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Prompted by intense public debate and policy shifts, this study examines news media representations of gender‐affirming care for transgender and gender diverse (TGD) youth in Sweden from 2019 to 2023. The analysis draws on Hall's theories of media representation and articulation, with a framework focussing on risk and temporality. Analysing media representations is crucial for understanding how societal discourses on gender dysphoria are shaped. The media articulates a dramatic rise in youth seeking gender‐affirming care, and portrays a new group of patients, primarily young “girls” with neuropsychiatric conditions. This group is frequently articulated as vulnerable, mentally unstable and influenced by social contagion. The media representations draw on a risk discourse, centred on the threat of future regret, the irreversibility of medical interventions and suicidality. Both critics and supporters of gender‐affirming care invoke suicide risk to justify their positions. The study highlights how TGD youths' voices are largely absent from the media representations. It critiques the simplified constructions of gender dysphoria and calls for more nuanced understandings of the rise of a diagnosis, care access and mental health. Finally, the paper illustrates shifting alliances and resistance within a broader conjuncture where professional and cultural tensions shape public discourse on gender‐affirming care.

Background: Previous research shows that gendered differences in time use unfairly impact women’s career advancement and influence workforce management. Despite a growing body of literature on gendered time use, the topic has not been well documented among specializing medical doctors in sub-Saharan African countries, including Uganda. Objectives: This study was conducted among specialist medical doctors at Makerere University to: (i) analyze gendered differences in time use for paid and unpaid activities and (ii) assess whether parenting influences time use. Methods: The study sample comprised 244 medical doctors pursuing graduate specialist programs in 2024. The data collection, which utilized a self-administered questionnaire, assessed socio-demographic factors and self-reported time spent on paid work, unpaid domestic work, unpaid care for household members, studying, socializing, and leisure activities. Quantile regression analysis, with 95% confidence intervals, was used to compare median differences in reported time use across various activities for men and women. Results: Compared to men, women reported spending more time on unpaid domestic work (2 vs 1 h/day: 95% CI: 0.6, 1.4) and less time on leisure activities (4 vs 7 h/week: 95% CI: −5.3, −0.8). Women with children spent more time on paid work than their male counterparts. Women with children reported spending half a day more on paid work and an additional hour on unpaid domestic work compared to men with children. Conclusion: This gender imbalance in time use could negatively impact the career progression and well-being of female doctors and further reinforce gender inequalities in the medical workforce in Uganda.

Objectives. To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods. Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results. Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions. Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

Objetivos. Calcular las tasas de cobertura del tamizaje del cáncer cervicouterino y evaluar la distribución espacial y las agrupaciones de departamentos y municipios bolivianos.

Métodos. Se calcularon las tasas estandarizadas de cobertura con el método de estandarización directa. Se utilizó la prueba de la I de Moran global para determinar si había autocorrelación espacial en la cobertura, y se aplicó la prueba de la Gi* de Getis y Ord para encontrar posibles agrupaciones espaciales de municipios donde la cobertura fuese alta o baja.

Resultados. La cobertura general fue baja. En el 2022, en Bolivia se aplicó el tamizaje del cáncer cervicouterino a alrededor del 14% de las mujeres de entre 20 y 69 años. Se observan importantes inequidades geográficas en las tasas de cobertura tanto entre departamentos como entre municipios. A nivel municipal hay grandes diferencias, con valores que van del 59% a menos del 1%. Se observaron zonas de cobertura alta en el nordeste y el sudeste de Bolivia, concretamente en los departamentos de Pando, Chuquisaca y Tarija, mientras que las zonas de cobertura baja se ubicaban en los departamentos de Beni y Santa Cruz.

Conclusiones. Bolivia aún está muy lejos de alcanzar la meta de la Organización Mundial de la Salud de una cobertura del tamizaje del cáncer cervicouterino del 70%. Los presentes resultados indican dónde debe reforzarse el programa de tamizaje para mejorar la capacidad de respuesta del sistema de salud boliviano para atender las necesidades de salud reproductiva de las mujeres.

Objetivos. Estimar as taxas de cobertura do rastreamento do câncer do colo do útero e avaliar aglomerados e a distribuição espacial entre departamentos e municípios na Bolívia.

Métodos. Taxas padronizadas de cobertura do rastreamento do câncer do colo do útero foram calculadas por meio do método de padronização direta. Utilizou-se o índice I de Moran global para investigar a ocorrência de autocorrelação espacial na cobertura do rastreamento e estatística Getis-Ord Gi* para identificar aglomerados espaciais de municípios com cobertura alta (hot spot) ou baixa (cold spot).

Resultados. A cobertura geral foi considerada baixa. Aproximadamente 14% das mulheres de 20 a 69 anos realizaram o rastreamento na Bolívia em 2022. Foram constatadas grandes iniquidades geográficas nas taxas de cobertura do rastreamento do câncer do colo do útero, tanto entre os departamentos como entre os municípios. No nível municipal, o rastreamento apresentou enormes diferenças, variando de 59% a menos de 1%. Foram identificados hot spots no noroeste e no sudeste da Bolívia, especificamente nos departamentos de Chuquisaca, Pando e Tarija. Por outro lado, foram identificados cool spots nos departamentos de Beni e Santa Cruz.Conclusões. A Bolívia ainda está longe de alcançar a meta de 70% de cobertura do rastreamento estabelecida pela Organização Mundial da Saúde. Os resultados indicam áreas onde o programa de rastreamento precisa ser fortalecido para aprimorar a capacidade de resposta do sistema de saúde da Bolívia às necessidades de saúde reprodutiva das mulheres.

Background: The number of youths seeking care for gender dysphoria has increased globally over the last ten years. In December 2022, the Swedish National Board of Health and Welfare published an updated knowledge support for the care of minors (children and adolescents) with gender dysphoria. This knowledge support recommends stricter criteria for prescribing puberty blockers and cross-gender hormones to minors, and differs both from previous healthcare practices and from international guidelines.

Aim: This study aimed to explore healthcare professionals’ perceptions of the updated knowledge support and its impact on healthcare practices and the care seekers (minors with gender dysphoria).

Methods: This qualitative interview study included 11 participants who worked clinically with gender-affirming care of minors (both evaluation and providing medical interventions). The participants came from different regions, different evaluation teams, and different professions. Reflexive thematic analysis was used.

Results: While the new knowledge support was partly intended to solve geographical differences, different evaluation teams had implemented the new guidelines differently. New criteria around childhood debut, neuropsychiatric conditions, and hormonal treatment seemed to have partly changed the conditions for the evaluation. The greatest change had been regarding access to puberty blockers and hormonal treatment. Some participants argued for a larger shift towards psychosocial support, while others highlighted the tension between care seekers’ needs and the shrinking opportunities to help based on the new guidelines. Some participants perceived that people lacking in expert knowledge had affected the content of the knowledge support.

Conclusions: Differing opinions of the knowledge support were expressed by healthcare providers working with gender-affirming care for minors. Some were pleased with the new guidelines and believed the new knowledge support to be clearer than the old one. Others were more critical, stating that the knowledge support had not taken clinical experience into consideration, was too open to interpretation, and was too restrictive.

Denna rapport redovisar resultat från ett femårigt forskningsprojekt om unga transpersoners psykiska hälsa i Sverige. Syftet var att utforska vilka sociala faktorer som stärker respektive påverkar negativt den psykiska hälsan hos unga transpersoner i åldern 15–25 år, med särskilt fokus på tillgång till könsbekräftande vård och fritidsmiljöer.

Genom 16 individuella, halvstrukturerade ­ intervjuer har unga transpersoner fått beskriva sina egna­ erfarenheter av vardag, fritid och mötet med vården. Intervjuerna analyserades tematisk enligt Braun & Clarke (2006). Deltagarna representerade olika könsidentiteter, geografiska områden och vårderfarenheter.

Stärkande faktorer

• Queera och inkluderande rum: Möten med andra hbtq-personer i såväl fysiska grupper som­ onlineforum gav känslor av tillhörighet, normalitet och trygghet.

• Kreativa uttrycksformer (teater, cosplay, konst) ­ erbjöd trygga arenor för att utforska­ köns­ identiteten och uttrycket.

• Trygga relationer: Stödjande familj, vänner, skola och arbetsplatser fungerade som viktiga skyddsfaktorer.

• Fysiska fritidsaktiviteter: För de som hade möjlighet att vara fysiskt aktiva beskrevs det som viktigt för den psykiska hälsan. Flera uttrycker en stark önskan att vara mer fysiskt aktiva, men­ tillgången till sådana aktiviteter begränsas ofta av cisnormativa och utestängande strukturer (se Hinder och Utmaningar).

• Tillgång till könsbekräftande vård: Tillgång till ­ hormoner, kirurgi och annan könsbekräftande vård beskrevs som avgörande för den psykiska hälsan för deltagare som önskade sådan vård.

Hinder och utmaningar

• Fysiska fritidsaktiviteter: Flera upplevde hinder (omklädningsrum, rädsla för trakasserier) som begränsade deltagandet i sport och motion.

• Långa väntetider för könsbekräftande vård: Den utdragna processen för utredning och ­ hormonell/kirurgisk behandling upplevdes som det ­ mycket påfrestande – livet sattes ”på paus” och det ­ upplevdes bidra till försämrad psykisk hälsa.

• Psykiatriska diagnoser, stereotypa krav och beroendeställning: Utgjorde andra hinder och utmaningar i utredningen för könsbekräftande vård.

• Självmedicinering: Avsaknad av tillgång till offentlig vård ledde till att flera skaffade ­ hormoner via nätet eller på annat sätt privat ­ finansierad­ behandling, vilket innebar en betydande ekonomisk belastning.

• Bristande kompetens i övrig vård: ­ Felaktiga namn/pronomen, normativa antaganden och okunnighet i primärvård och specialistvård ­ skapade obekväma, otrygga och ibland diskriminerade vårdmöten samt bidrog till­ undvikande av vårdkontakter.

Rekommendationer

Förkortade och förutsägbara väntetider inom den könsbekräftande vården, utbildning av vårdpersonal kring bemötande och transpersoners livs­villkor, samt utveckling av kostnadsfria,­ inkluderande fritidsmiljöer specifikt för unga­ transpersoner är centrala åtgärder för att förbättra ungas psykiska hälsa och livskvalitet. En helhetssyn som adresserar både individuella behov och strukturella normer är nödvändig för att skapa en bättre psykisk hälsa bland unga transpersoner.

Through interviews with 16 social workers, drawing on the concept of “willful subjects”, the aim of this paper is to analyze how social workers working in Swedish municipal social services make sense of, adapt, and/or challenge routine questions about intimate partner violence, and how such routines affect their professional role and agency. We found that participants renegotiated standardized ways of asking by stressing the need to use such questionnaires with care, and stating that the individual judgement and agency of the social worker is paramount. The participants also renegotiated the purpose of asking; while their routine questions about IPV seldom led to a disclosure of ongoing exposure to violence, social workers considered it important to ask because it “opens the door” and signals the possibility of receiving help in the future. We argue that social workers are not necessarily stripped of agency when following standardized protocols and routines, despite increasing efforts to include controlling mechanisms in their everyday practice. However, our results also show that social workers’ legal obligation to report to child protection services, if there are children in the household, limits their room for discretion and how the routine questions about violence are asked and perceived by clients.

Background: Trans and gender-diverse people experience a high burden of health issues and face barriers to accessing care. Primary care has a large responsibility in providing equitable access to care and thus improving the health of the population. We, therefore, explored trans and gender-diverse people’s experiences of primary care in Sweden.

Method: Semi-structured interviews were conducted with 12 self-identified trans or gender-diverse persons living in Sweden, aged over 15, and with experience of primary care. Participants were recruited via trans organizations. The interviews were analysed using reflexive thematic analysis.

Results: Five themes were identified: “Preparations and low expectations”, “Attempts at trans-competent care”, “When trans experiences are not present – from smooth to excluded”, “When being trans becomes a problem – from friction to overt violations”, and “Effects of healthcare encounters – from discomfort to shifted responsibility”.

Conclusion: Findings show that participants’ experiences with primary care in Sweden were influenced by cisnormativity, leading to invisibility, exclusion, misgendering, and a lack of knowledge. Experiences of discomfort on the part of care providers, ridicule, disrespect, and denial of care imply the presence of transphobia. These barriers result in trans and gender-diverse people experiencing low levels of trust, having to navigate their care without support, and not having their healthcare needs met. There is an urgent need for increased trans competence and allyship with trans communities to ensure equitable access to healthcare. Training and further research should be developed in close consultation with trans organisations to address these disparities.

The increase in private shelters for women escaping men’s violence in Sweden prompts an analysis of discursive struggles on separatism, violence, and safety. The analysis of websites and interviews with representatives from private shelters and women’s shelters show that the woman-to-woman approach is important for women’s shelters whereas private shelters frame their use of male staff as a practical necessity or a way to show women that there also exist ‘good’ men. Women’s shelters articulate the importance of knowledge about men’s violence for counteracting normalization of violence and self-blame, while private shelters emphasize therapeutic knowledge and interventions. To provide safety, women’s shelters articulate the importance of a homey atmosphere and ‘inner safety’, where private shelters emphasize security; shell protection, perpetrator profiles, and risk assessments. The women’s shelters position their work within a discourse of social change, whereas private shelters emphasize their lack of political ambitions, with profit-making as their primary motivation. Should public funding continue to be funnelled to private shelters, rather than to women’s shelters, it will undermine women’s shelter’s dual role of providing refuge and contributing to social change. Should the private shelters discourse prevail it will likely alter the support provided to victims of violence.

Background: Transgender and non-binary (TGNB) people tend to report worse health than cis people, however, despite an increased need for care, they face several barriers when trying to access healthcare. These barriers might be exacerbated when young age intersects with a trans identity, and so there is a need for studies highlighting the experiences of TGNB youth.

Aims: To explore and compare how TGNB youth (15–26 years old) in Sweden and Spain experienced their access to healthcare, in order to shed light on the strengths and limitations of different kinds of healthcare systems and improve healthcare provision and policy development.

Methods: This study was based on a qualitative analysis of semi-structured interviews with TGNB youth living in Sweden (n = 16) and Spain (n = 18). Of these, 22 identified as male or transmasculine, six as non-binary, and six as women or transfeminine; 25 had undergone some type of gender-affirming care, and the rest were on the waiting list or undergoing preparatory visits and had not started hormonal treatment. The interviews were analyzed using reflexive thematic analysis. An abductive approach was applied, and the Levesque conceptual framework was used to compare the analyses of each set of materials.

Results: We present our findings using the structure of the accessibility framework, focusing on approachability, acceptability, availability, affordability, and appropriateness. The conceptualization of accessibility in combination with the concept of cisnormativity illustrates how specific ideals and normative expectations affect access to healthcare for TGNB people across contexts, with most barriers arising from the appropriateness of the services.

Discussion: Young TGNB people experience barriers to accessing healthcare both in the Spanish and the Swedish contexts. Strategies to reduce these barriers should be framed within the critique of and resistance to cisnormativity and should focus on users with intersecting marginalized identities to promote health equity.

Denna rapport handlar om hälsa och livsvillkor bland hbtq-personer över 65 år. Resultaten bygger på kvalitativa intervjuer med 16 deltagare i åldrarna 65–83 år.

Önskan om att få åldras som jag lever nu: Det övergripande resultatet kan sammanfattas i en önskan om att få åldras som man lever nu. Det handlar bland annat om att kunna fortsätta leva ett öppet liv som hbtq-person och att bli bemött med respekt. Det rymmer även förhoppningen att ha kvar hälsan, behålla sitt oberoende, kunna vara social och engagera sig i sina intressen.

God hälsa nära kopplad till livsvillkor: Studiens resultat visar att många deltagare uppger en god hälsa. Samtidigt framkommer att hälsan är tätt sammankopplad med livsvillkor och levnadsförhållanden såsom öppenhet och synlighet, tillgång till sociala sammanhang, socialpolitiska förutsättningar samt hbtq-kompetent vård och omsorg. Deltagarnas berättelser visar på erfarenheter och oro som de delar med äldre personer generellt, men det synliggörs också hur hetero- och cisnormativitet samverkar med ålder och skapar specifika erfarenheter och livsvillkor som kan påverka hälsan både negativt och positivt.

Åldrandet ger både trygghet och rädsla: Åldrandet upplevs generellt som oproblematiskt, i vissa fall också som positivt eftersom det kange en större trygghet. Några deltagare beskriver hur åldrandet inneburit nya eller större möjligheter att leva öppet. Det finns samtidigt en rädsla att som äldre komma att förlora fysiska och psykiska förmågor och därmed bli beroende av andras omsorg. Trots en övervägande god hälsa beskriver deltagarna samtidigt en del krämpor, mindre allvarliga medicinska diagnoser och minskad sexlust. En del beskriver också psykisk ohälsa som en konsekvens av internaliserad homo- och transfobi.

Sociala sammanhang och relationer skyddar mot ensamhet: Sociala sammanhang såsom partner och egna barn, självvald familj, vänner och organiserad hbtq-verksamhet är mycket viktiga för deltagarnas hälsa. Utöver att vara en källa till glädje, social stimulans och praktiskt såväl som emotionellt stöd, upplever deltagarna att goda relationer ökar deras trygghet. Motsatt är oro för ensamhet kopplat till rädsla bland deltagarnaoch ofrivillig ensamhet ökar upplevelser av utsatthet.

Öppenhet är centralt för hälsan: Att vara öppen med sin identitet har stor betydelse för hälsan, inte minst påverkar det deltagarnas självbild. Vidare kan möjligheten att vara öppen även ha betydelse för sociala sammanhang och relationer, samt för hur man föreställer sig framtiden. Möjligheterna att leva öppet har för deltagarna varierat utifrån olika tidsperioder och sammanhang. Den socialpolitiska situationen och samhällsattityder har stor betydelse för deltagarnas upplevda möjligheter till öppenhet. För en del beskrivs öppenheten också som villkorad av närstående.

Beredskap och oro för okunskap i vård och omsorg: Deltagarna har överlag goda erfarenheter av vården och beskriver generellt att de får ett gottbemötande. Trots detta beskriver de olika strategier och en beredskap för att hantera eventuellt dåligt bemötande. Vad som beskrivs som ett dåligt bemötande är oftast relaterat till okunskap om hbtq, eller normativa antaganden bland vårdgivare, snarare än avsedd diskriminering. En del upplever eventuella framtida omsorgsbehov som oproblematiska, medan en majoritet geruttryck för oro. Oron handlar bland annat om att deltagarna är osäkra på om personalen kommer att ha adekvat utbildning om hbtq för att kunna ge ett gott och respektfullt bemötande och tillgodose hbtq-specifika behov.

Socialpolitisk situation påverkar hälsa och livsvillkor: Den socialpolitiska situationen är betydelsefull för deltagarnas hälsa och livsvillkor. Åldersgruppen som ingår i studien har en livstid som spänner över en omvälvande tid i svensk hbtq-historia. Under perioder när hbtq har ansetts avvikande och bemötts negativt har de flesta känt sig begränsade, rädda och utsatta. För vissa har tidigare erfarenheter av våld, hot, diskriminering, osynliggörande och patologisering lett till långvariga negativa konsekvenser förhälsan. I resonemang om den nutida socialpolitiska situationen upplever flera deltagare hbtq-rättighetersom hotade. Vissa anger också att kampen för lika rättigheter ständigt måste pågå.

Identifierade utvecklingsområden: Utifrån studiens resultat och befintlig kunskap har Folkhälsomyndigheten identifierat följande utvecklingsområden:

• Befintlig kunskap om äldre hbtqi-personers hälsa och livsvillkor är begränsad och behöverutvecklas
• Det finns behov av att implementera kunskap om hbtqi i vård- och omsorgsutbildningar från gymnasienivå upp till universitetsnivå.
• Genom integrering av hbtqi-perspektiv i organisationer och äldreförbund skulle förutsättningarna för inkludering av hbtqi-personer i olika sammanhang kunna öka
• Fler organiserade mötesplatser, särskilt bortom storstäderna, skulle kunna skapa bättre sociala förhållanden och ökad trygghet för äldre hbtqi-personer

This report addresses the health and living conditions among LGBTQ people over the age of 65.The results are based upon qualitative interviews with 16 participants aged between 65 and 83.

The desire to age as I live now: The overall content can be summarised as the participants hoping to age in a context similar tothe one they are currently living in. This involves being able to continue living openly as an LGBTQ person and be treated with respect. It also involves the hope of remaining in good health, maintaining independence and being able to socialise and pursue personal interests.

Good health closely linked to living conditions: The results show that many participants report being in good health. At the same time, health appears to be closely linked to living conditions and factors such as openness and visibility, access to social connections, sociopolitical conditions and health and social care that is well-versed in LGBTQ issues. The participants’ accounts demonstrate experiences and concerns they share with older people in general, however they also highlight how both heteronormativity andcisnormativity interact with age and create specific experiences and living conditions that canimpact health both positively and negatively.

Aging provides both security and fear: Aging is generally seen as being unproblematic and in certain cases even positive as it can provide greater security. Some participants describe how aging has led to new or greater opportunities for living openly. At the same time, there is a fear that as an older person, they willlose physical and mental capacity and become dependent on the care of others. Despite generally being in good health, the participants describe a number of ailments, minormedical conditions and lower sex drive. A number also describe mental health problems caused by internalised homophobia and transphobia.

Social connections and relationships protect against loneliness: Social connections, such as their own children and partners, chosen families, friends and organised LGBTQ activities are vital to the participants’ health. The participants believe thatgood relationships increase their security – in addition to providing a source of happiness, social stimulation and practical and emotional support. In contrast, fears of loneliness form asignificant concern among the participants, with involuntary loneliness increasing feelings of vulnerability.

Being open is central to health: Participants being open about their identity is of great importance to their health, especially asthis affects the way participants view themselves. In addition, being able to be open is alsosignificant to social connections and relationships, as well as the way we imagine the future. The ability to live openly varies for the majority of participants, depending on the period and the context. Sociopolitical situations and social attitudes have a major impact on how participants perceive their ability to be open.

Preparedness and concern that health and social care lack knowledge: Generally, the participants’ experiences of the healthcare services are positive, and they describe being treated with respect and understanding. Despite this, they describe various strategies andpreparedness for responding to any negative actions. These negative actions are described aspoor treatment in terms of ignorance towards LGBTQ issues or normative assumptions from healthcare professionals, rather than blatant discrimination. A number are not concerned about any future social care needs, whereas a majority are. Concerns include participants being unsure whether staff will have the necessary knowledge about LGBTQ issues for providing positive and respectful treatment, while meeting the needs specific to LGBTQ people.

Sociopolitical situation affects health and living conditions: The sociopolitical situation is significant to participants’ health and living conditions. The age group included in this study have lived through a revolutionary period in Swedish LGBTQ history. During periods when being LGBTQ was seen as being deviant behaviour and met with negativity, the majority felt restricted, afraid and vulnerable. For some, previous experiences of violence, threats, discrimination, erasure and pathologisation have led to long-term negative health effects. When discussing the current sociopolitical situation, several participants feel that the rights of LGBTQ people are threatened. Some also state that the fight for equal rights must never stop.

Areas for development identified: Based on the results of the study and existing knowledge, the Public Health Agency of Swedenhas identified the following areas for development:

• There is currently limited knowledge about older LGBTQI people’s health and livingconditions, and this needs to be developed.
• There is a need to implement knowledge of LGBTQI issues in health and social care training, from upper secondary education to university level.
• The conditions for LGBTQI inclusion in various contexts can be improved by integrating LGBTQI perspectives into organisations and associations for older people.
• More organised meeting places – especially outside of the major cities – could create better social conditions and increased security for LGBTQI people