Bridging the Silence: Monash Researcher Sethini Wickramasinghe Explores South Asian Women’s Access to Family Planning in Australia
When Monash University PhD candidate Sethini began exploring the gaps in reproductive healthcare for migrant women, she discovered an uncomfortable truth—one of Australia’s largest and fastest-growing migrant groups remains underrepresented in research on contraception and family planning.
Women born in India, Nepal, Pakistan, and Sri Lanka now make up a large share of Australia’s South Asian diaspora, many of whom migrate during their reproductive years. Yet few studies have investigated how they navigate the country’s healthcare system when it comes to contraception. “Women who have migrated to Australia from South Asia are one of the largest migrant groups in the country, with many women migrating during their reproductive age,” says Sethini. “The research in Australia suggests that migrant and refugee women have lower uptake of contraception and experience more barriers when accessing sexual and reproductive healthcare compared to women born in Australia. Therefore, it is important to me to find out about the needs, preferences and experiences of South Asian women when accessing contraception information and care in Australia to understand how service delivery could better meet their needs.”
Her research, undertaken through the Global and Women’s Health Unit at Monash University, is part of a broader PhD project examining both the structural and cultural barriers that affect how South Asian women access contraception. It involves two main studies: an anonymous online survey and a qualitative interview component. Both have received ethics approval from the Monash University Human Research Ethics Committee.
For Sethini, the project grew from noticing how often South Asian women’s experiences were generalised or absent in data. “I was drawn to this research after reading and observing the limited research that captured the experiences of women from South Asia when accessing sexual and reproductive healthcare including contraception in Australia,” she explains. “It is only in the last 10 years that South Asian migrant populations have become a larger and continuously growing migrant population in Australia. This could be a reason this group of people may be underrepresented in the current literature.”
Her work comes at a time when Australia’s migrant profile is changing. According to the latest Census, the number of people born in India has more than tripled since 2006, with women forming a strong part of the inflow. This demographic shift has implications for public health services, yet research has lagged behind.
Navigating silence and stigma
Across the interviews and literature reviewed so far, cultural and structural challenges emerge in equal measure. “Our review of the existing literature of South Asian women in high-income, English-speaking countries is currently under review,” says Sethini. “Nearly all studies were conducted in the UK, and one was in the US. They all reported several barriers that South Asian women faced when accessing care. The obstacles reported in the reviewed studies included a lack of information or education about contraception, pressure from family members to have children, English-language barriers and concerns of maintaining one’s confidentiality during consultations.”
The sensitivity of discussing sexual and reproductive health, especially contraception, is heightened for unmarried women. In many South Asian communities, conversations around sexual health are closely tied to notions of modesty and family honour. “The studies also reported sensitivity discussing sexual and reproductive healthcare, particularly contraception and how these sensitivities were exacerbated for unmarried, South Asian women,” she says.
One of the early insights from her research is that even within the South Asian community, there are varied experiences shaped by language, faith, and family expectations. “We have received some feedback from the community that research about contraception or family planning access for unmarried women may be viewed as inappropriate or not relevant,” she says. “We have experienced engagement in this research by both married and unmarried South Asian women. We continue to seek the participation and the opinions of both groups of South Asian women in this research as they provide insights into whether their experiences and needs when accessing contraception are different.”
While stigma plays a role, so too does the healthcare system itself. Sethini points out that both structural and cultural factors influence how women make choices about family planning. “The influence of structural level factors from the healthcare system as well as individual and community level factors such as culturally informed beliefs are both important aspects we are seeking to investigate in our studies,” she says. “By doing this, we hope to investigate which factors influence access to contraception and to what extent they do so.”
The survey, which can be completed anonymously in about 15–20 minutes, asks participants about their awareness, affordability, and access to information, while also exploring how cultural beliefs may influence contraception decisions. “Culturally informed opinions and beliefs are also an influential component in people’s contraception decision making process,” she says. “The survey asks participants about the possible influence of their cultural beliefs on their access to contraception.”
Between culture and care
For many women, choosing contraception is not just a personal health decision—it’s often negotiated through layers of cultural expectation and family influence. “The balance between choosing a contraception option that aligns with one’s needs and culturally informed expectations is a key finding from our review of literature,” says Sethini. “The studies we reviewed found that contraception may not be acceptable for some unmarried women and that family members may have expectations for women to have children soon after marriage.”
Her research aims to find out if those same pressures exist among women living in Australia, where they encounter a very different healthcare culture. “We would like to see if these expectations are also experienced by South Asian migrant women in Australia. In particular, the interviews with women will provide an opportunity for women to share their experiences and details about the nuances of possible cultural expectations and if they act as barriers in accessing contraception that best suits their circumstances.”
General practitioners, nurses, and midwives play an important role in this conversation, especially as the first point of contact for contraception advice and services. Yet gaps in understanding cultural sensitivity can create unintentional barriers. “Healthcare providers, particularly those working in primary care settings, such as general practitioners, nurses and midwives, play a crucial role in the delivery of contraception care,” she explains. “They are the most common point of contact for individuals when accessing contraception care and options. Therefore, we hope to interview South Asian women who have accessed contraception care in Australia to understand if they have accessed care through a healthcare provider and if not, why.”
The findings will inform a future study involving healthcare providers themselves, aiming to build a bridge between cultural understanding and clinical practice. “We want to hear more about their experiences on the barriers and enablers to their experiences with a healthcare provider,” she says. “These findings, alongside the findings from the survey, will help us design a study to interview healthcare providers on how they can be better supported to address any barriers expressed by South Asian women in primary healthcare settings.”
At Monash’s Global and Women’s Health Unit, such projects feed into broader conversations about equity in healthcare access. “Ultimately, the findings from this research can contribute to the existing body of literature on the experiences of migrant populations accessing contraception care in Australia,” says Sethini. “We hope they can provide more nuanced findings into the specific experiences of South Asian migrant populations.”
Her team’s aim is to move beyond identifying barriers and towards improving how care is delivered. “The results from each of the PhD study components will help us better understand how to proceed in applying the findings to inform recommendations for contraception service delivery in primary healthcare settings.”
The project also spans generations, seeking perspectives from women aged 18 to 49. “By inviting participation from a range of ages, we hope to answer the question on whether there are differences in the contraception needs, methods used and barriers experienced by South Asian women from different age groups,” she explains.
When the research is complete, it will form one of the most detailed studies of its kind in Australia, mapping the experiences of South Asian women across a variety of settings. But Sethini’s ambitions don’t end with data collection. “Once this research is complete we will have both quantitative and qualitative data on the barriers and facilitators of South Asian women when accessing contraception information and care as well as their experiences of accessing care through a primary healthcare provider,” she says. “We will then use this information to interview primary healthcare providers to understand how they can be better supported to address any barriers expressed by women during healthcare consultations.”
She also wants the findings to reach the community in a way that benefits those who participated. “We hope to hear suggestions from South Asian women on ways to share the findings from our studies with the community in a way that benefits them the most.”
For Sethini, this work is as much about representation as it is about reform. By amplifying the voices of women whose experiences have long been missing from Australia’s health research, she hopes to help shape a system that listens more closely and serves more fairly.
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