study designs rarely allowed direct comparison or objectification of these explanations. The authors argue that understanding the underlying reasons is essential for developing effective strategies, even if the effect on health-seeking behavior is likely to be the same regardless of whether the discriminatory acts can be objectively verified.

Based on the evidence, the review identifies four broad avenues for reducing discrimination in healthcare. First, healthcare providers need training to recognize the specific needs and barriers faced by refugees, including education in cultural diversity, anti-discrimination strategies and legal healthcare entitlements. Second, health systems must be strengthened with adequate staffing, infrastructure, information systems and supply chains, alongside the use of professional interpreters, trained refugee healthcare workers and telemedicine to reduce miscommunication and build trust. Third, inclusive policies are needed that remove legal barriers, ensure access to healthcare regardless of legal status, protect migrants from violence and deportation, and translate global health commitments into national and local frameworks supporting Universal Health Coverage. Fourth, further research is needed—research that uses validated measures of self-reported discrimination, clearly defines study populations, includes appropriate control groups, and examines where, when, why and against whom discrimination occurs. The authors emphasize that improving healthcare alone will not be sufficient: discrimination must ultimately be addressed as a fundamental social determinant of health, requiring action on the deeper systems of categorization, marginalization and oppression that underpin racism and xenophobia in all their forms.

Subject of Research: Perceived discrimination against forcibly displaced people in healthcare settings in low- and middle-income countries

Article Title: Discrimination in medical settings as perceived by forcibly displaced people within low- and middle-income countries: a scoping literature review

Article References: Grosheintz-Laval, K. M., Kwizera, P., & Winkler, M. S. (2026). Discrimination in medical settings as perceived by forcibly displaced people within low- and middle-income countries: a scoping literature review. Public Health Reviews, 47, Article 1609595. https://doi.org/10.3389/phrs.2026.1609595

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1609595

Keywords: refugees, forcibly displaced people, healthcare discrimination, low- and middle-income countries, scoping review, health equity, xenophobia, maternal health, health systems, migrant health, PRISMA, public health

The central claim of the commentary is deceptively simple but institutionally disruptive. Participatory and co-produced approaches are now well established in migrant health research, supported by a proliferation of frameworks explaining how to conduct research with rather than on migrant communities. Yet, as Uribe Guajardo documents, real-world stories of co-creation remain inconsistently reported and tend to concentrate in the operational aspects of projects, such as recruitment and data collection, rather than in agenda-setting, analysis, leadership, dissemination, or decision-making. Research continues to be conducted predominantly on migrants rather than with migrants as equal partners in knowledge production. The paper argues that without changing who holds authority over knowledge, existing patterns of epistemic marginalisation will simply be reinforced.

Epistemic justice, a concept drawn from philosophy and increasingly applied in decolonial health scholarship, sits at the heart of the argument. In this framing, epistemic justice means enabling marginalised researchers and communities to think about and analyse their own experiences in ways that value and appropriately recognise those experiences, particularly when those interpretations clash with dominant, institutionally sanctioned discourses. Applied to public health, it requires challenging the traditional hierarchies that privilege academic and institutional expertise while marginalising lived expertise. Uribe Guajardo contends that migrants should be recognised not merely as research participants or beneficiaries, but as legitimate knowers whose knowledge is systematically incorporated into decision-making, and as leaders, agenda-setters, and producers of public health evidence.

The evidence for this argument comes from an evolving program of research spanning three domains: health and social care integration, public health emergency preparedness, and international collaborations with migrant communities, frontline workers, and researchers. In the earliest phase, the work focused on understanding and strengthening the systems that support migrants in Sydney, Australia, before shifting attention to who holds power within those systems. Studies of policy mechanisms for integrating health and social care for culturally and linguistically diverse communities identified how governance arrangements, partnerships, workforce models, and service coordination could support more integrated responses, while also exposing persistent fragmentation across sectors. Related work on data sharing found that information exchange between sectors remained limited, hampered by inadequate governance, funding structures, and organisational capacity to meet migrant communities’ needs.

These early findings pointed to a structural gap that goes beyond service delivery. Even where integration models made progress, community representatives, migrants themselves, were rarely formally embedded in the health or social care systems that shape research, policy, and practice affecting their lives. The research concluded that effective migrant responsiveness depends not only on how services are delivered, but on the policy infrastructures that enable organisations to work together through shared governance, including clearly embedded community decision-making, information flows, and resources. Meaningful and equitable integration of migrant voices in research, policy, and practice, the paper notes, remains low, and researchers have yet to challenge the system in sustainable ways.

A second strand of the commentary examines the relational infrastructure that underpins any genuine shift in power. Relationships and partnerships, both formal and informal, proved decisive throughout the research program, and never more so than during the COVID-19 pandemic. During the crisis, these networks were crucial in translating health and public information, facilitating access to health and social services, identifying emerging needs, and supporting communities through successive waves, including the Delta phase in Sydney’s diverse ethnic communities. Policymakers contributed insight into system-level priorities and constraints; service providers described the practical realities of implementation; and community-led organisations and migrant volunteers illuminated how policies and services are actually experienced on the ground. Bringing these perspectives together produced a more comprehensive understanding of the barriers and opportunities for equity than any single vantage point could offer.

Yet this relational work carries a cost that academic systems rarely acknowledge. Meaningful engagement with migrant representatives requires significant investments of time, trust, and relationship-building, and formal institutions must in turn develop trust in community-led organisations and individuals. Building partnerships across health, social care, and community sectors involved ongoing communication, repeated engagement, coordination of diverse interests, and a commitment to understanding stakeholder priorities beyond the immediate objectives of crises or funded projects. Uribe Guajardo is candid that this invisible labour sits outside traditional measures of academic productivity, even though it is essential for producing evidence that is relevant, actionable, and capable of supporting system-wide change. In her account, the partnerships became both a mechanism for generating evidence and an outcome in themselves, fostering connections that support ongoing collaboration and contribute to more integrated, responsive, and inclusive systems.

The commentary also offers a technical account of what co-production actually requires in migrant health research, and where it most often falls short. Positionality must be acknowledged first, followed by deliberate trust-building with communities and the creation of spaces that value lived experience while avoiding colonising narratives and frameworks. Co-production, the paper argues, often begins before co-production formally starts: engaging and getting to know migrant leaders before a grant application or project is developed allows researchers to leverage fully formed relationships rather than assembling community panels as an afterthought. Recognising communities as legitimate knowledge holders and contributors, including as authors on publications, creates a concrete shift towards epistemic justice. In Uribe Guajardo’s own program, forming formal governance structures in which migrant representatives formally drive the research, including through reimbursement, strengthened knowledge generation and helped ensure the research was not positioned for epistemic extraction, while giving back to the community in ways the community itself chose to define.

Importantly, the paper warns against a subtle failure mode: rejecting non-traditional narratives simply because they do not fit conventional research conventions. Instead, research approaches should prioritise and accommodate diverse forms of knowledge, including those grounded in lived experience, culture, and community practice, which may require challenging, adapting, or rejecting colonising frameworks that fail to align with the realities and priorities of participating communities. The commentary extends this logic to how success itself is measured. Existing governance and research systems frequently rely on institutionally determined indicators, such as academic outputs, that overlook what communities value. Shared governance, by contrast, creates space for communities to participate not only in identifying problems but in defining desired outcomes, including cultural expression, social connectedness, and self-determination.

The destination of this journey, Uribe Guajardo argues, is a model in which reciprocity and sustained engagement are not ancillary to governance but constitute governance itself. Relational infrastructure, encompassing long-term partnership building, shared accountability, and ongoing investment in community relationships, is a critical yet frequently undervalued component of shared governance; without it, participation risks becoming symbolic rather than transformative. She also cautions against framing migrants solely through narratives of vulnerability and disadvantage: while attention to structural inequities remains essential, shared governance requires simultaneous recognition of migrant agency, creativity, resilience, resistance, and leadership. The commentary distils the conceptual ladder that the field must climb: collaboration concerns relationships and partnerships, co-production concerns meaningful contributions to research and practice, epistemic justice concerns the recognition of migrants as legitimate knowers, and governance concerns authority, power, and decision-making. Viewed this way, the next evolution of migrant health research lies not in strengthening participation or co-production alone, but in advancing institutionally embedded models of migrant-centred governance, with these processes reported as outcomes of the research itself. The result, the paper suggests, would be public health research, policy, and practice that are more equitable, accountable, and responsive to the communities they claim to serve.

Subject of Research: Epistemic justice and migrant-centred governance in public health research

Article Title: Leading by example: a migrant health researcher’s journey from participation to epistemic justice and migrant-centred governance in public health research

Article References: Uribe Guajardo, M. G. (2026). Leading by example: a migrant health researcher’s journey from participation to epistemic justice and migrant-centred governance in public health research. International Journal for Equity in Health, 25(1), Article 245. https://doi.org/10.1186/s12939-026-03055-y

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03055-y

Keywords: migrant health, epistemic justice, co-production, participatory research, public health, health equity, shared governance, community engagement, health and social care integration, decolonising research, COVID-19, research leadership

The scale of the populations involved makes the findings consequential far beyond Belize’s borders. Foreign nationals make up 11.5 percent of the country’s population, while Maya communities account for 9.8 percent. Together, these groups represent a substantial share of the national population, yet Belize’s current strategic health plans contain no systematic consideration of how their access patterns differ from those of the general population. Most existing research on health inequity in similar settings has concentrated on barriers that arise in communities, such as poverty, geography, or distrust. This study deliberately shifted the analytical lens toward the health facility itself, asking what happens to patients once they arrive, and what they encounter along every step of their journey through the system.

Methodologically, the research triangulated three distinct forms of evidence. The team conducted a narrative literature review to establish the policy and epidemiological context, carried out semi-structured interviews with 67 participants, and performed structured direct observation of patient journeys at five health facilities across Belize. Data collection took place in September 2025. The researchers used maximum variation sampling, deliberately recruiting participants across migration status, gender, ethnicity, and professional roles, so that the analysis would capture the widest possible range of experiences rather than a narrow demographic slice. Ethical approval was granted by the Institutional Review Board of Belize’s Ministry of Health and Wellness, and all participants gave written informed consent in English or Spanish, in accordance with the Declaration of Helsinki.

The analytical engine of the study was a hybrid coding approach. Deductive codes were drawn in advance from the World Health Organization’s accessibility framework, giving the team a structured vocabulary for known categories of access barriers such as availability, affordability, and acceptability. Inductive codes were then allowed to emerge from the fieldwork itself, capturing patterns the pre-existing framework did not anticipate. This combination matters technically because purely deductive designs can miss locally specific phenomena, while purely inductive designs risk losing comparability with the international literature. By running both in parallel, the researchers could anchor their findings in established global frameworks while still letting Belize’s particular realities shape the analysis.

The headline finding is deceptively simple: care in Belize is formally free, but practically expensive. The study documents how extensive waiting times impose hidden costs on patients who must sacrifice wages or daily work to sit in queues, and how financial barriers such as transportation expenses and the cost of medications erode the promise of free care. For some patients living near the border, these cumulative costs become so burdensome that seeking care across the border becomes the rational choice, despite the formal availability of services at home. This dynamic illustrates a concept well known in health services research: the effective price of care is not the fee charged at registration, but the total cost, in money and time, of completing a patient journey.

Communication emerged as a second, deeply structural barrier. Elderly Maya patients who speak Q’eqchi’ or Mopan frequently cannot communicate with health staff, and interpretation within facilities remains informal and unsystematic, often depending on whoever happens to be available, including family members or bystanders. In clinical settings, informal interpretation is a recognized patient safety risk, since medical terminology, dosing instructions, and consent conversations can be distorted or lost. Compounding this, system navigation is hindered by a scarcity of multilingual information about available services and procedures, meaning that patients who already face language barriers must also decipher an unfamiliar bureaucratic landscape without adequate signage, leaflets, or guidance in languages they understand.

The study also identified a feedback problem that quietly silences the very populations most affected. Patient feedback mechanisms in Belizean facilities are available only in English and lack anonymity, which discourages migrants and Maya patients from filing complaints or suggestions even when their experiences are poor. In the architecture of health system accountability, feedback channels function as sensors; when those sensors are linguistically inaccessible and socially risky to use, facility managers lose the information they need to detect and correct inequities. The result is a system that can appear responsive on paper while remaining blind to the experiences of its most vulnerable users.

Perceived discrimination, the researchers found, arises primarily from interpersonal dynamics during registration, the very first point of contact between patient and institution. This finding is significant because registration is a routine, high-volume interaction, and small failures of courtesy or cultural understanding there can color a patient’s entire perception of the health system. The problem is exacerbated by chronic staff shortages, which stretch personnel thin, lengthen queues, and heighten tensions at reception desks. In other words, what patients may experience as disrespect is often rooted in a resourcing problem, a distinction that matters for policy because the remedy is not simply sensitivity training but also adequate staffing levels.

The study’s central conclusion reframes the problem in a way that carries lessons for multicultural health systems across low- and middle-income countries. Healthcare inequities affecting migrants and Maya populations in Belize do not stem from formal exclusion, since no rule bars anyone from care. Instead, they emerge from the cumulative effect of structural, linguistic, cultural, and resource barriers encountered throughout the journey to and through the health system. Each individual barrier might seem minor, but their interaction produces outcomes as severe as outright exclusion, including cross-border care seeking and untreated illness. This cumulative framing shifts the policy target from changing eligibility rules, which are already inclusive, to redesigning the patient journey itself.

To translate diagnosis into action, the researchers propose a three-layered framework. The first layer addresses the facility environment, improving the physical and informational conditions patients encounter, from multilingual signage to streamlined registration. The second layer focuses on staff capacity development, equipping health workers with the linguistic and cultural competencies needed to serve a diverse population, while also confronting the underlying staff shortages that strain every interaction. The third layer anchors solutions in communities themselves, building on Community Health Workers, trusted local figures who can bridge the gap between households and facilities, provide interpretation, and guide patients through the system. Because the framework was developed with Belize’s Ministry of Health and Wellness as a partner and funded through the Inter-American Development Bank, it is positioned for direct policy uptake rather than academic shelf life. For a small country with a diverse population and limited resources, the study’s message is ultimately optimistic: the barriers are real, but they are specific, mappable, and fixable, and strengthening universal access for everyone may require nothing more radical than paying close attention to the journeys of those the system currently serves worst.

Subject of Research: Barriers to healthcare access for migrant and Maya populations in Belize

Article Title: A qualitative study identifying barriers and policy solutions for healthcare access among migrants and Maya populations in Belize

Article References: Sánchez Meertens, C., Cho, K., Terry, C., Bell, L., Diaz-Musa, M., Arriaga, A., & Góngora-Salazar, P. (2026). A qualitative study identifying barriers and policy solutions for healthcare access among migrants and Maya populations in Belize. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15792-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15792-5

Keywords: Belize, healthcare access, migrant health, indigenous health, Maya populations, health equity, qualitative research, patient journey, Community Health Workers, health policy, language barriers, health services research

The study, led by Katri Kantojärvi and colleagues at the Finnish Institute for Health and Welfare (THL), was published in the International Journal for Equity in Health. Its central question is deceptively simple: who falls through the cracks of a welfare system famous for its generosity? While the barriers migrants face in accessing healthcare have been studied extensively across Europe, social services, income support, housing assistance, child welfare, care for older adults and people with disabilities, have remained a striking blind spot in the research literature. Yet these are precisely the services that people in crisis depend on most, and delays in accessing them can cascade into homelessness, debt, and deteriorating mental health.

To answer the question, the team turned to two nationally representative cross-sectional surveys. The first, MoniSuomi, surveyed 1,384 foreign-born adults living in Finland and was specifically designed to capture the experiences of the migrant population, with data collection sensitive to linguistic and cultural diversity. The second, the Healthy Finland survey, covered 1,221 individuals of Finnish origin and provided the comparison group. Crucially, the researchers restricted their analysis to respondents who had actually used social services within the previous twelve months, ensuring that the findings reflect the experiences of people who had genuine contact with the system rather than speculative opinions about it.

The methodological heart of the study lies in its treatment of vulnerability. Rather than treating disadvantage as a single variable, the researchers measured six distinct indicators: unemployment, financial stress, psychological distress assessed with the Mental Health Inventory-5, severe functional limitation, poor social inclusion measured with the Experiences of Social Inclusion Scale, and low digital skills. Each indicator captures a different dimension of precarity, and each was examined both individually and in combination. The outcomes were equally concrete: whether respondents perceived unmet service needs, and whether they perceived delays in gaining access to services. Survey-weighted logistic regression models produced odds ratios with confidence intervals, and interaction terms were used to formally test whether the effects of vulnerability differed between migrant-origin and Finnish-origin respondents.

The results paint a coherent and sobering picture. Four of the six vulnerability indicators, poor social inclusion, psychological distress, financial stress, and severe functional limitations, were strongly associated with both unmet needs and perceived delayed access, and they did so in both populations. A person who was socially isolated, mentally strained, financially squeezed, or physically limited was substantially more likely to say that the system had not delivered what they needed, or had delivered it too late. Unemployment and low digital skills showed weaker or less consistent associations, a finding that itself carries a technical lesson: not all forms of disadvantage translate equally into service system failures, and the mechanisms linking hardship to unmet need are likely to be specific rather than generic.

The most striking result, however, is what the researchers did not find. When migrant-origin and Finnish-origin individuals were exposed to the same vulnerabilities, there were no statistically significant differences between the groups in their reports of unmet needs or delays. In other words, the much-feared migrant penalty in social service access did not emerge once vulnerability profiles were held constant. This is a finding with real political weight in a European debate often framed around migration as a special burden on welfare systems. The Finnish data suggest that the system does not discriminate by origin in this domain; what it fails at, it fails at for everyone.

But the absence of an origin effect is only half the story. When the researchers aggregated the six indicators into a cumulative vulnerability score, the picture changed dramatically. Individuals carrying multiple vulnerabilities were substantially more likely to report both unmet needs and delays, and the sum score model explained more variance than any individual predictor, particularly for unmet needs. The researchers also compared model fit using the Akaike Information Criterion, a standard statistical measure that penalizes model complexity, and found that the cumulative models performed better than models built on single vulnerabilities. This is a textbook demonstration of what social epidemiologists call cumulative disadvantage: risks do not merely add together, they compound, creating service needs that are complex, intersecting, and poorly served by systems organized around single problems.

The mechanism behind this compounding is not hard to imagine. A person facing unemployment alone may navigate the benefit system without much trouble. Add financial stress, and the stakes of any administrative error rise. Add psychological distress, and the cognitive bandwidth available for filling out forms, attending appointments, and appealing decisions shrinks. Add social isolation, and there is no one to help interpret a letter, make a phone call, or advocate on the person’s behalf. Add low digital skills to a system that increasingly routes access through online portals, and the barriers multiply. Each vulnerability is manageable in isolation; together, they can overwhelm both the individual and a service architecture designed for simpler cases.

The policy implications follow directly from the data. The authors argue that service models must be inclusive in a specific, structural sense: they must recognize and respond to complex vulnerability profiles rather than treating each hardship as a separate case for a separate office. They recommend simplifying service pathways, reducing the number of doors a person in crisis must knock on, and investing in proactive outreach, actively identifying and contacting individuals facing multiple disadvantages rather than waiting for them to navigate the system unaided. In an era when welfare agencies across Europe are digitizing their interfaces, the finding that digital skills matter less than social connection and mental health is a useful corrective: technology can streamline access for the capable, but it cannot substitute for human contact with those least able to demand it.

There are, as with any cross-sectional study, limits to what can be concluded. Perceived unmet needs and delays are self-reported, and perception is shaped by expectations as much as by objective service quality; the study measures how the system feels to those inside it, which is a legitimate and important outcome, but not identical to administrative measures of waiting times or benefit denials. Because the data capture a single point in time, causality runs in both directions: psychological distress may make services harder to access, and inaccessible services may deepen distress. Still, the consistency of the pattern across two independent, nationally representative surveys, and across two population groups with very different histories of arrival in Finland, gives the central conclusion considerable weight. In the Nordic welfare state, the study suggests, the fault line of inequity does not run between natives and migrants. It runs between those carrying a single burden and those carrying many, and it is the accumulation of hardship, not the passport in a person’s pocket, that determines whether help arrives in time.

Subject of Research: Cumulative vulnerability and inequitable access to social services among migrant-origin and Finnish-born populations in Finland

Article Title: Cumulative vulnerabilities increase perceived unmet needs and delays in access to social services in migrant origin and Finnish-born populations

Article References: Kantojärvi, K., García-Velázquez, R., Mäki-Opas, J., Kuusio, H., & Skogberg, N. (2026). Cumulative vulnerabilities increase perceived unmet needs and delays in access to social services in migrant origin and Finnish-born populations. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03040-5

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03040-5

Keywords: social services, health equity, migrant health, cumulative vulnerability, Finland, welfare state, unmet needs, service access delays, social inclusion, psychological distress, digital skills, survey research

The study was conducted by researchers at the National Research Center in Complementary and Alternative Medicine at UiT The Arctic University of Norway, together with a colleague from VID Specialized University in Oslo. Between February and August 2024, the team administered an online cross-sectional survey built on an adapted version of the International Complementary and Alternative Medicine Questionnaire, known as the I-CAM-Q, an instrument designed to allow comparisons of complementary medicine use across countries and populations. Participants were 488 first-generation immigrants, meaning people born in Pakistan who migrated to Norway, and 445 second-generation immigrants born in Norway to Pakistani parents, all aged 18 or older. To avoid the skewed samples that plague many online surveys, the researchers used proportional stratified random sampling, drawing participants from the National Register of Citizens so that gender, generation, and age groups were represented in proportion to the underlying population.

The headline numbers are striking. Natural products, which in this context include herbal remedies, spices, oils, and other ingestible preparations rooted in South Asian tradition, were used by 99.3 percent of respondents in the previous year. Religious self-care practices, encompassing prayer and other spiritually grounded health activities, were reported by 75.7 percent. Self-care activities such as yoga and meditation were practiced by 35.1 percent, and 27.8 percent had visited a traditional and complementary medicine provider, whether a herbalist, a practitioner of Unani medicine, or another kind of traditional healer. Taken together, these figures suggest that for this community, complementary medicine is not an occasional experiment or a fringe preference but a continuous, everyday framework of health maintenance.

The intensity of use varied considerably across subgroups, and the patterns are statistically revealing. First-generation women emerged as the heaviest users of all, reporting a median of 16 different traditional and complementary medicine modalities, with an interquartile range of 23, meaning the middle half of these women reported anywhere from a handful to dozens of distinct practices. After adjusting for other variables in logistic regression models, women were significantly more likely than men to engage in self-care practices. Meanwhile, visiting traditional and complementary medicine providers was significantly associated with older age, higher income, and the presence of chronic disease. That last association makes intuitive sense: people living with long-term conditions often seek additional sources of relief when conventional care does not fully resolve their symptoms, and those with more disposable income can afford to pursue options outside the public health system.

One of the most consequential findings concerns geography. Several participants reported visiting traditional and complementary medicine providers abroad, typically during trips to Pakistan or other countries where such practitioners are embedded in the mainstream health landscape. This detail matters for patient safety in ways that a simple prevalence figure cannot capture. Practitioners operating outside Norway are beyond the reach of Norwegian regulation, and the products they dispense may not have been assessed under European standards. When patients later return to Norwegian general practitioners, they may not mention these consultations or the remedies they brought home, creating a hidden layer of pharmacological exposure that clinicians cannot see. The researchers argue that this pattern underscores the need for open, non-judgmental communication about traditional medicine use during clinical encounters.

Why do people turn to these practices? The survey found that traditional and complementary medicine was used mainly for well-being and illness prevention, framing it as part of a proactive, holistic approach to health rather than a desperate fallback. At the same time, 42.7 percent of participants reported using natural products for acute conditions, such as infections, digestive complaints, or minor injuries. This dual role, both preventive and curative, mirrors patterns documented in Pakistan itself, where traditional and complementary medicine is widely used for both health maintenance and illness management, and it confirms that migration does not sever these habits. The researchers interpret the persistence as evidence of a culturally rooted, holistic model of health that continues to make sense to people regardless of which country they live in.

The perceived benefits were overwhelmingly positive, but the survey did not shy away from risks. Although most participants found traditional and complementary medicine helpful, some reported adverse effects, and these were attributed mainly to natural products, with 23.8 percent of users of such products reporting harm. This is a critical nuance. The word natural carries a halo of safety in popular discourse, yet herbal preparations are pharmacologically active substances. They can interact with prescription drugs, vary unpredictably in potency and purity, and in some cases contain contaminants. For a community in which essentially everyone uses natural products, even a modest adverse effect rate translates into a substantial number of people. The authors highlight this as a central argument for integrating questions about traditional medicine into routine healthcare conversations rather than leaving patients to volunteer the information.

The generational comparison embedded in the study design adds another layer of interest. Because the sample deliberately included both migrants and their Norwegian-born children, it offers a window into how health practices transmit, or fade, across generations. The persistence of high overall use suggests that the family remains a powerful conduit for health culture, but the differences between generations in specific modalities hint at selective adaptation. Second-generation immigrants navigate two healthcare worlds simultaneously, and understanding which practices they retain, which they abandon, and which they reinterpret is essential for designing health services that actually meet them where they are. The study’s stratified sampling and statistical adjustments, using Pearson’s chi-square and Fisher’s exact tests for categorical associations alongside non-parametric tests for differences in natural product use and overall use, give these comparisons a methodological solidity that convenience-sample surveys often lack.

Methodologically, the study took care with ethics and privacy. Approval was obtained from the Norwegian Agency for Shared Services in Education and Research, and the Regional Committees for Medical and Health Research Ethics determined that the project did not constitute health research requiring their approval. Participants received information letters in both Norwegian and Urdu and gave explicit informed consent before proceeding. No identifying information such as names, birth dates, or addresses was collected by the researchers, although the survey company linked responses to basic demographic data from the national register to enable the stratified sampling. The work was funded by the National Research Centre for Complementary and Alternative Medicine at UiT, with publication charges covered by the university’s publication fund.

The broader significance of this research extends well beyond the Pakistani-Norwegian community. European health systems are increasingly serving multicultural populations, and studies like this one demonstrate that complementary and traditional medicine is not a marginal phenomenon confined to alternative-lifestyle subcultures. It is a mainstream reality for entire communities, woven into religious practice, family tradition, and everyday self-care. The Norwegian findings argue for a pragmatic response: healthcare providers should routinely and respectfully ask about traditional medicine use, pharmacists should be prepared to advise on interactions involving herbal products, and health services should develop culturally sensitive approaches that acknowledge, rather than dismiss, the healing frameworks patients bring with them. With 99.8 percent of a community engaged in some form of traditional health practice, the choice facing clinicians is not whether these practices exist in their patients’ lives, but whether they will be visible in the medical record.

Subject of Research: Traditional and complementary medicine use among first- and second-generation Pakistani immigrants in Norway

Article Title: Use of traditional and complementary medicines among first- and second-generation Norwegian Pakistanis: a cross-sectional survey

Article References: Khalid, S., Stub, T., Alpers, L.-M., & Kristoffersen, A. E. (2026). Use of traditional and complementary medicines among first- and second-generation Norwegian Pakistanis: a cross-sectional survey. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05521-0

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05521-0

Keywords: traditional medicine, complementary medicine, Pakistani immigrants, Norway, natural products, herbal medicine, self-care, cross-sectional survey, migrant health, cultural health practices, patient safety, I-CAM-Q

The study, led by Sharyn Graham Davies of Monash University together with Nelly Martin-Anatias of Massey University and Carina Truyts of Deakin University, was conducted between 2020 and 2023 and funded by a New Zealand Royal Society Marsden Fund grant. Rather than treating each marginalized group in isolation, as most previous research has done, the team set out to map where barriers overlapped, where they took different forms, and where they were especially punishing. The design reflects a growing critique in reproductive health scholarship: that siloed studies of LGBTQ+ exclusion, migrant exclusion, or religious exclusion can each reveal important injustices while obscuring the shared architecture of the system that produces them all.

The evidence base is substantial. The researchers carried out 52 in-depth interviews with 73 individuals and ran four focus groups involving 40 participants, for a total of 113 people. Participants spanned heterosexual, gay, lesbian, older, single, coupled, Muslim, migrant, Māori and Pacific communities, and were recruited through fertility clinics, community organisations and social networks. All data were analysed using reflexive thematic analysis, a qualitative method in which researchers iteratively code interview material and refine themes while explicitly reflecting on how their own positions shape interpretation. Crucially, the team then subjected those themes to a structured comparison across participant groups, asking systematically where barriers converged, where they differed in form, where they were most pronounced, and where they were not clearly evidenced at all.

What emerged were six recurring barriers to accessing assisted reproductive technology. The first was exclusionary clinical design, meaning that clinics and their administrative processes were built around a narrow model of who a fertility patient is. The second was the privileging of the heterosexual nuclear family, an assumption embedded in eligibility criteria, referral pathways and everyday clinical interactions. The third involved cultural and religious tensions around kinship and permissible reproduction, particularly acute for Muslim participants for whom third-party gametes raise serious religious questions. The fourth was the emotional labour demanded of patients, together with judgments about parental deservingness that participants felt were imposed on them. The fifth concerned the scarcity and governance of gametes and surrogacy. The sixth was economic: the sheer cost of treatment, compounded by funding rules that determine who receives public support and who pays out of pocket.

The analytical heart of the paper lies in showing that these six barriers did not operate uniformly. Donor scarcity, for example, hit different groups through entirely different mechanisms. Single women and lesbian participants faced it as long waitlists and limited donor availability, a straightforward supply problem. Muslim participants encountered it as a religious constraint, because restrictions on third-party gametes meant that donor programs could be theologically off-limits regardless of supply. Gay men faced a compounded version of the problem, since building a family through surrogacy requires both egg donation and a surrogate, multiplying the scarcity they must navigate. The same underlying shortage, in other words, was refracted through religion, sexuality and family structure into three distinct experiences of exclusion.

Funding rules emerged as especially consequential, particularly where they intersected with age, residency status, body mass index and pathway-specific costs. New Zealand’s public fertility funding, like that of many countries, attaches conditions to eligibility, and the study shows how those conditions land differently depending on a person’s social location. Migration trajectories interact with residency requirements, so that a migrant may become ineligible precisely during the years when treatment would be most effective. Singlehood and sexuality determine which clinical pathways are even offered, and later-life family formation collides with age thresholds. A rule that appears neutral on paper, the authors suggest, becomes a mechanism of inequity once it passes through the realities of migration status, relationship recognition and the biological clock.

Central to the study’s framing is the concept of social infertility, a term the researchers use to describe situations where societal conditions, rather than biological dysfunction, constrain a person’s reproductive possibilities. A lesbian couple with no medical fertility problem is infertile only in the sense that the system is not built for them; the same applies to a single woman, a gay couple, or someone whose religion forbids the only treatments on offer. Biological infertility has been studied exhaustively, the authors note, but social infertility remains comparatively underexplored. By placing social infertility at the centre of a comparative design, the study reframes what looks like a series of private misfortunes as a public, structural problem, one that is produced by formal funding rules, clinic and administrative design, donor-market conditions, legal regulation and informal cultural exclusion.

The researchers are careful about what their comparison does and does not show. Finding cross-group convergence, they stress, does not mean that different social locations are interchangeable. A Muslim woman navigating religious prohibitions on donor gametes faces a qualitatively different challenge from a gay man negotiating international surrogacy law, and a migrant on a temporary visa faces constraints neither of them will ever encounter. The value of the comparative approach is precisely that it distinguishes the shared institutional scaffolding from the group-specific mechanisms that operate within it. That distinction matters because it changes what policy can realistically fix: a barrier produced by a funding rule requires a legislative answer, while one produced by clinical culture requires changes in how clinics are designed and how staff are trained.

Those policy implications form the study’s practical core. The authors call for mechanism-specific responses rather than blanket statements of inclusivity. Equitable eligibility and funding rules would address the formal gatekeeping that disadvantages migrants, older prospective parents and those on non-heteronormative pathways. Inclusive administrative and clinical design would tackle the everyday friction of forms, intake systems and assumptions that signal to patients who belongs. Culturally and religiously responsive care would acknowledge that for some communities, permissible reproduction is a live theological question that clinics must engage with rather than ignore. Clearer information pathways would reduce the burden of emotional labour that currently falls on patients to decode the system themselves. And reforms addressing donor and surrogacy scarcity would attack the supply-side bottleneck that constrains single women, lesbian couples and gay men in particular.

The study arrives at a moment when assisted reproduction is expanding globally, with clinics marketing their services to an ever-broader clientele even as access remains rationed by cost, law and culture. Its findings suggest that the inequities embedded in fertility care are not incidental frictions but features of how the system was designed, and that they will persist until the mechanisms producing them are addressed one by one. For the 113 New Zealanders who shared their experiences, the message of the research is that their struggles were not separate stories of bad luck or individual circumstance, but chapters of a single structural account. For policymakers, the message is sharper still: making fertility care genuinely equitable will require looking past the categories that divide patients and fixing the machinery that excludes them all.

Subject of Research: Social infertility and intersecting barriers to assisted reproductive technology access in Aotearoa New Zealand

Article Title: Shared struggles: Muslim, migrant, lesbian, gay, single and older experiences of accessing assisted reproductive technology

Article References: Davies, S. G., Martin-Anatias, N., & Truyts, C. (2026). Shared struggles: Muslim, migrant, lesbian, gay, single and older experiences of accessing assisted reproductive technology. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03050-3

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03050-3

Keywords: assisted reproductive technology, social infertility, reproductive equity, LGBTQ+ family building, migrant health, Muslim perspectives, donor scarcity, surrogacy, fertility funding, heteronormativity, Aotearoa New Zealand, qualitative research

A new study by Eleonora Trappolini, Elisa Barbiano di Belgiojoso and Stefania M.L. Rimoldi, published in SSM – Population Health, tackles this question with an unusually direct research design. Drawing on the 2025 MIGHTY Survey of migrants in Lombardy, Italy, the authors asked respondents to rate their health twice: once as it was before they left their country of origin, and once as it stood at the time of interview. This retrospective pre-migration measure, rare in European datasets, allowed the researchers to compare each individual with their own past self, rather than comparing different groups of people who may differ in countless unobserved ways. The analytical sample comprised 2,331 foreign-born residents of Lombardy, roughly half of them women, including undocumented migrants and naturalised citizens who are typically invisible to residence-based statistics.

The methodological core of the study is a correlated random-effects ordinal logistic regression, a statistical framework that separates within-individual change from between-individual differences. Each respondent contributed two observations, one pre-migration and one post-migration, with age treated as a time-varying covariate and supplemented by Mundlak terms, which capture the individual-level means of time-varying variables and allow the model to distinguish ageing from the effect of migration itself. Because the outcome, self-rated health, is measured on a five-point scale from very good to very bad, the authors used ordinal models and, when diagnostic tests revealed that the proportional-odds assumption was violated, they relaxed it, presenting category-specific marginal effects rather than forcing a single summary coefficient onto a process that operates differently at different points of the health distribution.

The headline finding is stark: once ageing is accounted for, post-migration health deterioration is concentrated among women. Among female respondents, the odds of reporting poorer self-rated health after migration were roughly four times higher than before, an association that remained stable across every model specification. Among men, the corresponding coefficient was smaller and not statistically significant. Before migration, men and women reported almost identical probabilities of being in very good health, 38.5 percent and 38.0 percent respectively. After migration, those probabilities fell to 29.1 percent among men and 24.6 percent among women, opening a gender gap where none had existed. The decline was driven primarily by the loss of very good health and its redistribution into the fair category, with women gaining seven percentage points in the fair category compared with four points among men. Movement into the worst health categories remained modest for both groups.

This gendered pattern is consistent with the double burden hypothesis. Migrant women in Italy are disproportionately employed in domestic and care work, sectors characterised by social isolation, emotional labour, irregular schedules, blurred boundaries between work and rest, and weak labour protections. On top of paid employment, many carry disproportionate unpaid and transnational caregiving responsibilities, juggling the roles of worker, mother, partner and breadwinner simultaneously. The authors caution that their survey does not directly measure time use or caregiving, so these mechanisms remain plausible interpretations rather than demonstrated pathways. But the fact that the gender gap emerges only after migration, from a baseline of near-identical health, strongly suggests that it reflects post-migration experiences rather than differential selection into migration.

Occupational status told a more complicated story, and one that differed sharply by gender. Among men, the decline in very good health varied significantly across occupational positions, ranging from under five percentage points among employees in non-physically demanding jobs to nearly twenty points among those in marginal or non-standard work arrangements. Self-employed men in non-physically demanding occupations also showed pronounced deterioration, a finding the authors interpret in light of the Italian context, where self-employment often functions as a fallback for those shut out of standard employment and can entail economic insecurity, long hours and weak social protections. Among women, by contrast, the decline was both larger and remarkably uniform across occupational categories; the interaction between migration timing and occupational status was not statistically significant in this group. This asymmetry, confirmed by a significant three-way interaction between migration timing, gender and occupation, complicates any simple double-burden narrative. One reading is that the burdens migrant women face, combining paid work with unpaid care, cut across occupational positions, elevating deterioration everywhere and leaving little room for occupation to differentiate the decline. For men, health consequences appear more tightly bound to specific working conditions.

The authors are careful about what their design can and cannot establish. Occupational status was measured at interview, after the health change had occurred, so the associations cannot be read causally; migrants whose health has deteriorated may also drift into self-employment or out of employment altogether, a selection process that could partly generate the observed gradients. Unemployed and inactive respondents showed smaller losses in the best health categories but larger increases in poor health, a pattern consistent with reverse causation, whereby illness pushes people out of work. The authors also acknowledge that their occupational classification, which distinguishes physically demanding from non-physically demanding jobs, may understate the physical and psychosocial strain of domestic and care work, the very sectors where migrant women are concentrated, potentially masking heterogeneity among women.

Retrospective self-reports carry their own hazards, and the study confronts them head-on. Recall bias may lead some respondents to idealise their pre-migration health, a phenomenon known as rosy retrospection, while response shift, a change in the internal standards against which people judge their health, may alter how the same objective condition is reported before and after years of life in a new society. Robustness analyses suggest these mechanisms may inflate the magnitude of the estimated decline but do not manufacture it: deterioration is present even among the most recently arrived migrants, the gender difference survives fixed-effects specifications, and a bounding analysis indicates that only a large, gender-specific recall bias could overturn the result. Other limitations include the restriction to Lombardy, the observational equivalence of cumulative exposure and ageing in a two-observation design, and the possibility of selective return migration, the so-called salmon bias, which could bias estimates in either direction.

What the study ultimately delivers is a reframing of migrant health inequality as a dynamic process rather than a static comparison. The probability of reporting bad or very bad health remained low both before and after migration, confirming that migrants are a positively selected population, but the erosion of that advantage is neither uniform nor random. It is steeper for women than for men, and for men it tracks occupational position, with the sharpest declines among those at the margins of the labour market. The authors argue that this stratification calls for differentiated policy: for men, stronger labour protections and occupational health services extended to non-standard and undeclared work; for women, interventions that reach beyond the workplace to address the combined weight of paid and unpaid care, including extending health surveillance into private households and improving physicians’ capacity to identify work-related illness among migrant home-care workers. As Europe’s workforce ages and its dependence on migrant labour deepens, the finding that the price of migration is paid unevenly, and most heavily by women, is one that policymakers cannot afford to ignore.

Subject of Research: Gender and occupational differences in post-migration health decline among migrants in Italy

Article Title: Do all migrants decline equally? Gender and occupational status differences in post-migration health in Italy

Article References: Trappolini, E., Barbiano di Belgiojoso, E., & Rimoldi, S. M. (2026). Do all migrants decline equally? Gender and occupational status differences in post-migration health in Italy. SSM – Population Health, Article 101971. https://doi.org/10.1016/j.ssmph.2026.101971

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101971

Keywords: migrant health, healthy immigrant effect, exhausted migrant effect, self-rated health, gender inequality, occupational status, Italy, Lombardy, longitudinal analysis, cumulative disadvantage, care work, labour market segmentation

The estimates were produced by Livia Elisa Ortensi using an enhanced indirect estimation approach applied to the 2021 census round. Because neither European censuses nor routine health registers record FGM/C status, researchers must combine information on the country of birth of migrant women with age-specific prevalence data from FGM/C-practicing countries of origin, drawn primarily from Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted between 2004 and 2022. The method accounts for cohort effects, the fact that older generations in practicing countries were more likely to have undergone the procedure, and for migrant selectivity, the possibility that migrants differ from the general population of their origin countries. The resulting figures should be read as statistically modeled estimates rather than exact case counts, but they provide the most comprehensive picture to date of the older dimension of FGM/C in Europe, updating the benchmark estimates produced by Van Baelen and colleagues nearly a decade ago.

The headline numbers conceal striking variation across the continent. France hosts the largest estimated population of older women living with FGM/C, with 38,566 women aged 50 and above, followed by the Netherlands with 32,737, Italy with 26,073, and Germany with 19,229. Prevalence among women born in FGM/C-practicing countries rises steeply with age, from 41.3 percent among those aged 50 to 64, to 49.1 percent among those aged 65 to 74, and 58.7 percent among those aged 75 and older, a pattern consistent with cohort effects in countries of origin where the practice has declined over successive generations. In Greece, estimated prevalence among older migrant women reaches 81.4 percent, and in Poland 80.5 percent, reflecting the specific origins of their migrant communities, dominated by women born in Egypt and other countries where historical prevalence was near universal.

Perhaps the most consequential finding concerns the demographic weight of the older population. In Greece, Croatia, Poland, and the Netherlands, women aged 50 or older account for more than half of all women aged 15 and older estimated to be living with FGM/C. In the Netherlands, where the largest group of older affected women originates from Indonesia, the figure stands at 50.6 percent. This is not a marginal population approaching the end of its demographic life; it is a structural feature of Europe’s aging migrant communities. The leading countries of origin across the region as a whole are Indonesia, accounting for 17.2 percent of older women estimated to be living with FGM/C, Egypt with 15.7 percent, and Somalia with 9.8 percent, a composition that varies sharply from one destination country to another and carries direct implications for how services should be tailored.

Why does this matter clinically? As women with FGM/C move beyond their reproductive years, they tend to disappear from research agendas, clinical guidelines, and health policy, precisely at the point where new health needs may emerge. Menopause brings hormonal changes that interact with the scarring, altered anatomy, and tissue damage caused by FGM/C. Evidence suggests these interactions may worsen vaginal dryness, intensify genitourinary syndrome of menopause, and increase susceptibility to infection. The physiological reasoning is straightforward: declining estrogen already thins and reduces the elasticity of genital tissue, and in women with extensive scarring or infibulation, these changes can compound existing structural damage, chronic pain, and urinary or menstrual complications that were never surgically addressed.

The psychological dimension is equally underexplored. Little is known about how depression, anxiety, and post-traumatic stress related to FGM/C evolve with age, even though trauma-related conditions may persist or resurface decades after the original procedure. Compounding the problem, older women may normalize FGM/C-related genital symptoms as an expected part of aging, delaying help-seeking or disclosure to clinicians who themselves may not ask. Access to care is further constrained by intersecting barriers related to age, gender, migration status, language, culture, and socioeconomic disadvantage, including differences in how pain and menopause-related symptoms are understood, expressed, and interpreted by both patients and providers.

The study also exposes a structural gap in European data infrastructure. Because the United Kingdom has left the European Union, Eurostat no longer receives harmonized population data from the UK Office for National Statistics, making comparable estimates for the UK impossible within this framework. For the countries covered, the analysis demonstrates that census-based indirect estimation can be systematically repeated as new census rounds become available, allowing health planners to track how the population ages and where needs will concentrate. The method’s reliance on origin-country survey data also means estimates inherit the limitations of those surveys, including recall issues and coverage of only nationally representative samples, which the underlying study discusses in detail.

The policy implications are clear and, the author argues, urgent. The number of older women living with FGM/C is likely to increase further as migrant communities age in the coming decades. Research funding should prioritize the clinical and social implications of aging with FGM/C, a field that remains strikingly thin. Future studies should routinely include women beyond reproductive age rather than capping samples at 49 years. Clinical guidance should explicitly address older women, and the services they already use, including geriatric medicine, primary care, gynecology, urology, and mental health services, should be equipped to recognize and respond to the specific needs of women living with FGM/C. Training curricula and awareness materials aimed at health professionals should extend beyond maternity care to the full life course.

Ultimately, the analysis reframes FGM/C in Europe as an aging and diversity issue, not solely a child protection or reproductive health issue. Recognizing the presence of nearly 173,000 older women living with the consequences of FGM/C is presented as an essential precondition for European health systems to respond equitably to the aging of their increasingly diverse populations. As the demographic transition documented in this study continues, the choice for policymakers is between planning for a visible, quantified population with documented needs, or continuing to allow tens of thousands of older women to remain statistically and clinically invisible.

Subject of Research: Estimating the population of older women living with female genital mutilation/cutting in Europe and its implications for health policy and research

Article Title: Making older women with female genital mutilation visible: new estimates for the EU-27, Norway, Switzerland, and Iceland and implications for health policy and research

Article References: Ortensi, L. E. (2026). Making older women with female genital mutilation visible: new estimates for the EU-27, Norway, Switzerland, and Iceland and implications for health policy and research. The Lancet Regional Health – Europe, 70, Article 101867. https://doi.org/10.1016/j.lanepe.2026.101867

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101867

Keywords: female genital mutilation, FGM/C, older women, migrant health, Europe, demographic estimates, census data, menopause, health policy, aging migrant populations, The Lancet Regional Health Europe, women's health