Sexual and Reproductive Health Experiences of International Students Studying in Universities of Western Countries

A Critical Literature Review

Authors

DOI:

https://doi.org/10.32674/jis.v14i3.6011

Keywords:

international students, sexual and reproductive health, sexual taboo, sexual wellness, Western universities

Abstract

Engaging in sexual relationships is part of adulthood, but doing so in a foreign country can be risky because unsafe sexual experiences can have severe consequences for international students. This review explored sexual and reproductive health (SRH) experiences and needs of international university students in Western countries to identify challenges and gaps and to discuss critical SRH interventions. Four databases (Scopus, Embase, Web of Science, and PubMed) were searched for peer-reviewed journal articles published between 2000 and 2023. After screening 1607 articles, 10 met the inclusion criteria. Results of the review showed that many international students lack comprehensive knowledge about sexual health and sexually transmitted infections. They often obtain SRH information from informal sources, face language barriers, and experience difficulties navigating the healthcare systems of their host countries. University sexual wellness programs should examine how cultural orientations impact the sexual health of international students and provide culturally appropriate SRH interventions.

Author Biographies

  • Dr. Abukari Kwame, University of Saskatchewan

    Abukari Kwame, BA, MPhil, MPhil, PhD, is a postdoc and interdisciplinary researcher in the College of Nursing, Prince Albert (PA) campus, University of Saskatchewan (Usask). His major research interests lie in the areas of patient-centred care and communication, health communication, medical anthropology, language acquisition, and Indigenous research. Email: abukarikwames@yahoo.com /abk384@usask.ca

  • Dr. Hua Li, College of Nursing, University of Saskatchewan

    Hua Li, RN, BSN, MPH, PhD, is an Assistant Professor and a faculty of the College of Nursing, Usask. Her major research interests lie in the areas of mental health and addiction, maternal and child health, immigrant health, and participatory community-based research. Email: hua.li@usask.ca

  • Professor Pammla M. Petrucka, College of Nursing, University of Saskatchewan

    Pammla M. Petrucka, RN, MN, PhD, is Professor and a faculty of the College of Nursing, Regina campus, Usask. Her research interests lie in the areas of global health, maternal health, Indigenous Peoples’ health, participatory diagramming, and participatory community-based research. Email: pammla.petrucka@usask.ca

  • Dr. Geoffrey Maina, College of Nursing, University of Saskatchewan

    Geoffrey Maina, RN, BScN, MN, PhD, is an Associate Professor and a faculty member in the College of Nursing, PA campus, Usask. His major research interests lie in the areas of participatory and community-based research, HIV/AIDS prevention, mental health, and substance use and addiction. Email: Geoffrey.maina@usask.ca

References

Abu Rabiu, H. M. (2017). Undergraduate Arab international students adjustment to US universities. International Journal of Higher Education, 6(1), 131-139. doi:10.5430/ijhe.v6n1p131

Baek, Y., Akbar, H., & Baguley, G. (2012). Relationships and sexual health promotion project for QUT. In S. M. Chang (Ed.), In 23rd ISANA International Education Association Conference Proceedings (pp. 1-13). Auckland, New Zealand.: ISANA International EducationAssociation Inc. https://eprints.qut.edu.au/55039/1/55039P.pdf.

Belcastro, P. A. (2018). Examining the sexual enigma of the immigrant paradox with international students. Journal of International Students, 8(4), 1783-1814. https://doi.org/10.5281/zenodo.1469857

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806

Bunner, K. E. (2015). A global snapshot of sexual health education: Insights from international students at BGSU [MA Thesis, Bowling Green State University]

Burchard, A., Laurence, C., & Stocks, N. (2011). Female international students and sexual health: A qualitative study into knowledge, beliefs, and attitudes. Australian Family Physician, 40(10), 817-820. https://www.racgp.org.au/getattachment/389f5fd3-e164-437e-a159-351f96a2d91c/Female-international-students-and-sexual-health.aspx

Cassidy, C., Bishop, A., Steenbeek, A., Langille, D., Martin-Misener, R., & Curran, J. (2018). Barriers and enablers to sexual health service use among university students: A qualitative descriptive study using the Theoretical Domains Framework and COM-B model. BMC Health Services Research, 18(581). https://doi.org/10.1186/s12913-018-3379-0

Chadwick, K. A., & Collins, P. A. (2015). Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis. Social Science & Medicine, 128, 220-230. https://doi.org/10.1016/j.socscimed.2015.01.036

Abu Rabiu, H. M. (2017). Undergraduate Arab international students adjustment to US universities. International Journal of Higher Education, 6(1), 131-139. doi:10.5430/ijhe.v6n1p131 DOI: https://doi.org/10.5430/ijhe.v6n1p131

Baek, Y., Akbar, H., & Baguley, G. (2012). Relationships and sexual health promotion project for QUT. In S. M. Chang (Ed.), In 23rd ISANA International Education Association Conference Proceedings (pp. 1-13). Auckland, New Zealand.: ISANA International Education Association Inc. https://eprints.qut.edu.au/55039/1/55039P.pdf

Belcastro, P. A. (2018). Examining the sexual enigma of the immigrant paradox with international students. Journal of International Students, 8(4), 1783-1814. https://doi.org/10.5281/zenodo.1469857 DOI: https://doi.org/10.32674/jis.v8i4.231

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806 DOI: https://doi.org/10.1080/2159676X.2019.1628806

Bunner, K. E. (2015). A global snapshot of sexual health education: Insights from international students at BGSU [MA Thesis, Bowling Green State University]

Burchard, A., Laurence, C., & Stocks, N. (2011). Female international students and sexual health: A qualitative study into knowledge, beliefs, and attitudes. Australian Family Physician, 40(10), 817-820. https://www.racgp.org.au/getattachment/389f5fd3-e164-437e-a159-351f96a2d91c/Female-international-students-and-sexual-health.aspx

Cassidy, C., Bishop, A., Steenbeek, A., Langille, D., Martin-Misener, R., & Curran, J. (2018). Barriers and enablers to sexual health service use among university students: A qualitative descriptive study using the Theoretical Domains Framework and COM-B model. BMC Health Services Research, 18(581). https://doi.org/10.1186/s12913-018-3379-0 DOI: https://doi.org/10.1186/s12913-018-3379-0

Chadwick, K. A., & Collins, P. A. (2015). Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis. Social Science & Medicine, 128, 220-230. https://doi.org/10.1016/j.socscimed.2015.01.036 DOI: https://doi.org/10.1016/j.socscimed.2015.01.036

Chaliawala, K. S. (2021`). Sexual health knowledge, attitudes, and behaviours amongst South-Asian international students at the University of Central Oklahoma [Master's Thesis, University of Central Oklahoma].

Chang, S., Kuang, P., & Trumpour, S. (2022). A qualitative study of international students' sexual health information behavior: The case of Chinese men who have sex with men. Transitions: Journal of Transient Migration, 99-118. https://doi.org/10.1386/TJTM_00045_1 DOI: https://doi.org/10.1386/tjtm_00045_1

Chen, H., Blakkarly, J., & McKenny, L. (March 2018). The sex education gap haunts Australia's international students. SBS News. https://www.sbs.com.au/news/article/sex-education-gap-haunts-australias-international-students/ibp7qvfyb

Crossman, E., Choi, Y., Lu, Y., & Hou, F. (2022). International students as sources of labour supply: A summary of recent trends. Statistics Canada. https://doi.org/10.25318/36280001202200300001-eng

Douglass, C. H., Qin, C., Martin, F., Xiao, Y., El-Hayek, C., & Lim, M. S. C. (2020). Comparing sexual behaviours and knowledge between domestic students and Chinese international students in Australia: Findings from two cross-sectional studies. International Journal of STD & AIDS, 31(8), 781-790. https://doi.org/10.1177/0956462420921726 DOI: https://doi.org/10.1177/0956462420921726

Du, H., & Li, X. (2015). Acculturation and HIV-related sexual behaviours among international migrants: A systematic review and meta-analysis. Health Psychology Review, 9(1), 103-122. DOI: https://doi.org/10.1080/17437199.2013.840952

Esagoff, A., Cohen, S. A., Chang, G., Equils, O., & van Orman, S. (2022). Human papillomavirus and Chinese international students in the United States: Attitudes, knowledge, vaccination trends, healthcare behaviors, and sexual activity. Human Vaccines & Immunotherapeutics, 18(1), 1882283. https://doi.org/10.1080/21645515.2021.1882283 DOI: https://doi.org/10.1080/21645515.2021.1882283

Gamanya, T. (2021). Analysis of international students' health determinants in Australia [MPH Thesis, The University of South Africa]. https://uir.unisa.ac.za/bitstream/handle/10500/28959/dissertation_gamanya_t.pdf?sequence=1&isAllowed=y

Gao, H., Okoror, T. A., & Hyner, G. C. (2016). Focus group study of Chinese international students’ knowledge and beliefs about HPV vaccination before and after reading an informational pamphlet about Gardasil. Journal of Immigrant and Minority Health, 18, 1085-1092. https://doi.org/10.1007/s10903-016-0349-7 DOI: https://doi.org/10.1007/s10903-016-0349-7

Garrod, M., Vafaei, A., & Martin, L. (2020). The link between difficulty in accessing healthcare and health status in a Canadian context. Health Services Insights, 13, 1178632920977904. https://doi.org/Artn117863292097790410.1177/1178632920977904 DOI: https://doi.org/10.1177/1178632920977904

Glass, C. R., & Cruz, N. I. (2023). Moving towards multipolarity: Shifts in the core-periphery structure of international student mobility and world ranking. Higher Education, 85, 415-435. https://doi.org/10.1007/s10734-002-00841-9 DOI: https://doi.org/10.1007/s10734-022-00841-9

Griese, L., Berens, E.-M., Nowak, P., Pelikan, J. M., & Schaeffer, D. (2020). Challenges in navigating the health care system: Development of an instrument measuring navigation health literacy. International Journal of Environmental Research and Public Health, 17(16), 5731. https://doi.org/10.3390/ijerph17165731 DOI: https://doi.org/10.3390/ijerph17165731

Hutcheson, S. (2020). Sexual violence, representation, and racialized identities: Implications for international students. Education & Law Journal, 29(2), 191-221.

Lim, M. S. Y., Hocking, J. S., Sanci, L., & Temple-Smith, M. (2022). A systematic review of international students’ sexual health knowledge, behaviours, and attitudes. Sexual Health, 19(1), 1-16. https://doi.org/10.1071/SH21073 DOI: https://doi.org/10.1071/SH21073

MacPhail, C., & Stratten, M. (2022). Sexual health in a new cultural context: A resource for international students in regional Australia. Health Promotion International, 1-11. https://doi.org/10.1093/heapro/daab212 DOI: https://doi.org/10.1093/heapro/daab212

Martins, S. L., Hellerstedt, W. L., Bowman, S. B., Brady, S. S., & Mason, S. M. (2020). International travel as a context for sexual and contraceptive behaviors: A qualitative study of young women traveling outside the U.S. Archives of Sexual Behavior, 49, 1039-1052. https://doi.org/10.1007/s10508-019-1400-2 DOI: https://doi.org/10.1007/s10508-019-1400-2

Meherali, S., Louie-Poon, S., Idrees, S., Kauser, S., Scott, S., Salami, B., Valliantos, H., Meherali, K. M., Patel, K., Suthar, P., Akbarzada, Z., Marcus, I., Khangura, M., & Mangat, A. (2020). Understanding the sexual and reproductive health needs of immigrant adolescents in Canada: A qualitative study. Frontiers in Reproductive Health, 4:940979. doi:10.3389/frph.2022.940979 DOI: https://doi.org/10.3389/frph.2022.940979

Migration Data Portal. (2023, March 3). International students. Retrieved from Migration Data Portal: https://www.migrationdataportal.org/themes/international-students

Mundie, A., Lazarou, M., Mullens, A. B., Gu, Z., & Dean, J. A. (2021). Sexual and reproductive health knowledge, attitudes and behaviours of Chinese international students studying abroad (in Australia, the UK and the US): A scoping review. Sexual Health, 18(4), 294-302. https://doi.org/10.1071/SH21044 DOI: https://doi.org/10.1071/SH21044

Okeke, S. R. (2021). How perceived Australian sexual norms shape sexual practices of East Asian and sub-Saharan African international students in Sydney. BMC Public Health, 21(395). https://doi.org/10.1186/s12889-021-10445-0 DOI: https://doi.org/10.1186/s12889-021-10445-0

Okeke, S. R. (2022a). “I always prefer to withdraw than use a condom”: Condomless sex among East Asian and sub-Saharan African international students in Sydney. BMC Public Health volume, 22(2168). https://doi.org/10.1186/s12889-022-14512-y DOI: https://doi.org/10.21203/rs.3.rs-868421/v1

Okeke, S. R. (2022b). “It was protected, except, it wasn’t [with] a condom": a mixed-methods study of BBVs/STIs protective practices among international university students in Sydney, Australia. Archives of Public Health, 80(20). https://doi.org/10.1186/s13690-021-00777-z DOI: https://doi.org/10.21203/rs.3.rs-1920293/v1

Organization for Economic Co-operation and Development (OECD). (2022). International students: A growing group of migrants in the OECD. OECD. https://www.oecd-ilibrary.org/sites/ec0742a4-en/index.html?itemId=/content/component/ec0742a4-en

Parker, A., Harris, P., & Haire, B. (2020). International students’ views on sexual health: A qualitative study at an Australian university. Sexual Health, 17, 231-238. https://doi.org/10.1071/SH19209 DOI: https://doi.org/10.1071/SH19209

Pedersen, E. R., D’Amico, E. J., LaBrie, J. W., Klein, D. J., Farris, C., & Griffin, B. A. (2020). Alcohol and sexual risk among American college students studying abroad. Prevention Science, 21, 926-936. https://doi.org/10.1007/s11121-020-01149-9 DOI: https://doi.org/10.1007/s11121-020-01149-9

Poljski, C., Quiazon, R., & Tran, C. (2015). Ensuring rights: Improving access to sexual and reproductive health services for female international students in Australia. Journal of International Students, 4(2), 150-163. DOI: https://doi.org/10.32674/jis.v4i2.475

Roesch, C. G., Alldred, P., Brady, G., Siebert, P., Burns, F. (2022). Sexual and reproductive health of international students in the UK: Access and inequality. Sexually Transmitted Infections, 98(Suppl 1). http://dx.doi.org.cyber.usask.ca/10.1136/sextrans-BASHH-2022.149 DOI: https://doi.org/10.1136/sextrans-BASHH-2022.149

Ryan, R., Dowler, B., Bruce, S., Gamage, S., & Morris, A. (2016). The well-being of international students in the city of Sydney. University of Technology Sydney, Institute for Public Policy and Governance.

Todorova, M. S., Brooks, H. H., Persaud, R. S., & Moorhouse, E. A. (2022). Sexual violence prevention and international students in Canadian universities: Misalignments, gaps, and ways forward. Comparative and International Education/Éducation comparée et internationale, 50(2), 33-50. https://doi.org/10.5206/cieeci.v50i2.14250 DOI: https://doi.org/10.5206/cieeci.v50i2.14250

Top International Managers in Engineering (TIME). (2021). International student mobility report. Secretary General - T.I.M.E. Association. https://timeassociation.org/wp-content/uploads/2021/10/TIME_Association_International_Mobility_Report.pdf

Wang, S. (2022). Migrant allies and sexual remittances: How international students change the sexual attitudes of those who remain behind. Sociological Perspectives, 65(2), 328-349. https://doi.org/10.1177/0731121421992801 DOI: https://doi.org/10.1177/0731121421992801

World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health, 28-31 January 2002. Geneva, WHO.

Yang, N., Xu, Y., Chen, X., Yu, B., Yan, H., & Li, S. (2018). Acculturative stress, poor mental health and condom-use intention among international students in China. Health Education Journal, 77(2), 142-155. https://doi.org/10.1177/0017896917739443 DOI: https://doi.org/10.1177/0017896917739443

Zhang, X., Rhoads, N., Rangel, M. G., Hovell, M. F., Magis-Rodriguez, C., Sipan, C. L. et al. (2017). Understanding the impact of migration on HIV risk: An analysis of Mexican migrants' sexual practices, partners, and contexts by migration phase. AIDS and Behavior, 21(3), 935-948. http://dx.doi.org/10.1007/s10461-016-1622-4 DOI: https://doi.org/10.1007/s10461-016-1622-4

Zhou, Q., Wu, W., Yi, M., Shen, Y., Goldsamt, L., Alkhatib, A., Jiang, W., & Li, X. (2022). HIV knowledge, sexual practices, condom use and its associated factors among international students in one province of China: A cross-sectional study. BMJ Open, 12(e058108). https://doi.org/10.1136/bmjopen-2021-058108 DOI: https://doi.org/10.1136/bmjopen-2021-058108

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Published

2023-08-24

How to Cite

Sexual and Reproductive Health Experiences of International Students Studying in Universities of Western Countries: A Critical Literature Review. (2023). Journal of International Students, 14(1), 248-268. https://doi.org/10.32674/jis.v14i3.6011