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Background: Male partners’ involvement in family planning can be crucial for women’s contraceptive choices. Limited research exists on migrant men’s experiences and perceptions of family planning and associated decisions. The study aims to investigate experiences and perceptions of family planning use and decision-making among Arabic-speaking men living in Sweden.

Methods: This qualitative study utilized reflexive thematic analysis of eighteen in-depth interviews. The participants aged 22–43 years, had relocated to Sweden within the past decade, and represented various countries of origin (e.g., Syria, Iraq, Palestine) with most participants having 13 or more years of education.

Results: We identified an overarching theme, “Navigating the complex family planning decision-making in a new setting” supported by four sub-theme; 1) “The new living conditions influencing family planning decision-making” described how financial (in)stability, childcare responsibilities, personal development goals, and the impact of changing circumstances shaped family planning choices; 2) “Social norms affecting family planning decision-making” emphasized the diversity of gender roles and norms within Arabic-speaking communities, with an emphasis on joint decisions and shared responsibility. Instances of controlling behaviour and the role of beliefs and extended family members were also noted; 3) “Challenges in accessing contraceptive services free of discrimination” underscored the need for and importance of access to comprehensive information and culturally sensitive services in shaping family planning decisions; 4) “Conflicting considerations when deciding on contraceptive method” addressed factors such as familiarity with the methods, perceived effectiveness and safety, fear of side-effects, and taboos associated with the methods.

Conclusions: The findings highlight the diverse factors influencing family planning decisions. The study underscores men’s willingness to be active partners for family planning and highlights the need for improved information provision and services to empower informed decision-making.

Background: Decentralization has been a prominent strategy to enhance health systems’ efficiency, service quality, autonomy and accountability in low- and middle-income countries (LMICs) like Tanzania since the 1990s. Previous studies have mainly focused on assessing how much power for decision-making on different health system functional areas is granted to local-level authorities from the central government and the interconnections between decision space, organizational capacity, and accountability mechanisms. Empirical evidence on its impact on performance remains limited. This study investigates conditions for good performance in a decentralised health system of Tanzania.

Methods: We used fuzzy set qualitative comparative analysis to analyse the necessary and sufficient conditions for good health system performance. Eighteen purposively districts were chosen to capture variations in performance and geography in a multiple case study approach.

Results: Functional Health Facility Governing Committees (HFGCs) emerged as a necessary condition for good performance. To achieve good performance, however, there is a need for functional decision space among managers or high accountability among managers or high capacity of staff/ okay level of staffing.

Conclusion: The study underscores the importance of the interplay between decision space, organizational capacity, and accountability in improving health system performance. While decentralization aims to provide greater autonomy, effective implementation depends on the development of local capacities and oversight through accountability. Decentralization alone is not sufficient to enhance healthcare delivery; HFGCs and their local context that promote (social) accountability are essential. Further research is warranted to identify interventions supporting HFGCs in fulfilling their mandates and enhancing health service delivery.

Denna studie undersöker barns upplevelser och perspektiv på sina rättigheter under COVID-19-pandemin. Genom kvalitativa metoder visade data från 22 barn i Umeå hur pandemin påverkade barnens liv och skolgång. Barnen uppskattade Sveriges hantering av pandemin men tyckte samtidigt att deras fysiska och mentala hälsa påverkades negativt.

Distansundervisningen medförde flera utmaningar, inklusive tekniska ojämlikheter och bristande stöd från lärare. Barnen betonade behovet av bättre kommunikation och informationsdelning, samt föreslog fler kanaler för att kommunicera med beslutsfattare. De framhöll också vikten av investeringar i skolhälsa och åtgärder mot ojämlikhet och diskriminering. Resultaten understryker betydelsen av att integrera barnens perspektiv i beslutsfattande och krisberedskap för att säkerställa att deras rättigheter skyddas och främjas. Denna studie belyser vikten av barnens röster för att skapa en mer rättvis och inkluderande framtid.

Background: Evidence amounted early that migrants, who are often side-lined in pandemic response or preparedness plans, are disproportionately affected by the COVID-19 pandemic and its consequences. However, synthesised evidence that quantifies the magnitude of inequalities in infection risk, disease outcomes, consequences of pandemic measures or that explains the underlying mechanisms is lacking.

Methods: We conducted a systematic review searching 25 databases and grey literature (12/2019 to 09/2023) and considered empirical articles covering migrants, refugees, asylum-seekers, and internally displaced persons reporting COVID-19 cases, hospitalisation, ICU admission, mortality, COVID-19 vaccination rates or health consequences of pandemic measures. Random-effects meta-analysis of observational studies and qualitative analysis were performed for evidence synthesis. A protocol was registered with PROSPERO (CRD42021296952).

Findings: Out of 17,088 records, we included 370 reports in the review. For the quantitative studies (n = 65; mainly from high income countries), meta-analysis with over 53 million participants studied showed that, compared to non-migrants, migrants have an elevated risk of infection (RR = 1.84; 95%-CI: 1.44–2.35) but similar risk for hospitalisation (RR = 1.10; 0.91–1.33), while the probability of ICU admission was higher (RR = 1.23; 0.99–1.52). Among those hospitalised, migrants had a lower risk of mortality (RR = 0.56; 0.42–0.76), while their population-based mortality tended to be higher (RR = 1.46; 0.95–2.26). The qualitative synthesis (n = 75) highlighted the complex interplay of social and COVID-19-related factors at different levels. This involved increased exposure, risk, and impact of pandemic measures that compromised the health of migrants.

Interpretation: Even in the advanced stages of the pandemic, migrants faced higher infection risks and disproportionately suffered from the consequences of COVID-19 disease, including deaths. Population-level interventions in future health emergencies must better consider socio-economic, structural and community-level exposures to mitigate risks among migrants. Enhancing health information systems is crucial, as the lack of migration variables makes it difficult to close coverage gaps, leaving migrants largely ‘invisible’ in official data.

Methods: Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers’ (HCPs) perspectives on the barriers to young men’s access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women).

Results: We developed three themes: 1) It’s about the youth clinics and those working in them—the clinics suffered from low organizational support, which affected their ability to accommodate young men’s needs and were perceived as “girls’ clinics”. Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women’s profession for women’s SRH; 2) It’s not all about the youth clinics—young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access—the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns.

Conclusion: There is a need for societal efforts to increase young men’s knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.

Background: Sweden has welcomed migrants, but attitudes have shifted, becoming hostile due to populism and the growing number of migrants. This has left migrants feeling unwelcome and marginalized. Few studies have examined the extent to which migrants perceive discrimination, who, why, where and its relationships with different outcomes. This study has two aims: to assess the prevalence, reasons, and determinants of perceived discrimination among migrants (1) and its associations with self-rated health, sexual health, healthcare use, and integration (2).

Methods: We analysed data from a 2018 survey on migrants' sexual and reproductive health and rights. The survey included 1740 migrants aged 16 or older. We used descriptive and log-binomial regression analyses to estimate prevalence, crude and adjusted prevalence ratios (APR) with 95% confidence interval (CI).

Results: About 36% of participants perceived discrimination in Sweden, with ethnic origin (62%) and religion (35%) as main reasons. Perceived discrimination occurred in public spaces (47%), schools (33%), internet (20%), work (19%), public services (18%), residential areas (16%), and healthcare settings (10%). Migrant men (APR: 1.26, CI:1.07–1.49), born in Middle East and North Africa (APR: 1.57, CI:1.26–1.95) and South Asia (APR: 1.61, CI:1.27–2.04) regions, with more than 12 years of education (APR: 1.33, CI:1.10–1.60), a non-heterosexual orientation (APR: 1.21, CI: 1.02–1.43), a non-Christian religion (APR: 1.41, CI: 1.10–1.80), economic stress (APR:1.67, CI: 1.44–1.93) or Swedish language skills (APR: 1.24, CI:1.07–1.43) perceived discrimination more than their counterparts. In contrast, the oldest participants (46 years or more) perceived less discrimination (APR:0.55, CI: 0.37–0.80) than the youngest ones (16–25 years). Moreover, perceived discrimination was associated with poor self-rated general (APR:1.72, CI: 1.45–2.04) and sexual health (APR:1.40, CI:1.2–1.64), integration (APR:1.25, CI:1.14–1.37), and healthcare access (APR: 1.48, 1.16–1.89).

Conclusions: This study shows that migrants in Sweden face widespread perceived discrimination based on ethnicity and religion. This can affect their health, healthcare use, and social integration. The study calls for policies and interventions that tackle systemic perceived discrimination, foster inclusion, and guarantee equal opportunities in accessing healthcare and resources for migrants. It also urges support for vulnerable groups who perceive more discrimination, such as migrants from certain regions or under economic stress.

Background: Efforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys’ and young men’s access to youth clinics in Sweden.

Methods: Employing a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden – chosen for their demographic and geographic diversity – will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness.

Discussion: The added value of this project is generating robust evidence regarding boys and young men’s involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men’s SRH; (2) informing future young men’s health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men’s participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.

Background: Young migrants are particularly vulnerable to SV (SV) due to their age and the challenges of migration. However, there is limited knowledge regarding SV among young migrants in Sweden. This study aims to assess the prevalence, determinants, perpetrators, and reporting patterns of SV and rape.

Methods: We analyzed data from the 2018 survey on migrants’ sexual and reproductive health and rights, involving 1773 migrants aged 16–29. We estimated prevalence rates and calculated crude and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) using descriptive and log-binomial regression analyses.

Results: The overall prevalence of SV was 25.1%, with rape at 9%. Higher SV prevalence were reported by non-binary individuals (APR: 2.60, CI: 1.54 to 4.38), Lesbian, Gay, Bisexual and Asexual (LGBA) individuals (APR: 1.56, CI: 1.22 to 2.01), those with 10–12 years (APR: 1.35, CI: 1.04 to 1.74) and over 12 years of education (APR: 1.61, CI: 1.23 to 2.11), and migrants awaiting asylum decisions (APR: 1.67, CI: 1.25 to 2.23). Rape prevalence was higher among those born in non-conflict settings (APR: 2.38, CI: 1.43 to 3.97), non-binary individuals (APR: 3.32, CI: 1.35 to 8.18), and LGBA individuals (APR: 1.68, CI: 1.02 to 2.75). Although men reported higher SV and rape levels than women in descriptive and bivariate analyses, these differences were not significant in multivariate analyses. Perpetrators included strangers (46.3%), partners (24.8%), family/friends (15.8%), and colleagues (15.4%). Most survivors did not report SV (63.7%) but confided in friends/relatives (29%) and trusted individuals like teachers/counselors (9.5%), with fewer reporting to authorities (3.4%).

Conclusion: The findings urge policymakers to prioritize targeted interventions, raise awareness, provide comprehensive support services tailored to the diverse needs of migrant groups, various perpetrator types, and the individual, systemic, and structural factors influencing reporting behaviors. These initiatives should adopt a migration-trajectory approach that recognize that migrants may have experienced SV throughout their journey and consider the unique experiences and vulnerabilities of non-binary individuals, LGBA individuals, those with low education levels, and migrants without formal residence status, regardless of their origin.

Background: Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants’ sexual and reproductive health (SRH) is rarely studied in Sweden.

Objectives: To explore young migrants’ understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

Methods: This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

Results: Young migrants understood SRH as both ‘essential’ and ‘a right.’ Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the ‘open environment,’ however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services’ quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

Conclusion: The access of young migrants to SRH services is facilitated by an ‘open environment’ and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.