Course:SOWK551/2021/Healthcare Navigation for Racialized Immigrant Survivors of Family Violence

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Short Summary

Literature review exploring racialized immigrant survivors of family violence navigating the heathcare system.

Introduction

Immigrant women, particularly those that are migrants, refugees or trans face persistent and deep inequities when interacting with the Canadian healthcare system. These challenges become more complex when they are experiencing family violence (also referred as intimate partner violence or IPV, and Gender Based Violence or GBV) and seeking support through the healthcare system. According to Women and Gender Equality Canada (WAGE), 44% of women aged 15 and older have who have been in an intimate relationship report experiencing some form of IPV, emphasizing an urgent need to reduce barriers towards offering appropriate safety and care-based interventions. For marginalized women, the intersection of immigration related stressors, precarious legal status, cultural norms and systemic discrimination compound the harm of violence and limits opportunities to receive timely and culturally responsive care. Improving healthcare access for immigrant women experiencing violence requires acknowledging the complex health impacts of IPV, addressing systemic and structural barriers, confronting provider biases and recognizing the role of both informal and formal support networks. In doing so, it would reframe the lack of access to appropriate care as a policy and systemic failure rather than an individual one and help us in building a coordinated, culturally responsive, violence and trauma informed healthcare system that meets diverse and intersecting needs of immigrant survivors.

Health Impacts of Intimate Partner Violence

Intimate Partner Violence (IPV) produces interconnected physical, psychological and reproductive health consequences for immigrant women. Tastsoglou et al. (2025) note that violence often results in serious injuries, chronic reproductive issues and long-term mental health effects that are further intensified by the impact of trauma and migration. These interconnected outcomes demonstrate the limitations of our siloed models of care within the healthcare system where physical and emotional needs are treated independently despite being interconnected. While visible signs of abuse may be identified and addressed by healthcare providers, IPV related brain injuries, also known as traumatic brain injury (TBI) can go unnoticed and untreated. Toccalino et al. (2024) emphasize that TBI symptoms often overlap with mental health disorders and get misdiagnosed. By not being ablet to access imaging and other appropriate diagnostic tools, survivors are unable to receive confirmation of injury, leading to undiagnosed and inadequate treatment. Similarly, maternal health research demonstrates a higher level of vulnerability among migrant and refugee women. Khanlou et al. (2017) report that language barriers, limited familiarity with the healthcare system, and social isolation contribute to insufficient prenatal and postnatal support resulting in higher rates of postpartum depression, particularly among refugee women. These findings highlight the need for integrated, culturally responsive maternal care that takes migration related vulnerabilities along with the compounded impacts of IPV on overall health of an individual.

Systemic and Structural Barriers

Systemic and structural barriers within the healthcare system further add onto the challenges that immigrant women face when navigating support for IPV. Across multiple studies, language barriers emerged as one of the most significant obstacles in accessing care (Tastsoglou et al., 2025; Kalich et al., 2015; Tsai & Ghahari, 2023). Due to limited access to appropriate translators and interpreters, feeling discomfort in having to discuss sensitive issues through a third party (a stranger or relative or their child), and low health literacy all reduce women’s ability to communicate their needs, understand treatment plans or seek help in a crisis such as when experiencing violence in the family. Communication challenges often result in multiple delays in receiving care, misinterpretations of symptoms, and feeling unsupported or misunderstood by the medical team.

Cultural norms and expectations also play a large role in an immigrant women’s experiences and cause delays in seeking timely support. Baloch et al. (2025) highlight the role of shame, stigma and concerns about dishonoring the family which leaves the woman to feel discouraged in disclosing the violence. These cultural pressures then interact with systemic gaps such as culturally inappropriate care or limited awareness of the healthcare provider about IPV resulting in an environment where immigrant women may feel unsafe or judged for attempting to access help.

Immigration based barriers such as having a precarious immigration status, having to be dependent on the abusive partner during the sponsorship process, or fearing deportation is another factor that prevents immigrant women from seeking formal assistance (Tastsoglou et al., 2025; Merken et al., 2023; Allen-Leap et al., 2022). While help seeking behaviour does depend on the individual, women may avoid healthcare all together because they fear disclosure of violence would result in deportation, or lead to child welfare involvement. For undocumented women, or those with limited eligibility for healthcare coverage such as on Interim Federal Health Program (IFHP), essential healthcare services including mental health services are either financially limited or unavailable altogether. Additionally, financial or logistical barriers which are often connected to the individual’s immigration status can restrict access to timely care. For instance, common challenges for newcomers includes transportation costs, childcare responsibilities, long wait times, and gaps in system navigation (Kalich et. al., 2015; Tsai & Ghahari, 2023). While there are government funded programs such as Crime Victim Assistance Program (CVAP) which provides limited financial support for individuals impacted by a violent crime, having to potentially pay out of pocket for medication, specialised services or ongoing counselling sessions can prevent women from seeking the help they need. These barriers are intensified for recent newcomers who would be facing a deep financial loss if they were to separate from an abusive partner. Immigrant women having to experience these structural constraints that highlight great difficulty in accessing care are not individual failings, rather are rooted in broader systemic inequities. For immigrant women experiencing IPV, these barriers play a large role in delaying or even preventing seeking help from healthcare or even social services spaces.

Practitioner Level Barriers and Support Systems

Practitioner level barriers play a large role in shaping how immigrant women experience healthcare when seeking support for IPV. The interaction with a practitioner plays a large role in influencing how safe and believed the woman feels, and the extent to which they are able to then disclose the extent of violence they are facing. Healthcare providers may unintentionally reinforce harm through judgmental attitudes, minimization of the woman’s symptoms or experience, and through culturally insensitive responses (Baloch et al., 2025; Merken et al., 2023; Toccalino et al, 2024; Barrett & Pierre, 2011; Allen-Leap et al., 2022; Tsai, 2023). Baloch et al. (2025) further describes how women often feel blamed, dismissed, or misunderstood by practitioners leading them to avoid seeking care from them in the future. For instance, when a practitioner attaches reproductive or mental health concerns a client brings up to cultural assumptions rather than violent or abusive behavior, thus creating an additional barrier for a woman navigating a complex and traumatic situation. Furthermore, trans immigrant women face additional discrimination and exclusion when navigating various support systems, including healthcare. Merken et al. (2023) documents experiences of transphobia, misgendering, and inequitable treatment within shelters, when interacting with police and healthcare spaces. Therefore, while healthcare settings must work to create safer and more accessible environments for survivors, attention must also be given to the informal and formal supports immigrant women seek out when healthcare feels unsafe. These interventions provide critical support and offer models that healthcare providers can learn from or refer clients to, ensuring survivors receive appropriate and meaningful care.

Despite systemic challenges and barriers, immigrant women demonstrate determination, strength and agency in seeking support. Barrett (2011) points out that though most survivors use at least one formal or informal support, immigrant and racialized women are less likely to access formal services because of structural, cultural and practitioner level barriers. Furthermore, Allen-Leap et al. (2022), emphasize that trusting and empathetic relationships with healthcare providers can support clients in disclosing even when women are feeling a shame, fearing deportation or child welfare involvement. On the other hand, community-based organizations play an equally important role in clients feeling supported in a holistic manner. Raynayake et al. (2022) mention the crucial role of immigrant serving agencies acting as mediators, advocates, and system navigators in women understanding their rights, coordinating medical appointments, and accessing other essential services or funding. Moreover, these agencies support clients facing language, cultural barriers along with system navigation (Tsai & Ghahari, 2023; Kalich, 2015). However, these supports are often constrained by limited funding, high caseloads, and precarious organizational structures (Ratnayake et al., 2022). The ability of immigrant survivors of IPV to access timely and appropriate care highly depends not only on the client’s own strength but also on the ability of service providers to practice cultural humility and offer violence and trauma informed care.

Application to Social Work

For social workers, supporting immigrant clients facing IPV within a healthcare setting have direct implications on their practice. As mentioned earlier by Tastsoglou (2025), the documented physical, psychological and reproductive consequences of violence, which are often worsened due to migration related stress and isolation, require social workers to bring in their trauma and violence informed approaches that emphasize client’s dignity, autonomy and right to safety. This further aligns with the social work code of ethics which calls on social workers to uphold individuals’ rights to self-determination and freedom from violence (CASW, 2024). As IPV related TBI is frequently misdiagnosed or undetected (Toccalino et al., 2024), social workers can bring this factor to the case consultations to ensure medical practitioners have performed an appropriate screening process to rule it out. Social workers can also remain attentive to any cognitive and emotional symptoms that survivors may struggle to articulate due to language or cultural barriers – sometimes it can be helpful to say the awkward thing out loud to ensure it has been addressed rather than have it go unnoticed. In doing so, a social worker would be acting in accordance to CASW (2024, Value 7) which requires providing accurate and culturally safe assessments to offer a competent service to clients.

Social workers also have a duty to address practitioner level barriers that clients may face, including judgement, minimization of client experience or culturally inappropriate responses, which often result in survivors feeling silenced (Baloch et al., 2025; Allen-Leap et al., 2022). While social workers may not be able to have direct conversations with medical practitioners to encourage them to change their harmful behavior, through offering non-judgmental, violence and trauma informed care which is rooted in respect and curiosity; clients can feel heard and validated about their experiences of violence. For system navigation support, social workers can help reduce barriers by ensuring access to interpreters, facilitating informed consent, explaining medical information, and coordinating appropriate culturally responsive referrals. In addition, social workers can offer clear information about client’s legal rights and help clarify any immigration related misinformation client may have received from the abusive party.

Finally, as the social work profession values collaboration and is rooted in building a client’s network, practitioners can collaborate with community-based organizations to help fill in any gaps the client’s needs. For example, immigrant serving agencies provide culturally grounded support, advocacy, translation and interpretation services along with one-on-one supportive counselling services or support groups in various languages. Social workers can strengthen a client’s social determinants of health while providing support that is often out of the scope of many health care settings.

Conclusion

Ultimately, the experiences of immigrant women impacted by IPV and navigating healthcare reveal profound systemic challenges and gaps that social worker are uniquely positioned to help address. Through slowing down the conversation, creating space for the client to share her story and responding with respect and empathy, social workers can foster a collaborative environment that prioritizes safety, dignity and trust.

Community Resources - Family Violence/Intimate Partner Violence (Canada Specific)

Advocacy, Education and Training:

• BCSTH (BC Society of Transition Houses)
• Coercive Control (English and French Resources)
• EVA BC (Ending Violence Association of BC)

Frontline Support and or Transition Housing:

• BWSS (Battered Women's Support Service)
• MOSAIC - (Settlement Agency, Violence Prevention and Support Program)
• NISA Foundation (Transition Housing, Emotional Support etc)
• Options Community Services (Transition Housing)
• VLMFSS (Multicultural Family Support Services)
• YWCA (Transition Housing, Support Groups, Legal Support etc)

Legal Support:

• Immigration and Refugee Legal Clinic
• RISE Women's Legal Centre
• South Asian Legal Clinic
• Migrant Workers Center BC

Other Trauma Informed, Women Centred Resources:

• Dress for Success - (Employment Workshops, Clothing)

References

Allen-Leap, M., Hooker, L., Wild, K., Wilson, I. M., Pokharel, B., & Taft, A. (2022). Seeking help from Primary Health-Care Providers in High-Income Countries: A scoping review of the experiences of migrant and refugee survivors of domestic violence. Trauma Violence & Abuse, 24(5), 3715–3731. https://doi.org/10.1177/15248380221137664

Baloch, S., McLindon, E., Hameed, M., & Hegarty, K. (2025). South Asian women’s lived experiences of health care after disclosure of family violence: a qualitative meta-synthesis review. BMC Public Health, 25(1), 445. https://doi.org/10.1186/s12889-025-21619-5

Barrett, B. J., & St Pierre, M. (2011). Variations in women’s help seeking in response to intimate partner violence: findings from a Canadian Population-Based study. Violence Against Women, 17(1), 47–70. https://doi.org/10.1177/1077801210394273

CASW. (2024). Core social work values and guiding principles. https://www.caswacts.ca/files/attachements/CASW_Code_of_Ethics_2024_One_Pager.pdf

Government of Canada. (2025). Temporary health care coverage: What is covered. Canada.ca. https://www.canada.ca/en/immigration-refugees-citizenship/services/refugees/help-within-canada/health-care/interim-federal-health-program/coverage-summary.html

Kalich, A., Heinemann, L., & Ghahari, S. (2015). A scoping review of immigrant experience of health care access barriers in Canada. Journal of Immigrant and Minority Health, 18(3), 697–709. https://doi.org/10.1007/s10903-015-0237-6

Khanlou, N., Haque, N., Skinner, A., Mantini, A., & Landy, C. K. (2017). Scoping Review on Maternal Health among Immigrant and Refugee Women in Canada: Prenatal, Intrapartum, and Postnatal Care. Journal of Pregnancy, 2017, 1–14. https://doi.org/10.1155/2017/8783294

Merken, S., Slakoff, D. C., Aujla, W., & Moton, L. (2023). Navigating Biases and Distrust of Systems: American and Canadian Intimate Partner Violence Service Providers’ Experiences with Trans and Immigrant Women Clients. Victims & Offenders, 18(1), 141–168. https://doi.org/10.1080/15564886.2022.2136319

Ratnayake, A., Sayfi, S., Veronis, L., Torres, S., Baek, S., & Pottie, K. (2022). How are Non-Medical Settlement Service Organizations supporting access to healthcare and mental health services for immigrants: a scoping review. International Journal of Environmental Research and Public Health, 19(6), 3616. https://doi.org/10.3390/ijerph19063616

Tastsoglou, E. (2025). Gender-Based Violence in a Migration Context: Health Impacts and Barriers to Healthcare Access and Help Seeking for Migrant and Refugee Women in Canada. Societies, 15(3), 68. https://doi.org/10.3390/soc15030068

Toccalino, D., Haag, H., Nalder, E., Chan, V., Moore, A., Wickens, C. M., & Colantonio, A. (2024). “Using the right tools and addressing the right issue”: A qualitative exploration to support better care for intimate partner violence, brain injury, and mental health. https://doi.org/10.1371/journal.pone.0311852

Tsai, P., & Ghahari, S. (2023). Immigrants’ experience of health care access in Canada: a recent scoping review. Journal of Immigrant and Minority Health, 25(3), 712–727.https://doi.org/10.1007/s10903-023-01461-w