Accompaniment in the Gender and Social Discrimination of Migrant Women Victims of Gender-Based Violence: From Bibliography to Situated Key in Burgos, Spain

: Migrant women who experience gender-based violence face a framework of social vulnerability that is compounded by their status as both women and migrants, requiring speci ﬁ c a tt ention in social support. The aim of this study is to understand the situation of women in the social and health access realm, drawing from scienti ﬁ c literature as well as the voices of migrant women and professionals who support them, in order to establish priority guidelines for social support. The study begins with a bibliographic analysis of scienti ﬁ c literature on migrant women who have experienced gender-based violence, which informs six interviews with migrant women and ﬁ ve professionals, delving into their social needs and support requirements. The most prominent results point to the need for sustained and interdisciplinary support throughout the process of accessing healthcare and legal services. In addition, there is a call for social awareness in understanding the speci ﬁ c and personal needs of migrant women. Finally, educational support is required to disman-tle patriarchal beliefs that legitimize gender discrimination and violence, avoiding re-victimization and acknowledging the multi-dimensional nature of women’s experiences.


Introduction
"Normally, no one has ever looked out for me, and I've spent my entire life looking after others. Now, I am worn out, with nowhere to sleep, and they tell me that the only choice I have is to keep caregiving for elderly individuals without a contract until they can attend to my needs at the police station, but that could take months...". (anonymous migrant woman, 2023) Violence against women is a widespread problem around the world, leading to gender inequality and discrimination. This problem is further compounded in the global migrant population, which exhibits higher prevalence rates of violence and faces greater difficulty accessing available resources, complicated by their administrative status (Retamozo and Monteros 2021). Being a woman and a migrant demands a particular analysis of the structural violence they experience. Violence becomes explicit in situations of physical, sexual, psychological, or economic violence (Fawole 2008). Although any situation that results in discrimination based on gender, ethnicity, or other factors constitutes a violation of human dignity and the principles of equal rights, the reality shows that the migrant status dilutes the perception of discrimination. Especially in communities with fewer socioeconomic resources, there is increased exposure to xenophobic situations and limited access to services (Chauvin et al. 2021). In this regard, it is noteworthy that high-level affluent migration is perceived more favorably by society (Rubin et al. 2008). Sociocultural stereotypes in the developed world about women and migrants position this demographic problematically (Agustín 2003). This includes reinforcing stereotypes about culture, education and social mobility. This does not support a closer understanding of the migrant women's lived experiences. For example, migrant women also face structural and political difficulties that include judicial neglect of gender-based violence and laborrelated discrimination. This crystallizes as institutional gender-based violence (Bodelón 2014).
In scientific research, the focus on women's role in migration has often emphasized male dominance and overlooked their own reasons for moving to new locations. These reasons include seeking a better life, economic opportunities, and the potential for social and professional advancement (Antman 2018;Boyd and Grieco 2003). Due to gender stereotypes, migrant women are often portrayed as taking on domestic and familial responsibilities, following the implicit guidance of men (Nuño Gómez and Álvarez Conde 2017).
When immigration laws become stricter, and borders are closed, individuals often turn to illegal networks that help them enter another country in exchange for money. However, this dangerous process can result in loss of life (UNODC 2021). Some female migrants are lured by promises of a better life and fall into networks of human trafficking, transported from one place to another, to be exploited either sexually or labor-wise in the destination country and held captive under threats against themselves or their family (Barbuzano et al. 2020). As for those who face risks of death in their own countries, the lack of knowledge about the bureaucracy and culture of the destination country also hinders effective application for international protection.
Being a woman and an immigrant increases vulnerability exponentially, and the chances of experiencing abuse multiply (Giannoni et al. 2016;De Rose et al. 2021). Indeed, the data reveals that in Spain, 33% of the fatalities due to gender-based violence between 2003 and 2019 were migrant women. While only 8% of the beneficiaries of assistance for gender-based violence were migrant women, highlighting an overrepresentation and social imbalance (Retamozo and Monteros 2021). In this regard, the migratory processes of women are associated with a complication in the possibilities of protection as victims of gender-based violence. In this sense, a more exhaustive analysis is needed that considers the psychological implications and the necessary sustained support over time, especially considering situations of silence as a coping strategy for episodes of violence experienced (Pocock et al. 2020).
Gender-based violence and discrimination are particularly prevalent among female migrants, who face additional challenges and vulnerabilities due to their status as immigrants. This study aims to analyze some of the main obstacles faced by migrant women, from their personal condition, considering the guidelines indicated by impactful bibliographic publications. The perspective of migrant women who have sought social support in Burgos (Spain) is incorporated to comprehend their unique needs and the professional implications of providing assistance.

Materials and Methods
The study consists of 2 phases of qualitative research: a systematic literature review, which facilitates a specific and rigorous approach to the object of study (de Dios et al. 2011), and a contrast from the emerging categories through interviews with 6 migrant women and a focus group with 5 professionals who accompany them: 3 social educators, 1 nurse and 1 lawyer. Finally, a restitution session in the field (Sabirón 2006) was included with the women who participated in the study, in which the included categories of analysis were presented, and the resulting keys for professional support were discussed.
The heterogeneity of migratory experiences and experiences of gender-based violence motivates an initial approach from a transnational analysis of the migratory phenomenon in women through the systematic review. Following this, and in consensus with the social support centers, the semi-structured interviews were constructed around different thematic areas to stimulate situated understanding in Burgos. The study was approved by the Bioethics Commission (IR 10/2022).

Bibliographic Analysis
Firstly, a global approach to gender-based violence in migrant women was carried out by searching the institutionalized databases Scopus and Web of Science (WOS) using the following terms: "gender discrimination" AND "Violence" AND "migrant". The results obtained on 24 January 2023 are presented in Table 1. A total of 8 articles were found in Scopus and 7 in WOS, of which 5 were repeated.

Scopus
Id. Web of Science Id. (Obach et al. 2022 7 (Obach et al. 2022). Repeated (Coovadia et al. 2009). 8 If the term 'migrant' was removed, that is, the search was specified in 'gender discrimination' AND 'violence,' there were 300 results in Web of Science, 37 of which correspond to 2022, and 319 in Scopus, 53 of which are from 2022, indicating an interest in the topic, but without a prioritized interest placing gender discrimination on migrant women. The global and cross-cutting nature of the topic is evidenced by an interdisciplinary interest, highlighting the volume of disciplines such as psychology, sociology, and social sciences.

Interviews and Focus Group
Interviews with 6 migrant women who use social services were planned to understand their personal needs for effective support and social inclusion. The 6 participants in the interviews were users of social support services and have been victims of genderbased violence. They voluntarily agreed to participate in the study under the monitoring of their respective social reference centers, which approved their participation and the interview motivations, ensuring their anonymity.
Semi-structured interviews were chosen in order to focus the conversation on the core areas of interest while not overlooking the comprehensive approach required to address the referential framework of migrant women (Kvale 2011). An initial space was respected in the interviews to build a communicative plan with the informants, starting with their everyday experiences of social support at the center (Jachyra et al. 2015). The interviewers were chosen from the interviewees' everyday acquaintances in order to enhance communication, credibility, and well-being while also ensuring the preservation of anonymity. This approach was adopted to establish a trusting environment during the interviews, allowing for a more open and candid exchange of information.
A group discussion was developed as a methodological strategy to stimulate shared reflexivity in contrast to the professionals who accompany the women (Barbour 2013). Specifically, 3 social educators, 1 nurse, and 1 lawyer are involved, all of whom are women. The professionals participated voluntarily in the focus group, with authorization from their workplace, and were familiar with the purpose of the study. Their involvement served as a valuable contrast to emphasize and/or define the needs of women based on their professional experiences and daily interactions with them.
The areas of interest for the interviews and the focus group were defined based on the preliminary categorization of the contributions from the systematic review. These categorizations helped to specify 3 contrasting areas: (1) the use of health services and coping mechanisms, (2) limitations in social development, and (3) beliefs about gender-based violence.
In a final restitution session in the field (Sabirón 2006), the results were presented to the participants at the center in Burgos: migrant women users and professionals. In this session, the categories of analysis were consolidated, and the keys for supporting migrant women in Burgos were developed, which are presented in the Conclusions.

Results
The results are presented based on the analysis of the defined areas of interest. Therefore, and according to the criterion of dependence (Sabirón 2006), the 10 analyzed articles are organized in Table 2. Three categories are consolidated from the readings of the bibliographic references: access and attention to health services, the invisibility of class and gender, and beliefs about gender-based violence. 1º Access and Attention to Health Services (Obach et al. 2022). (Coovadia et al. 2009). (Tantet et al. 2019). (Zerm 2018). 2º Invisibility of Class and Gender (Erazo 2022). (Añón 2010). (Izcara 2022). (Gangoli et al. 2020). 3º Beliefs about Gender-Based Violence (Izugbara et al. 2020). (Rocca and Zinn 2019).

Access and Attention to Health Services
Institutional gender-based violence is evidenced by administrative complications in accessing healthcare and the trivialization of the needs of migrant women, with certain correspondences existing between an international context and the experiences of the participants in Burgos. The prioritized support in health centers in countries like France does not benefit migrant women. Rather, it is oriented towards certain health centers that allow for psychological, gynecological, general medical, and sometimes sexological follow-up. The detection of violence should be systematically examined, requiring specific training in this area (Tantet et al. 2019). This contrasts with the defense mechanisms that a woman who has experienced complex migration may possess semi-unconsciously. These demands sustained and relevant psychological support to the complexity of the human situation. In Spain, the public health system covers immigrants, and there is a special emphasis on protecting women who are victims of gender or sexual violence. However, accessing medical coverage requires knowing and completing various administrative processes.
Nurse: "In order to access the healthcare system in Spain, the first requirement is to be registered as a resident, which takes about three months. This process also requires renting a house or a room. Sometimes there can be difficulties if the owner of the property doesn't want to register you or if they charge for it, but it's important to note that the process is completely free.
You won't be assigned a primary care physician until you have your health card. If someone has a critical health situation, they can go to the emergency room, but they will be charged for the service. To avoid payment, an administrative process needs to be followed. Referring someone to a specialist can be done through coordination and networking between social entities and healthcare services. However, there can be difficulties in obtaining a health card, such as when certain documentation, like a request for international protection, is not recognized by the administration." Coovadia et al. (2009, p. 817), from their study in South Africa, share that, in addition to the classic difficulties of ethnic and gender discrimination, labor systems, etc., access to and attention from the healthcare system is also vulnerable: "Pivotal facets of primary health care are not in place, and there is a substantial human resources crisis facing the health sector". This indicates that public resources do not address the depth of needs.
In this sense, beyond the evident physical trauma implied by situations of sexual violence, the impact on mental and somatic health extends to case management that is not thoroughly addressed and demands interdisciplinary, well-informed, preventive, and sustained attention (Tantet et al. 2019). However, reproductive and sexual health can trigger the decision to migrate. Obach et al. (2022) describe how young pregnant women, LGBTQI+ individuals, or those who are HIV-positive in Chile have been pushed to migrate in order to achieve a social context that reduces gender discrimination, highlighting the potential value of including the sexual dimension in health and societal prevention and support programs.
Social educator 1: "In some cultures, women still view homosexuality as a sickness or a deviant behavior. In fact, many are surprised to see how naturally same-sex couples are accepted in Spain. As for the transgender women we have worked with, all of whom are from Latin cultures, they have suffered traumas such as family rejection, sexual violence, and imprisonment. Because of this, Spain has become one of the chosen destinations for migration, not only because of the shared language but also because they can request international protection based on sexual orientation or gender identity." Female genital mutilation affects more than 200 million women worldwide and continues to expand every year. While countries such as Sudan, Somalia, and Egypt are the most prominent in terms of prevalence, the practice has spread to regions throughout the world, taking advantage of anonymity. This demands specific knowledge of the implications by healthcare, social, and educational specialists to achieve appropriate and respectful treatment at the destination, as well as proactive prevention. In this regard, awareness and information have increased in countries such as Germany, but they do not effectively address the needs of affected women, especially as cases continue to be reported worldwide (Zerm 2018).
Social educator 1: "During our work, we have assisted some women who have been victims of female genital mutilation. Not many, but some. This is because, in some cultures, this practice is considered to demonstrate the purity of women before marriage. Unfortunately, there are still scenes in the pornography industry that depict female genital mutilation. However, there is also a growing awareness in Spain regarding this issue. Those who have suffered or are at risk of female genital mutilation can now request international protection."

Invisibility of Class and Gender
Gender blindness obscures gender discriminatory practices in formation and occupational settings, legitimizing current situations of irregularity and/or precariousness. The situation of migrant women in Spain leads to forced social and labor exclusion, as the precariousness of their work in terms of wages and rights has become normalized. This systemic clandestine situation is a risk factor for gender-based violence, and it is common for women to be forced to live with their abusers in hopes of obtaining institutional benefits, such as a work permit (Añón 2010). Moreover, the need for survival and the vulnerability to which they are exposed leads them to accept jobs in the underground economy with longer working hours and lower pay than what the law establishes, which can result in situations of labor exploitation or servitude. The lack of documentation and fear of deportation prevents them from claiming their labor rights, leaving them in a state of defenselessness.
Social educator 2: "Accessing the job market can be challenging initially due to various factors. Firstly, getting academic qualifications recognized can be a long and expensive process, which leaves many women without education initially. Additionally, the available job options tend to be precarious and feminized, such as cleaners, hotel maids, domestic workers, or in the hospitality sector. One of the professions that has a significant number of immigrant women is domestic work. These women have fought for years to have their right to unemployment recognized, which was not acknowledged until the European Court of Justice ruled labor discrimination and forced Spain to address the situation." Women in irregular situations are forced to accept jobs in the private household sector as live-in help, which exposes them to situations of vulnerability and violation of their labor rights, such as salaries below those stipulated in agreements, deprivation of personal space, reduced rest times, increased workload, sexual harassment, threats, and coercion.

Migrant woman 1: "…even my friends have offered me opportunities to clean houses at night or do cleaning jobs in houses where drug dealing is going on, but later it turns out to be something else entirely. I know of jobs for a masseuse where you don't need an academic degree because it's something else entirely."
However, positive situations have been monitored by support and accompaniment centers for migrant women, where workspaces have been created where women can feel more valued.

Migrant woman 2: "The grandfather wouldn't start eating until I sat down with him at the table; I felt like part of the family."
This social withdrawal is evidenced by Gangoli et al. (2020) in the UK, highlighting the limitations of the social capital of migrant women to share their needs horizontally. This results in more limited access to justice on ethnic grounds. In this regard, they denounce that their justice system is still not sufficiently aware of ethnicity as a key indicator of inequality in the application of justice.
Lawer: "In general, all people, whether Spanish or immigrants, have access to justice, including free legal aid. However, the problem lies in the situation of irregularity in which women may find themselves. They may be afraid to access certain institutions such as the judicial system or law enforcement agencies, and one possible cause is the worldview they have of these institutions, as they come from countries where the entire system is corrupt, and there is no real guarantee of the law. In addition, for example, if they wanted to report a case of labor exploitation, they would need to provide evidence that proves the crime. However, they may still be in an irregular administrative situation in which they could be issued a deportation order." Gender differences have even been described in the process of forced migration. Izcara (2022) describes a scenario in which human traffickers use more aggressive coercion and deception methods on Latin American women than on men to initiate risky journeys into the United States. In both cases, deception is driven by demand, but in women, the interests of destination business owners are hidden and protected by the massiveness and clandestine nature of the sex trafficking industry, unlike in men, who can orient themselves towards tasks in the primary sector, such as agriculture. This migratory process is well-known and has become a classic on the North American border. Women's bodies are objectified, and they are constructed as consumer products, which transcends the reality portrayed in novels and artistic productions (Erazo 2022). This social reality for women can be further exacerbated when considering aspects related to race and social class. Social educator 3: "In patriarchal societies, women are subjected to objectification and sexualization as a means of controlling their sexuality. However, for migrant women, experiences of sexual violence are often influenced not only by gender oppression but also by factors such as race and social class. The majority of the women we work with report unpleasant situations in public spaces, such as being catcalled or receiving sexual comments. Some are even asked how much it would cost to have sex with them. When seeking employment as domestic workers, they are sometimes told that being "very affectionate" is part of the job description. In some cases, when advertising their services as house cleaners, they are directly offered money in exchange for sex."

Beliefs about Gender-Based Violence
Gender-based violence extends to the structuring of families, perpetuating gender stereotypes linked to the sexualization of women. Izugbara et al. (2020) delve into the perspective of refugee community workers in Kenya. They indicate that the incidence of gender-based violence can be addressed through three dimensions: (1) improving security, (2) increasing education, and (3) raising community awareness. This involves a collective reification in the meaning of certain traditions such as child marriage, beatings, or genital mutilation, but it also places a renewed focus on the masculine role of men, who may redirect their frustrations towards women.

Migrant woman 3: "I want to be left alone in a peaceful place to be, not to have my house keys taken away and to have my comings and goings controlled. I've already been trapped with my husband before."
Rocca and Zinn (2019) apply these patriarchal beliefs to Italy, pointing to honor and shame with respect to stereotyped gender roles as the idiosyncrasy of violence as a mechanism of intrafamily regulation. The capitalization of honor as a desirable value complicates socio-educational intervention, as it demands the cultural questioning of microsocial organization. Social educator 3: "As a professional, it's very sad when women ask me if they look like a prostitute or if the only option they have in Spain is to engage in prostitution. Personally, I warn them that these types of situations are very common because they are migrant women. I suppose this is because the other person believes they are in a position of power and impunity over them. Fortunately, with the Sexual Integrity Law, these acts are classified as sexual violence, and women must be protected regardless of their irregular status. Unfortunately, these behaviors are still normalized in the collective consciousness."

Discussion
The first category of analysis deals with access to and attention to healthcare. Access to healthcare is considered a right; however, reality shows that neither is there a preference for relevant care to personal needs nor is there sustained medical support over time that facilitates a patient-professional relationship (Tantet et al. 2019). Additionally, it is evident that certain bureaucratic formalities hinder the possibilities of healthcare for migrant women. This emphasizes the idea that human and specialized resources in public health are not sufficient to meet the needs (Coovadia et al. 2009) both in a global context and localized in Spain.
One of the most paradigmatic cases is female genital mutilation, as highlighted in the results. It is known to be present in Europe and stems from unfounded, aberrant, and patriarchal practices (Zerm 2018). Fortunately, there is a certain trend towards raising awareness to address this detected healthcare need, especially in the destination of some migrant women. In addition, as indicated by Obach et al. (2022), there are realities in which people within the LGBTQI+ community or pregnant women choose to migrate to destinations where healthcare policies are more accommodating. Although this attention is more sensitive to their needs, the results show that gender, race, and socioeconomic inequalities still exist. Furthermore, the optimization of healthcare must be accompanied by social education to eliminate practices that are based on absurd and illegal beliefs and vacuous social prejudices.
The second category of analysis addresses the invisibility of class and gender experienced by migrant women. The labor market continues to be a complex and elusive space to access. Illegality blurs the possibilities of addressing women's rights and can legitimize the power of abusive men (Añón 2010), as they may tolerate abusive working conditions in order to obtain some institutional recognition in the medium or long term.
In addition to preventing social withdrawal resulting from precarious employment (Gangoli et al. 2020), social and professional support centers can lead to the accompaniment to healthier and more reliable social and work environments. Despite this, it remains a reality that social need leads to acceptance of jobs in which women are invisibilized or objectified, which is compatible with the acceptance of deceit and coercion described by Izcara (2022) and Erazo (2022). Prostitution is one of the options offered by the underground labor market. The evidence of this reality should demand immediate attention to policies.
The perpetuation of precarious labor is due to situations in which women cannot prove the abuse of the employer. The judicial process can be tedious, although it may offer more guarantees than in the countries of origin of some of the women in the study. However, the expert accompaniment of specialized professionals is recommended, but it is not widespread, which suggests that access to justice may be limited due to ethnicity (Gangoli et al. 2020).
In the last category, beliefs about gender-based violence that continue to persist in current reality are analyzed. Patriarchal beliefs permeate the public and labor spheres. Although Europe may present a more advantageous situation for women compared to other geographic coordinates, there are still unacceptable grievances that violate human rights. The social invisibility of migrant women and their marginalization in preferential attention to their needs facilitate the perpetuation of a stereotyped social role of inferiority compared to men, as reported by Rocca and Zinn (2019). The results show that the political will to facilitate access to public services is insufficient if not complemented by other actions, such as those indicated by Izugbara et al. (2020), such as improving security, raising social awareness, and increasing preventative education for all. In other words, it is not only a matter of legislation but of preventative education that focuses on gender equality and the perpetuation of vacuous gender beliefs. This work shows that there is still much ground to cover and that the sexualization of women's bodies serves as a trigger for some of the situations that lead to gender-based violence.

Conclusions
Based on insights gained from readings in high-impact journals and the specific experiences of women informants in Burgos, we propose key transdisciplinary professional intervention strategies for this population. These conclusions emerged from shared reflection on the analysis of results and were consolidated through group discussions and a session for feedback to the field, including the five professionals.

Promoting Human Rights
The general framework of action cannot disregard respect for human dignity and freedom for autonomous decision-making. This implies support for personal capacity building and empowerment directed towards personal self-determination.

Positioning in Cultural Difference
Culture has always played a fundamental role in the analysis of gender-based violence. This culture has been understood within the generalized patriarchal social order and affects all women. It is considered a cross-cutting factor that is modulated according to the situated culture. Therefore, gender-based violence must be based on the framework of human rights but accompanied by the referential framework of the person and the culture that co-constructs their identity. In this scenario, the relevance of gender awareness and equality programs emerges.

Respecting the Singularity of Each Migration Process
Cultural, social, economic, structural, and conjunctural constraints affect personal motivations to undertake the migration process. Many circumstances converge on the generic distinction between voluntary or forced processes that must be addressed, understood, and respected at the moment and in the way they occur. The construction of personal identity is permeable to the consequences of the migration process.

Providing Information
It is indicated that social capital motivates access to justice. In a certain sense, this implies emotional support for addressing the complexity of the process being addressed. This can mean peer support in which experiences and lessons learned are exchanged. While it demands professionals not only to display qualities of empathy and cordiality but also to adapt the support to the possibilities offered by the environment, specific training in the disciplinary field is, therefore, a professional responsibility.

Fostering Empowerment
The personal needs of migrant women should not be understood solely in terms of lack of opportunities. Desires, concerns, personal interests, and competencies for social and professional development are areas of great value in their support. In fact, it can be consolidated as intrinsic or even extrinsic motivation for coping with gender discrimination situations inherent in the nearby social context.

Maintaining a Gender Perspective
It is evident that even in the migration process, there are gender differences that harm women. Gender stereotyping transcends the role assumed and consolidates as structural beliefs. Therefore, a gender perspective sustained over time and oriented towards practical effectiveness in the daily life of migrant women is demanded. The sexualization of women and their exclusive link to care limits their development potential.

Coordination of Assistance
Access to regular legal status through flexible access norms for work and residence authorizations, combined with an exhaustive control of informal work, is one of the main measures that adequately addresses the needs of migrant women. The systematization of care protocols eclipses the need for interdisciplinary support. Results emphasize the need for psychological and social support over time. The process of self-knowledge and assimilation of the implications of the migration process is complex and demands effective communication among the social agents who accompany the women.

Avoiding Revictimization
The reconstruction of scenarios in which the victim of discrimination and genderbased violence is exposed in the first person to traumatic episodes may emphasize the damage and the victim's role in the present. Secondary victimization affects personal coping capacities for concurrent and future structural difficulties, affecting the mobilized empowerment and resilience built by the victim. Funding: This research was funded by: Erasmus+, KA220 HED Cooperation partnerships in higher education, grant number F5265FF4 (European Union, 2021-1-ES01-KA220-HED-000034146), and The APC was funded by the project 360 REWIN-REsilient immigrant Women interventions for inclusion.

Institutional Review Board Statement:
The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee (11/2022, 2 October 2022).

Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Not applicable.

Conflicts of Interest:
The authors declare no conflict of interest.