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Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-0609-8745
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-8114-4705
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. The Public Health Agency of Sweden, Solna, Sweden.ORCID iD: 0000-0003-1217-0106
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2022 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 3, p. 287-298Article in journal (Refereed) Published
Abstract [en]

Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. 

Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. 

Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). 

Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

Place, publisher, year, edition, pages
Kerman University of Medical Sciences , 2022. Vol. 11, no 3, p. 287-298
Keywords [en]
Migrants, Youth, Access to Healthcare, Sexual Health, Reproductive Health, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-173748DOI: 10.34172/ijhpm.2020.123ISI: 000719952400001PubMedID: 32729283Scopus ID: 2-s2.0-85108111651OAI: oai:DiVA.org:umu-173748DiVA, id: diva2:1456002
Funder
Public Health Agency of Sweden Available from: 2020-07-30 Created: 2020-07-30 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Leaving the door ajar: young migrants’ sexual and reproductive health in Sweden
Open this publication in new window or tab >>Leaving the door ajar: young migrants’ sexual and reproductive health in Sweden
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att lämna dörren på glänt : Unga migranters sexuella och reproduktiva hälsa i Sverige
Abstract [en]

Young people and migrants are both prioritized groups regarding sexual and reproductive health and rights (SRHR), but studies about the sexual andreproductive health (SRH) of young migrants in Sweden are scarce. The aim of this thesis was to study the SRH of young migrants in Sweden, and specifically to: 1) explore how do young migrants understand SRH, and how do they experience their sexual rights; and 2) examine how do young migrants perceive and experience the process of accessing SRH services, including their approachability, acceptability, adequacy and quality.

This thesis is built upon three studies, which collected quantitative data (a national survey – Papers 1 and 2, and a youth clinics survey – Paper 3) and qualitative data (a qualitative study – Paper 4). The national survey is a population-based cross sectional study, which recruited 1773 newly arrived young migrants aged 16 to 29 years through visits to schools and other venues, letters sent home, and via a web survey. The data was analysed through descriptive statistics (Paper 1) and multivariate multiple linear regression (Paper 2). The youth clinic survey is a clinic-based cross-sectional study whichrecruited 1089 youths (118 had at least one parent born outside Sweden/Scandinavia) aged 16 to 25 years after their visit to a youth clinic in the four most northern regions in Sweden. I used multi-level analysis to analyse the data. The qualitative study builds upon 13 semi-structured interviews with newly arrived Arabic-speaking migrant men, which were analysed through qualitative thematic analysis.

Young migrants understood SRH as both “essential” and a “right”. The sexual rights of young migrants in Sweden were less fulfilled, compared to those of other young people in Sweden, and there were differences between the various groups of young migrants. The rights of men; people identifying as non-binary; people identifying as lesbian, gay, bisexual or asexual (LGBA); those born in South Asia; those without a residence permit; and people of low economic status were fulfilled to a lesser extent compared to their counterparts.

Studying the process of accessing SRH services – including sexual education and information, and services related to sexual function, sexually transmitted diseases and gender-based violence, as well as infertility, pregnancy, delivery, contraceptives and abortion – showed barriers and facilitators. SRH serviceswere to a large extent non-approachable; almost half of those who needed these services in the national survey did not use them. SRH services were perceived, with some exceptions, as acceptable due to the “open environment” of Sweden; however, some young migrants faced a lack of cultural sensitivity in iv SRH services, low parental support, and fear of exposure, which decreased their acceptability of the services. Regarding adequacy, young migrants complained about long waiting times for receiving care particularly specialised care, and that SRH services did not take their problems seriously. Those who visited youth clinics, however, perceived them as providing convenient and timely services. The quality of SRH services was perceived as good in general; the majority of young migrants were satisfied with SRH services in the national survey and perceived youth clinics as very friendly. However, negative experiences were reported in the national survey, where almost half of those who visited SRH services had at least one negative experience in the five domains of respect, equity, quality of consultation, privacy and non-prejudice. Migrant youths also reported worse experiences in the youth clinic survey than Swedish/Scandinavian youths in the domains of respect, equity and quality of consultation. 

Their legal entitlement to access most SRH services, the availability of good quality services and the “open environment” facilitate young migrants’ access to SRH services, however, their limited access to sexual education and to information about the health system, and cultural insensitivity and cultural racism when providing information and services, are serious barriers to young migrants’ access to SRH services. 

Abstract [sv]

Både unga och migranter är prioriterade grupper när det gäller sexuell och reproduktiv hälsa och rättigheter (SRHR) men studier om unga migranters sexuella och reproduktiva hälsa (SRH) i Sverige är få. Syftet med denna avhandling var att studera SRH bland unga migranter i Sverige, och specifikt att: 1) utforska hur unga migranter förstår SRH och hur de upplevde sina sexuella rättigheter; 2) undersöka hur migranter uppfattar och uppleverprocessen att tillgängliggöra sig SRH-tjänster. 

Denna avhandling bygger på två kvantitativa studier (“nationell enkätstudie”och “ungdomsmottagningsstudie”) och en studie med kvalitativ data (“kvalitativstudie”). Den nationella enkätstudien är en befolkningsbaserad tvärsnittsstudie som rekryterade 1773 nyanlända unga i åldern 16 till 29 år genom besök på skolor och andra platser, samt genom post- och webbenkät. Data analyserades genom beskrivande statistik och multivariat multipel linjär regression. Ungdomsmottagningsstudien är en klinikbaserad tvärsnittsstudie som rekryterade 1089 ungdomar (118 med migrantbakgrund) i åldern 16 till 25 år från ungdomsmottagningar i de fyra nordligaste regionerna i Sverige. För att analysera data användes flernivåanalys. Den kvalitativa studien byggde på 13 semistrukturerade intervjuer med arabisktalande nyanlända män, vilka analyserades genom kvalitativ tematisk analys.

Unga migranter förstod SRH som både “essentiellt” och som en “rättighet”. Unga migranters sexuella rättigheter var uppfyllda till en lägre grad i jämförelsemed ungdomar utan migrantbakgrund. Resultaten visar också på skillnader mellan olika grupper av unga migranter. Rättigheterna för män; icke-binära; lesbiska, gay, bisexuella och asexuella; de som är födda i Sydasien; de som inte hade uppehållstillstånd; samt de med låg ekonomisk status uppfylldes i lägre grad än för övriga grupper.

Tillgången till SRH-tjänster – inklusive utbildning och information om SRH, hälso- och sjukvård relaterad till sexuell funktion, sexuellt överförbara sjukdomar, könsbaserat och sexuellt våld samt vård under graviditet och förlossning, abortvård och preventivmedel – påverkades av olika faktorer både positivt och negativt. SRH-tjänster upplevdes i stor utsträckning vara svåra att nå; nästan hälften av dem som behövde dessa tjänster i den nationella undersökningen använde dem inte. SRH-tjänster upplevdes, med några undantag, som acceptabla på grund av den “öppna miljön” i Sverige; några unga migranter möttes dock av diskriminering, kulturell rasism, svagt föräldrastöd och rädsla för exponering. Unga migranter klagade på lång väntetid för att få vård, särskilt specialiserad vård och att deras SRH problem inte togs på allvar.

Unga migranter som besökte ungdomsmottagningar uppfattade dem dock som lättillgängliga. Kvaliteten på SRH-tjänster upplevdes generellt som god; majoriteten av unga migranter var nöjda med SRH-tjänsterna i den nationella undersökningen och upplevde ungdomsmottagningarna som mycket ungdomsvänliga. Dock rapporterades också negativa upplevelser; i den nationella enkätundersökningen hade nästan hälften av de som besökte SRH-tjänster minst en negativt upplevelse inom de fem domänerna; respekt, jämlikhet, kvalitet på konsultation, integritet och fördomar. Sämre erfarenheter bland unga med migrantbakgrund rapporterades också inom områdena; respekt, jämlikhet och kvalitet på konsultation i ungdomsmottagningsstudien.

Den lagliga rätten att ha tillgång till de flesta av SRH-tjänsterna, tillgängligheten, god kvalitet och den "öppna miljön" i Sverige underlättar unga migranters tillgång till SRH-tjänster. Den begränsade tillgången till sexualundervisning och till information om hälsosystemet, den kulturella okänsligheten och den kulturella rasismen vid tillhandahållande av information och tjänster skapar dock ett allvarligt hinder för unga migranters tillgång till SRH-tjänster.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2022. p. 93
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2182
Keywords
sexual and reproductive health and rights, sexual and reproductive health services, access to healthcare, quality of healthcare, youth, young adults, migrants, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-194449 (URN)978-91-7855-802-5 (ISBN)978-91-7855-801-8 (ISBN)
Public defence
2022-06-02, Sal Q0 Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2022-05-12 Created: 2022-05-05 Last updated: 2022-05-05Bibliographically approved

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Baroudi, MazenNkulu Kalengayi, FaustineGoicolea, IsabelJonzon, RobertSan Sebastian, MiguelHurtig, Anna-Karin

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