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Abstract

Equitable access to primary healthcare (PHC) is central to advancing health equity, yet Black African immigrant women (BAIW) in Canada often face multiple intersecting barriers that undermine timely and culturally safe care. Despite increasing immigration from African countries, few studies have examined the structural, cultural, political, and economic factors shaping their access to PHC. This dissertation investigates the healthcare experiences of BAIW in British Columbia (BC), through a critical ethnographic design, framed by an intersectional lens and analyzed using a qualitative descriptive approach. This study draws on a scoping review and primary qualitative research with 20 BAIW and 5 healthcare providers, illuminating both systemic barriers and the strategies BAIW employ to navigate care. Findings from the review of 26 North American studies highlights the intersecting structural and sociocultural challenges facing Black African immigrant and refugee women, including anti-Black racism, linguistic and financial barriers, restrictive immigration policies, and unmet needs in maternal, reproductive, and mental healthcare. Building on this, qualitative interviews with BAIW in BC reveal how experiences of medical mistrust, administrative exclusions, fragmented continuity, and dismissive provider interactions undermine engagement with PHC. Provider perspectives corroborate these findings, underscoring the influence of systemic racism, interpreter shortages, rigid institutional structures, and socioeconomic precarity in constraining access. Importantly, the dissertation also foregrounds BAIW’s agency: women actively mobilize self-advocacy, social networks, spiritual and cultural resources, transnational healthcare ties, and economic sacrifices to mitigate systemic neglect and ensure access to care. Taken together, the findings demonstrate that BAIW’s access to PHC is not determined simply by service availability but by overlapping systems of oppression – including racism, patriarchy, immigration policy, and labor market precarity – that structure inequities in care. At the same time, BAIW exercise resilience and resourcefulness, challenging deficit-based narratives of immigrant passivity. The dissertation calls for systemic reforms that embed anti-racist and culturally safe practices, improve relational continuity, expand interpreter and language supports, and address broader social determinants of health. By centering the intersecting identities and lived realities of BAIW, this work contributes to scholarship on healthcare equity and offers actionable insights for policy, practice, and future research in immigrant health.