Professor Jane Ussher said cultural and religious beliefs were major barriers to new migrant women accessing sexual health services. Credit:Sally Tsoutas At first, her husband had blamed her for their sexual inadequacies. Once she'd gained a little knowledge and some semblance of sexual agency he punished her for it, she said. "As a woman, you are doomed either way," Ms Jaffar said. "On one side you're not supposed to know anything about sex because that means you might have tried it [before marriage]. On the other side they blame you because you don't know anything." Ms Jaffar was made to feel her own sexual desire was abhorrent, and her partner felt his own desires were a sign of weakness. "When I asked for sex, I was said to be a bitch and abused with words," she said of her now ex-husband.

"I was scared of him. If I ever was not obedient he would threaten to take my kids away. I was scared of being humiliated. "It was hell for 16 years." Ms Jaffar now supports migrant women as a case worker at the Community Migrant Resource Centre in Parramatta. Shame, secrecy, silence and fear were keeping many new migrant women in the dark about their own sexual and reproductive health, found a recent study published in the Archives of Sexual Behavior. Cultural and religious beliefs were major barriers to many women accessing health services, warned the researchers who held focus groups with 169 single, married, divorced and widowed women who arrived in Australia or Canada from Sudan, South Sudan, Somalia, Iraq, Afghanistan, Sri Lanka, India and Latin America within the past six years.

Migrant and refugee women had higher rates of sexual health problems, said lead researcher Professor Jane Ussher at Western Sydney University's Translational Health Research Institute. "Many of the women in the focus groups were not allowed to talk or even think about sex before marriage," said Professor Ussher of the study participants, who were aged between 18 to 70 years old and of various religions including Islam (66 per cent), Christianity (20 per cent), Hinduism (7 per cent), Sikhism (2 per cent), and Buddhism (1 per cent). A woman who spoke about sex was tarred as a "whore", "vulgar", or "not a good girl", several women told their focus groups. "Any knowledge that these women have about sexual health issues is often pieced together from female friends, relatives and the media," Professor Ussher said. Their wedding night was often a frightening experience; one Iraqi woman said: "I thought he was doing the wrong things, and I started screaming."

"After the first night, I felt like running back home to my mother," a Tamil woman said. Professor Ussher said there was "a lot of shame around sex and very little knowledge about sexual desire". "They either had no experienced desire or if they had they were not allowed to express it," she said. The exceptions were some Islamic women, whose beliefs dictated a husband must please his wife, but women were still not permitted to ask for sex. Pain and discomfort was a common complaint, but the women felt they could not tell their husbands or stop the encounters.

"I hurts every time," one Afghani woman said. A Sudanese participant said: "I have to keep quiet. In my culture it's shame to talk about this pain, it is considered a normal [part] of having sex." Many said they felt they had no consensual rights and couldn't say no "because God or the angel would punish them", Professor Ussher said. Several women said they were shocked and frightened when they got their first period, thinking they were sick, injured, or they were being punished for some unknown wrongdoing. "I thought I must have ripped something in my belly," one Afghani woman said.

A Somali woman said: "I couldn't look at my father and mother faces [sic]." Many women felt too ashamed to use contraception or feared the contraceptive pill would cause cancer or make them permanently infertile. They had very little knowledge about cervical cancer, or the need for cervical screening. Some believed a pap smear would affect their virginity, and the human papillomavirus vaccine was not considered important for young women. Most women had never heard of STIs except for HIV/AIDS and believed if they were faithful to their husbands they would be safe from infection.

Despite many participants reporting having had urinary tract and yeast infections, they avoided or put off seeing a doctor because they did not know they should and, instead, used home remedies or put their health in the hands of fate or God's will. Many women were too shy to seek out additional information, and there was a lot of fear around talking to health professionals and not knowing what they could offer. Sexual rebellion But several women had found ways to resist control and embrace their sexuality in subtle ways. When they were in the mood, they would put on perfume and acceptably alluring clothing, Professor Ussher said.

"They'd find ways to be more seductive to gain some control, instead of asking outright," she said. Others rebelled by educating their daughters about their sexual rights, learning about consent and finding their own sexual pleasure when they came to Australia. "One woman went along to her daughter's sex education class so she could learn and talk with her daughter afterwards," Professor Ussher said. The research showed a clear and immediate need for culturally safe medical care, health education, and health promotion for new migrant women and to increase capacity to access sexual and reproductive services, Professor Ussher said, outlining several recommendations in an accompanying report. "It's also about involving the partner or husband so they are involved in the discussion, not reinforcing patriarchal control but educating both men and women so couples can talk about these things together," Professor Ussher said.