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Nkulu Kalengayi, F. K., Baroudi, M. & Hurtig, A.-K. (2024). Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden. BMC Public Health, 24, Article ID 699.
Open this publication in new window or tab >>Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden
2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, article id 699Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-221889 (URN)10.1186/s12889-024-18160-2 (DOI)38443834 (PubMedID)2-s2.0-85186878462 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2024-03-07 Created: 2024-03-07 Last updated: 2024-03-18Bibliographically approved
Baroudi, M. (2023). Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden. Global Health Action, 16(1), Article ID 2251783.
Open this publication in new window or tab >>Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden
2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2251783Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Culture, quality of healthcare, sexual education, cultural sensitivity, youth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-214373 (URN)10.1080/16549716.2023.2251783 (DOI)37698930 (PubMedID)2-s2.0-85170701088 (Scopus ID)
Funder
Public Health Agency of Sweden Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0235
Available from: 2023-09-12 Created: 2023-09-12 Last updated: 2023-10-02Bibliographically approved
Hintermeier, M., Pernitez-Agan, S., Lopez, J., Wickramage, K., Gottlieb, N., Baroudi, M., . . . Bozorgmehr, K. (2023). Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature. Paper presented at 16th European Public Health (EPH) Conference, Dublin, Ireland, November 8-11, 2023. European Journal of Public Health, 33(Supplement_2), Article ID ckad160.550.
Open this publication in new window or tab >>Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature
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2023 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no Supplement_2, article id ckad160.550Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-216065 (URN)10.1093/eurpub/ckad160.550 (DOI)
Conference
16th European Public Health (EPH) Conference, Dublin, Ireland, November 8-11, 2023
Note

Volume 33, Issue Supplement_2, October 2023: 16th European Public Health Conference 2023 Our Food, Our Health, Our Earth: A Sustainable Future for Humanity Dublin, Ireland, 8–11 November 2023

Available from: 2023-10-31 Created: 2023-10-31 Last updated: 2023-11-01Bibliographically approved
Pettersson, J. & Baroudi, M. (2023). Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: insights from healthcare providers in youth clinics. Sexual & Reproductive HealthCare, 39, Article ID 100942.
Open this publication in new window or tab >>Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: insights from healthcare providers in youth clinics
2023 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100942Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-217528 (URN)10.1016/j.srhc.2023.100942 (DOI)38091863 (PubMedID)2-s2.0-85179753362 (Scopus ID)
Funder
Public Health Agency of Sweden Forte, Swedish Research Council for Health, Working Life and Welfare, 2023-01314
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2023-12-27Bibliographically approved
Mengesha, Z., Hawkey, A. J., Baroudi, M., Ussher, J. M. & Perz, J. (2023). Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research. Sexual Health, 20(1), 20-34
Open this publication in new window or tab >>Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research
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2023 (English)In: Sexual Health, ISSN 1448-5028, E-ISSN 1449-8987, Vol. 20, no 1, p. 20-34Article, review/survey (Refereed) Published
Abstract [en]

Australia’s National Men’s Health Strategy 2020–2030 identifies refugee and migrant men from culturally and lingustically diverse backgrounds as priority groups for sexual and reproductive health (SRH) interventions. The paucity of SRH research focusing on refugee and migrant men is a significant gap to advance men’s health and policy. Hence, this review aimed to synthesise the available evidence on refugee and migrant men’s SRH needs, understandings and experiences of accessing services after resettlement in Australia. A systematic search of peer reviewed literature in PubMed, Scopus, and PsyInfo was made. A World Health Organization framework for operationalising sexual health and its relationship with reproductive health was used to map the identified studies. The socio-ecological framework was applied to thematically synthesise data extracted from individual studies and identify factors that influence the SRH of refugee and migrant men. We included 38 papers in the review. The majority of sexual health studies (16) were about sexually transmitted infections (STIs), mainly HIV (12), followed by sexual health education and information (5) and sexual functioning (3). Reproductive health studies focused on contraceptive counselling and provision (3), antenatal, intrapartum and postnatal care (1) and safe abortion care (1). Several factors influenced refugee and migrant men’s SRH, including a lack of access to SRH information, language barriers and stigma. We found that SRH literature on refugee and migrant men focuses on STIs, meaning other areas of SRH are poorly understood. We identified key gaps in research on experiences of, and access to, comprehensive SRH care.

Place, publisher, year, edition, pages
CSIRO Publishing, 2023
Keywords
Australasia, health promotion, health services, men, migrant and mobile populations, refugee, reproductive health, sexual health.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-200462 (URN)10.1071/SH22073 (DOI)000870152200001 ()36261118 (PubMedID)2-s2.0-85141369043 (Scopus ID)
Available from: 2022-10-20 Created: 2022-10-20 Last updated: 2023-08-02Bibliographically approved
Baroudi, M., Goicolea, I. & Hurtig, A.-K. (2023). The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?. Journal of Migration and Health, 7, Article ID 100153.
Open this publication in new window or tab >>The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?
2023 (English)In: Journal of Migration and Health, ISSN 2666-6235, Vol. 7, article id 100153Article in journal (Refereed) Published
Abstract [en]

Although migrant men constitute a large and growing proportion of men in Sweden, literature exploring migrant men's experiences in sexual and reproductive health (SRH) services is scarce. We aimed to explore how Arabic-speaking migrant men perceive and experience information and services related to SRH in Sweden. We conducted 13 semi-structured interviews with Arabic-speaking migrant men and analysed the data using reflexive thematic analysis. We developed four themes: 1) SRH is ‘something essential in life’; 2) the good: a transition to a ‘new open society’; 3) the bad: barriers to sexual education and health services; and 4) the why: blaming oneself or the system. SRH services and sexual education/information were perceived as needs and rights, and the participants were content with the new possibilities and the ‘new open society’. However, sexual education was not provided to most migrants, and SRH services provided to men had shortcomings that deprived some migrant men from fulfilling their needs. Moreover, internalised and cultural racism created a challenge to receive adequate/acceptable SRH services. There is a need to provide comprehensive sexual education for all, strengthen SRH services provided to men, and develop an action plan to reinforce the anti-discrimination/racism policies in healthcare and society.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Sexual and reproductive health, Cultural racism, Internalised racism, Arabic-speaking, Men
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-204319 (URN)10.1016/j.jmh.2023.100153 (DOI)000967407100001 ()2-s2.0-85147102590 (Scopus ID)
Available from: 2023-02-01 Created: 2023-02-01 Last updated: 2023-09-05Bibliographically approved
Baroudi, M., Nkulu Kalengayi, F., Goicolea, I., Jonzon, R., San Sebastian, M. & Hurtig, A.-K. (2022). Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey. International Journal of Health Policy and Management, 11(3), 287-298
Open this publication in new window or tab >>Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey
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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
Keywords
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:nbn:se:umu:diva-173748 (URN)10.34172/ijhpm.2020.123 (DOI)000719952400001 ()32729283 (PubMedID)2-s2.0-85108111651 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2020-07-30 Created: 2020-07-30 Last updated: 2023-03-24Bibliographically approved
Lukyamuzi, Z., Nabisere, R. M., Nakalega, R., Atuhaire, P., Kataike, H., Ssuna, B., . . . Butler, L. M. (2022). Community health workers improve HIV disclosure among HIV-affected sexual partners in rural Uganda: a quasi-experimental study. Global Health: Science and Practice (GHSP), 10(5), Article ID e2100631.
Open this publication in new window or tab >>Community health workers improve HIV disclosure among HIV-affected sexual partners in rural Uganda: a quasi-experimental study
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2022 (English)In: Global Health: Science and Practice (GHSP), ISSN 2169-575X , Vol. 10, no 5, article id e2100631Article in journal (Refereed) Published
Abstract [en]

Background: We evaluated the efficacy of a community health worker (CHW)–led intervention in supporting disclosure among adults living with HIV in heterosexual relationships.

Methods: We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure.

Results: Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25–37) years, the majority were women (76.5%), and most (80%) did not know their partners’ HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39).

Conclusion: CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.

Place, publisher, year, edition, pages
Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-199639 (URN)10.9745/GHSP-D-21-00631 (DOI)000893122400016 ()36316143 (PubMedID)2-s2.0-85140935391 (Scopus ID)
Available from: 2022-09-22 Created: 2022-09-22 Last updated: 2023-09-05Bibliographically approved
Teferi, H. M., San Sebastian, M. & Baroudi, M. (2022). Factors associated with home delivery preference among pregnant women in Ethiopia: a cross-sectional study. Global Health Action, 15, Article ID 2080934.
Open this publication in new window or tab >>Factors associated with home delivery preference among pregnant women in Ethiopia: a cross-sectional study
2022 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 15, article id 2080934Article in journal (Refereed) Published
Abstract [en]

Background: Home delivery is associated with a high risk of maternal and neonatal mortality. The prevalence and factors associated with home delivery have been studied retrospectively among women in Ethiopia. However, no national studies have assessed pregnant women’s preferences for home delivery.

Objective: To assess factors associated with preferences for home delivery among pregnant women in Ethiopia.

Methods: We analysed a sample of 678 pregnant women derived from the 2019 performance monitoring for action cross-sectional survey. The association between pregnant women’s preferences for home delivery and several individual, household, healthcare, and community factors were explored through log-Poisson regression with robust variance.

Results: The weighted prevalence of pregnant women’s preferences for home delivery in Ethiopia was 33%. Pregnant women between the ages of 15–19 years (PR = 2.3; 95% CI: 1.43–4.00) had a higher preference for home delivery compared to those above 34 years. Those who had no Antenatal care (ANC) visit in the current pregnancy (PR = 1.5; 95% CI: 1.11–2.11), multipara women (PR = 1.8; 95% CI: 1.19–2.92) those who did not discuss place of delivery with their partners (PR = 1.5; 95% CI: 1.18–2.10), did not participate in a community-based program called ‘1 to 5’ network meetings (PR = 4.5; 95% CI: 1.09–18.95), and those who perceived low community support for facility delivery (PR = 2.2; 95% CI: 1.53–3.20) had a higher prevalence of home delivery preference compared to their references.

Conclusions: A significant proportion of pregnant women preferred home deliveries in Ethiopia. Household and community supporting factors such as not discussing place of delivery with a partner, not participating in women developmental army meetings, and perceived low community support were associated with preference for home delivery. Interventions should address these factors to increase facility deliveries in Ethiopia.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
Home delivery, preference, community, maternal health, Ethiopia
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-198248 (URN)10.1080/16549716.2022.2080934 (DOI)000828880400001 ()35867544 (PubMedID)2-s2.0-85134597523 (Scopus ID)
Available from: 2022-07-24 Created: 2022-07-24 Last updated: 2022-08-01Bibliographically approved
Baroudi, M. (2022). Leaving the door ajar: young migrants’ sexual and reproductive health in Sweden. (Doctoral dissertation). Umeå: Umeå universitet
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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0609-8745

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