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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.

In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. A self-administered questionnaire was used to collect data from 1773 young (16 - 29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.

Background: Despite lack of evidence, there is a common notion that diseases are brought along with migrants, and thus a threat to people in the host country. In Sweden asylum seekers are to be offered a health assessment (HA), but national statistics show that the coverage is less than 50%. It has been assumed that asylum seekers do not want to attend, but this research data instead indicate structural barriers.

Objectives: To explore to what extent the Swedish healthcare system provides optimal conditions for asylum seekers to access the HA and how the HA could meet their own perceived health needs, as well as society’s demand on detecting contagious diseases, from a public health perspective.

Methods: This research project adopted a mixed method approach. A quantitative cross-sectional design was applied where different questionnaires were used, targeting administrators and healthcare professionals as well as former asylum seekers. In addition a qualitative, interpretative and descriptive research approach was applied, guided by grounded theory. Individual interviews were carried out among former asylum seekers.

Results: This research revealed that there is no coherent national system for the HAs on asylum seekers in Sweden. The structures, organizations, procedures and outcomes vary significantly between the 21 counties, and the reasons for the low coverage seemed multifold. The former asylum seekers stated feelings of ambiguity and mistrust due to lack of information on the purpose of the HA and how it might influence their asylum application. Poor communication was identified as one of several barriers to access healthcare. The attitude was positive to the HA as such, but it was considered to be just a communicable disease control, without focus on their own perceived health needs, thus an imbalance between control and care.

Conclusions: Although being an important contribution, the HA does not suffice to fulfill the right to health of asylum seekers, due to shortcomings regarding accessibility and acceptability of the information, procedures and services that it includes.

Bakgrund: Trots avsaknad av fakta så finns en föreställning om att migranter för med sig sjukdomar som utgör ett hot för personer i värdlandet. I Sverige ska asylsökande erbjudas en hälsoundersökning (HU), men nationell statistik visar på en genomförandegrad av mindre än 50 procent. Det har antagits att asylsökande inte vill delta, men resultat från denna forskning indikerar istället på strukturella hinder.

Syfte: Att utforska i vilken utsträckning det svenska hälsosystemet erbjuder optimala förutsättningar till asylsökande att få tillgång till en HU och hur HU kan möta den asylsökandes upplevda hälsobehov, liksom kravet på att upptäcka smittsamma sjukdomar, utifrån ett folkhälsoperspektiv.

Metod: I detta forskningsprojekt har olika forskningsmetoder använts. En kvantitativ tvärsnittsdesign tillämpades där olika frågeformulär användes till administratörer och vårdpersonal samt till före detta asylsökande. Vidare användes en kvalitativ design med tolkande och beskrivande forskningsansats enligt ”grounded theory”. Individuella intervjuer genomfördes bland före detta asylsökande.

Resultat: Forskningsresultaten visar på avsaknad av ett sammanhängande nationellt system för genomförande av HU av asylsökande i Sverige. Struktur, rutiner, uppföljning och resultat varierar avsevärt mellan de 21 landstingen, och skälen till den låga genomförandegraden förefaller vara mångsidig. Deltagarna uttryckte ambivalens och misstro eftersom de saknade information om syftet med HU och hur resultatet skulle kunna påverka deras asylansökan. Bristfällig kommunikation visade sig vara ett av flera hinder för att ta del av vård. Att bli erbjuden en HU uppfattades positivt, men fokus sades bara var på smittsamma sjukdomar och inte på den ohälsa man själv upplevde. Således fanns en obalans mellan kontroll av smittor och upplevda vårdbehov.

Slutsatser: Även om HU ansågs betydelsefull, visar resultaten på att den inte påtagligt bidrar till att förverkliga asylsökandes rätt till hälsa, på grund av hinder och bristande tillgänglighet och acceptans av information och genomförandet av HU.

BACKGROUND: Health assessments (HAs) for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how they are organized, and whether it is mandatory or not to attend varies between countries. Swedish national statistics have shown that only about 45% of asylum seekers attend the optional HA offered upon their arrival in Sweden. There are significant variations among Sweden's 21 counties, ranging from 20 to 90%. The reasons for the low attendance have not yet been fully explored, though there are indications of structural weaknesses within the healthcare system. This study aimed to identify variations in policies and implementation of HAs targeting asylum seekers and other migrants. The study analyzes the structure and processes in different Swedish counties and discusses how this might influence the coverage.

METHODS: This research project had an exploratory quantitative descriptive design applying a cross-sectional survey based on two structured questionnaires. Descriptive statistics were performed to summarize the data.

RESULTS: The number of healthcare centers in each county that carried out HAs on asylum seekers varied independently of the size of the county. Variations in regard to structure, organization, processes, and performance monitoring of the HA process also appeared diverse, and these were in some cases also reported differently by administrators and healthcare professionals in the same county. Most commonly, the HAs were carried out in ordinary health centers, though some counties presented alternative solutions on how to organize the HAs.

CONCLUSIONS: There seems to be no coherent national system for carrying out HAs on asylum seekers in Sweden. The structure, organization, processes, and outcomes vary between the counties, and the reasons for the low coverage of HAs appear to be multifaceted.

Background Swedish law entitles asylum seekers to a voluntary health assessment and to "health care that cannot be postponed". The last expression suggests, however, restrictions on the entitlement, and what it may or may not include remains ultimately a decision for health professionals in the specific case. Indeed, the health assessment constitutes the sole active effort from Swedish authorities to fulfill this right. This study was therefore aimed at assessing how the information, procedures and services related to the health assessment are accessible and acceptable to fulfill the right to health of asylum seekers, from their own perspective. Methods The study has a cross-sectional design. A questionnaire was administrated in 16 language schools for immigrants, in four counties of Sweden. Three hundred eighty-six individuals fulfilled the inclusion criteria. The frequency of their answers was tabulated to estimate how the information, procedures and services related to the health assessment correspond to the criteria for accessibility and acceptability regarding the right to health. Findings Forty-eight (12.4%) respondents did not undergo the health assessment. Thirty-one of them did not even receive the invitation letter. They said they lost the opportunity to know their health status, to obtain treatment for or advice about their health problems. Additionally, 55.2% of those who attended the health assessment indicated that their needs were overlooked, particularly when these were of a psychological nature. Two in three participants also considered the health assessment to be a communicable disease control, rather than an effort to take care of their health needs. Nevertheless, the respondents had a positive attitude towards the health assessment as such. Conclusions Although being an important contribution, the health assessment does not suffice to fulfill the right to health of asylum seekers because there are shortcomings regarding the accessibility and acceptability of the information, procedures and services that it includes.

Background: National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries. Aim: The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process. Methods: We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis. Findings: The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as ‘A state of limbo – in transition between two contexts’. Conclusions: There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance.