Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden

Social influences on Moroccan and Pakistani immigrant women's access and use of cervical cancer screening in Catalonia, Spain: a social network analysis

BACKGROUND

Participation in cervical cancer (CC) screening programs is lower among immigrants compared to native women in many Western countries, in substantial due to lower knowledge and culturally influenced attitudes regarding self-care and prevention. Education and information programs alone have limited impact on individuals' attitudes and behaviours, but may be bolstered by social influence methods such as peer support.

METHODS

In this study, we combined self-reported quantitative structural social network data with qualitative narratives and graphs to describe the social context of 12 Moroccan and 10 Pakistani immigrant women living in Catalonia, Spain. We used a survey protocol and semi-structured interviews to explore how women's contacts influence their CC screening behaviours.

RESULTS

We identified strong gender and ethnic homophily in these women's social networks. Despite maintaining frequent remote contact with their family ties, their immigrant peers were more influential in providing health information and advice. Furthermore, the women's husbands played two conflicting roles as health promoters and as a barrier to the use of health prevention services.

CONCLUSION

Our findings highlight the need to incorporate tailored social influence approaches in the design of behaviour change interventions. In this case, the use of peer-based programs to increase CC screening uptake among these two immigrant communities.

Awareness and utilization of Swedish youth clinics among migrants enrolled in Swedish language programmes: a cross-sectional study

BACKGROUND

Previous research has highlighted inequalities in access to Swedish youth clinics (YCs). These inequalities exist not only between non-migrant and young migrant populations but also within various migrant groups.

OBJECTIVES

To assess awareness and utilization of Swedish YCs among migrants enrolled in Swedish language programmes and explore associated factors.

METHODS

This cross-sectional study involved 1,112 migrants aged 15-65. The analytical sample included 642 (57%) participants who answered the main outcome question about awareness of YCs. Descriptive statistics, bivariate, and multivariate log-binomial regression analyses using a Bayesian approach were applied to summarize the data and identify factors associated with awareness and utilization of YCs among migrants.

RESULTS

The results revealed that 30% of all participants and 40% of the participants aged 15-25 years had heard of YCs. Additionally, 23% of the target group (15-25 years) had ever visited one. During descriptive and bivariate analyses, socio-demographic variations were evident in YCs' awareness and utilization. However, in multivariate analyses, only the associations between awareness and year of arrival, and YCs' utilization and year of arrival and type of residence permit, remained statistically significant.

CONCLUSION

This study highlights the level of awareness of YCs among migrants attending Swedish language programmes and their utilization by those aged 15-25 years, potentially impacting their access to crucial services and resources. Targeted interventions and sustainable strategies beyond one-time interventions are essential to address the specific needs of different socio-demographic groups and ensure equitable access to YCs' information and services.

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review

BACKGROUND

Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia.

METHODS

The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care.

RESULTS

A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling.

CONCLUSIONS

There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

Knowledge gaps related to HIV and condom use for preventing pregnancy: a cross-sectional study among migrants in Sweden

BACKGROUND

Information and knowledge of sexual and reproductive health and rights (SRHR) plays a crucial role in promoting safe sexual practices among young migrants. We aimed to assess the sociodemographic factors of migrants associated with knowledge of condoms and the prevention, treatment, and transmission of HIV to highlight the need for SRHR information, including comprehensive sexual health education.

METHODS

A cross-sectional survey was conducted (2018-2019) among migrants at Swedish language schools and high schools across Sweden. The survey included questions about knowledge of condom use for preventing pregnancy and HIV treatment and transmission. Descriptive statistics were calculated, and multivariable logistic regression analyses were performed to assess the responses to the knowledge questions and sociodemographic characteristics.

RESULTS

Out of 3430 respondents (median age: 35, interquartile range: 20), approximately 39% were unaware that condoms can prevent unplanned pregnancies. Only 58% of the respondents knew that condoms reduce the risk of contracting HIV. About 77% were unaware of HIV treatment, and 52% reported not knowing that a woman with HIV could transmit the virus to her baby during pregnancy or breastfeeding. Incorrect knowledge about condom use to prevent unwanted pregnancy was associated with several factors: younger age (15-19 years) adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI), 1.02-1.79); female respondents (aOR: 1.68; 95% CI 1.36-2.07); lack of previous sexual health education (aOR: 2.57; 95% CI 2.11-3.13); low level of education (aOR: 1.30; 95% CI 1.04-1.61). Originating from the Americas, European, or sub-Saharan African regions was associated with a 34-42% decreased likelihood of incorrect knowledge that condoms can reduce the risk of HIV infection compared to respondents from the Middle East and North Africa (MENA). More than half (64%) of respondents reported needing more SRHR information.

CONCLUSIONS

We found significant knowledge gaps on HIV and condom use for preventing pregnancy among migrants in Sweden. Comprehensive sexual health education in language schools, along with information to newly arrived migrants from diverse regional backgrounds and targeted sexual health services to younger individuals, women, and those who lack sexual health education, are needed to address these information gaps and provide crucial SRHR education and information.

Sexual and reproductive health (SRH) of women with mental illness (WMI) - An integrative mixed-method study

Background

Women with mental illness (WMI) are more likely to experience unreported sexual and reproductive health (SRH) problems. Mixed-method research studies with the strengths of quantitative and qualitative approaches provide deeper insight into SRH issues of WMI.

Methods

A sequential explanatory mixed-method design was used to understand better the SRH problems of WMI attending tertiary care psychiatry hospital. In phase 1, a survey was conducted to identify if they have SRH problems. Women who were identified to have SRH problems were part of Phase II. In this phase, in-depth interview was conducted to explore their lived-in experiences. Integration at the method level was adopted by connection through sampling. Using a narrative approach, integration was accomplished at the level of interpretation and reporting.

Results

Among the users, 261 (64.6%) female sterilization, 244 (93%) was the most common, and the other methods like coitus interruptus, male condoms, and intrauterine devices were reported less. Of the non-users, 137 (33.9%) WMI 100 (73%) were unaware of the best family planning approach. Most of them, 377 (93.3%), were ignorant about sexually transmitted infection (STI) symptoms. WMI reported 62 (15.3%) unusual foul-smelling vaginal discharge and 58 (14.4%) genital ulcers, with poor treatment-seeking behavior. Sexual dysfunction in desire, arousal, lubrication, orgasm, satisfaction, and pain were also reported. The findings were described in a single report based on the quantitative data followed by themes obtained from qualitative interviews using weaving techniques under the headings of contraceptive use and its awareness, prevalence of STI symptoms and its treatment, and sexual health experiences.

Conclusion

Data integration demonstrated that one-fourth of WMI had inadequate awareness of contraceptive use, were ignorant of STI symptoms, and experienced sexual dysfunction.

Immigrant men 's perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study

BACKGROUND

Male involvement in maternal health care has proven to be beneficial for improving maternal and child health and is often crucial in areas of family planning and contraceptive use. However, compared to male involvement in maternal health care, male involvement in contraceptive counselling is complex and controversial and thus faces certain challenges. Immigrant men in Sweden are often accompanying their partner for contraceptive counselling. Little is known about their presence and role.

AIM

To explore how immigrant men from the Middle East and Afghanistan perceive and experience accompanying their partner for contraceptive counselling provided by midwives in Sweden.

METHODS

Inductive qualitative content analysis guided the interpretation of data based on 21 individual in-depth interviews.

FINDINGS

Balancing conflicting values and norms about sexual and reproductive health and rights including family planning was challenging and confusing when living in Sweden. Contraceptive counselling was perceived as a joint visit, and men were often acting as decision makers. The midwife's role as a contraceptive counsellor was perceived as trusted, but knowledge was lacking about the Swedish midwifery model and the Swedish healthcare system. Providers' ways of communicating sensitive information were crucial. Without marriage contraceptive counselling was unthinkable.

CONCLUSION

Highlighting male engagement and including men's sexual and reproductive health at policy levels are necessary for improving women's sexual and reproductive health and rights. Additional and new ways of contraceptive counselling and midwifery services, such as outreach work and joint visits, are needed in order to reach both men and women.

The influence of social capital in the utilisation of sexual reproductive health services among the youth in Ghana. A community-based cross-sectional study

Social capital, often seen as the resources accessed through social connections, is currently gaining much attention in public health. However, limited studies have focused on the relationship between social capital and reproductive health services. Besides, while the factors associated with the use of reproductive health services among the youth are well documented in the literature, most studies have focused on narrowed perspective failing to take cognisance of the role of social capital. Yet, it is known that these behaviours can be influenced by social factors, which may be beyond the individual's control partly because the youth are embedded in social organisations. Therefore, this study examined the relationship between social capital and the youth's utilisation of reproductive health services.The study population comprised adolescents and young adults aged 15-24 years who were both in and out of school at the time of the survey. The study used a cross-sectional quantitative design involving a community-based household survey method to sample 792 respondents through multi-stage cluster sampling. The chi-square test examined the relationship between sociodemographic, social capital variables and reproductive health services. To account for potential confounding factors, a multivariable logistic regression model included variables from the binary logistic regression analysis with a p-value less than 0.05. In general, access to higher social capital was observed among 493 (62.2%). Almost half, 385 (48.6%) of the respondents have ever used at least one of the reproductive services examined in this study. After controlling all other significant predictors, the following social capital variables remained associated with increased utilisation of SRH services: higher trust in neighbourhood (AOR = 1.8; CI = 1.22-2.66), higher trust in people/institutions (AOR = 2.66; CI = 1.82-3.99), higher social cohesion (AOR = 3.35; CI = 2.21-5.08), stronger network (AOR = 7.55; CI = 4.43-12.87).Access to some social capital dimensions is associated with increased use of reproductive health services. However, any intervention such as mentoring including peer support programs, meant to address social capital needs in sexual and reproductive health should consider the efficacy of each social capital dimension and the intervention's environment.

Life satisfaction of multicultural married couples: Actor-Partner Interdependence Model analysis

We aimed to identify the actor and partner effects of health status, relationship satisfaction, and depression on the life satisfaction of married immigrant women and their husbands in South Korea. We used a cross-sectional design that included 2865 multicultural married couples with data from the 2015 national survey of multicultural families in Korea. We analyzed the data using path analyses within the Actor-Partner Interdependence Model (APIM) framework. Health status, depression, and relationship satisfaction had actor effects in both wives and husbands, while depression had no partner effects on either. Health status had partner effects only for wives, and relationship satisfaction had partner effects for both husbands and wives. Given that factors influencing life satisfaction differed in couples and since those with depression and poor health were more susceptible to lower life satisfaction, it is essential to introduce efforts to prevent depression and improve relationships considering differences of partner effects.

Knowledge and utilization of sexual and reproductive health services among young males in a slum area in Nigeria: A cross-sectional study

Background

Globally, young people are faced with sexual and reproductive health challenges such as unintended pregnancies, sexually transmitted infections and unsafe abortions which result from limited knowledge of sexual and reproductive health and poor utilization of the available services. The purpose of this study was to assess the sexual and reproductive health knowledge, pattern of service utilization, and the associated factors among young males in slum communities of Mushin Local Government Area (L.G.A), Lagos State, Nigeria.

Methods

The study was conducted among young males, 15-24 years in Mushin Local Government Area, Lagos State, Nigeria. Data was collected using a pre-tested structured questionnaire that consisted of three domains with 57 questions, and was interviewer-administered. Multi-stage sampling technique was used to select 422 participants. Descriptive statistics, bivariate analysis, and binary logistic regression were carried out using SPSS version 20.

Results

The mean age of the respondents was 21.01 years ± 2.00, and 73.06% of the respondents had good knowledge of sexual and reproductive health. 52.85% of the respondents had poor knowledge regarding the likely occurrence of pregnancy at mid-menstrual cycle. Nearly two-third (64%) of the respondents have ever visited a health facility for sexual and reproductive health service. Ethnicity(AOR = 2.73), access to the internet(AOR = 1.77) and having ever had sex(AOR = 1.96) were significantly associated with the utilization of the services.

Conclusion

Good knowledge of sexual and reproductive health was observed among the respondents, although misconceptions still exist. Service utilization, however, remains low due to some individual and socio-cultural factors. It is therefore important to increase awareness of Sexual and Reproductive Health, and make the services available and affordable to young people for increased uptake.

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?

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.

Factors associated with knowledge about family planning and access to sexual and reproductive health services by sexually active immigrant youths in Hillbrow, South Africa: a cross-sectional study

Background

In South Africa, universal access to health care services, including those relating to sexual and reproductive health (SRH) care, is contained in Section 27 of the Constitution and commits the country to supporting the United Nations 2030 Agenda for the Sustainable Development Goals (SDGs). The objective of this study was to examine the factors associated with knowledge about family planning and access to SRH services among sexually active immigrant youths in Hillbrow, South Africa.

Method

This cross-sectional study was based on data from a household survey conducted in Hillbrow during December 2019. Interviewer-administered questionnaires were used to collect information from immigrant youths (18–34 years old). Data on 437 sexually active respondents was analysed in STATA 14 using univariate, bivariate, logistic, and multinomial regression models. A p-value of < 0.05 was chosen as the level of significance.

Results

About half of the respondents had poor knowledge about family planning; about one-third (35%) of the immigrant youths had no access to SRH services, 42% had some access, and 23% had access. The adjusted logistic regression model showed that being a female (AOR = 3.85, CI: 2.34–6.35, belonging to age group 30–34 years (AOR = 3.88, CI: 2.00–7.53); belonging to the rich wealth index (AOR = 2.55 (1.32–4.93); not having received information about family planning (AOR = 0.17, CI = 0.10–0.29) and not using a contraceptive at the time of the survey (AOR = 0.37, CI: 0.19–0.70) were factors associated with having knowledge about family planning. The adjusted multinomial regression shows that the factors associated with not having access to SRH services were secondary or higher level of education (ARRR = 1.89, 95% CI = 1.06–3.36), belonging to the rich wealth quintile (ARRR = 2.25, 95% CI = 1.00–5.07), being undocumented (ARRR = 0.49, 95% CI = 0.27–0.88), having experienced discrimination in Hillbrow (ARRR = 2.06, 95% CI = 1.15–3.67) and having received information about family planning 6 months prior to the survey (ARRR = 0.49, 95% CI = 0.26–0.90, p-value < 0.05).

Conclusion

To move towards realization of the Constitution of South Africa, achieve the SDGs, and curb associated negative SRH outcomes, there is a need to advocate for the implementation of universal access to SRH services that is inclusive of immigrant youths.

Access to SRH services by adolescents and youths has been a serious public health concern globally. In South Africa, universal access to health care including reproductive health care services is contained in Sect. 27 of the Constitution. The country is committed to the 2030 Agenda of the SDGs with the theme “leaving no one behind”. The objective of this study was to examine the factors associated with knowledge about family planning and access to SRH services among sexually active immigrant youths in Hillbrow, South Africa. Interviewer-administered questionnaires were used to collect information on the socio-demographic, migration, and reproductive health characteristics from 439 sexually active immigrant youths in Hillbrow during December 2019. The data were analysed to assess the factors associated with knowledge about family planning and access to SRH services. The findings show that 46% of the immigrant youth had poor knowledge about family planning, while 35% had no access to SRH services, 42% had some access and only 23% had access. The study showed that the factors associated with knowledge about family planning are female respondents, from the rich income group, those in the older age category, those who received information about family planning 6-months prior to the survey and those using a contraceptive at the time of the survey. The factors associated with having no access to SRH services were those respondents having completed secondary education and higher, from the rich income group, undocumented immigrants, those respondents having experienced discrimination in Hillbrow, youths not having received information about family planning prior to the survey, and those not using a contraceptive. It is important to make access to SRH services available to immigrant youths to prevent associated negative SRH outcomes among the youths.

HIV among migrants in precarious circumstances in the EU and European Economic Area

HIV epidemics in the EU and European Economic Area are increasingly diverse in transmission modes and groups affected. Substantial gaps in data exist on HIV burden and access to the HIV continuum of care among migrants living in this region, particularly individuals in precarious circumstances such as migrants with irregular status. Migrants have a higher HIV burden compared with the general population, and high rates of post-migration HIV acquisition. Migrants also face challenges in access to health and HIV services, with irregular migrants, foreign-born key populations such as men who have sex with men, sex workers, and people who inject drugs, and migrants from sub-Saharan Africa being most affected. Intersecting factors negatively affect their access to services along the full continuum of care, including prevention and psychosocial services. Ensuring equitable access to general health and HIV services, regardless of immigration status, and implementing interventions to reduce stigma and discrimination are crucial to ending AIDS by 2030.

Childhood Origins, Migration, and First Modern Contraceptive Use in Turkey

This paper integrates contraception into the extant migrant-fertility framework using the case of internal migration within Turkey. Drawing from the 2013 Turkish Demographic and Health Survey data, we show that migration is positively associated with age of first modern contraceptive use. As women's migration is quickly followed by family formation, women also take up modern contraception after first childbirth, likely due to new encounters with medical professionals, differing contraceptive access and other social exposures. We also find that women whose childhoods were spent in urban areas have a higher risk of first modern contraception relative to women from rural areas, thus suggesting the enduring importance of socialization. These results show how selection processes, life-cycle factors, and sociocultural norms jointly shape modern contraceptive behavior in Turkey. Our results also demonstrate a need for increased reproductive care in rural areas and suggest continued fertility decline with urban migration.

Young migrants' sexual rights in Sweden: a cross-sectional study

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11672-1.

Migration and Contraception among Mexican Women: Assessing Selection, Disruption, and Adaptation

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women's contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands' solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants' reproductive health should recognize the deleterious effect of policies encouraging family separation. Healthcare must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Socioecological Factors Influencing Sexual Health Experiences and Health Outcomes of Migrant Asian Women Living in 'Western' High-Income Countries: A Systematic Review

Migrant health has been identified as one of the most pressing issues of the 21st century. Migration experiences are influenced by gender and gender norms and have important implications for the sexual health of migrant women. This systematic review explored socioecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in "Western" high-income countries. PRISMA guidelines were followed and this study was registered with PROSPERO. Five academic databases were searched for peer-reviewed articles published between 2000 and 2019. Of 2415 studies retrieved, 17 met the selection criteria: 12 qualitative, 4 quantitative, and 1 mixed-methods study. The four levels of Bronfenbrenner's socioecological model were applied to examine the individual, interpersonal, institutional, and societal factors of influence. Most studies (n = 13) reported individual level factors, focusing on knowledge and use of contraceptives. At a societal level, host country sociocultural factors, including gender and cultural norms, influenced knowledge, ability to access and utilise contraceptives, and access to health services. Findings suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.

Arabic speaking migrant parents' perceptions of sex education in Sweden: A qualitative study

BACKGROUND

It is well established that migrants underutilise sexual and reproductive health (SRH) services for structural and socio-cultural reasons. Sex education at Swedish schools is compulsory and an important part of Swedish upbringing, yet little is known about how migrants perceive this. This study examined migrant parents' views on sex education that their children receive at Swedish schools.

METHODS

This is a qualitative study using 14 focus group discussions (74 = n) with Arabic speaking migrant parents attending Swedish integration courses. Qualitative data analysis was used following Saldana's coding method.

RESULTS

Migrants' perceptions about sex education provided at Swedish schools are influenced by their home countries, where most participants received no sex education at schools and very little sex education at home. Therefore, values about sex in home countries and Sweden are often contrasting. Consequently, migrant parents are concerned about sex education that their children receive at Swedish schools. There are varied interpretations of sex education, concern over the content and methods taught, and there are numerous assumptions about potential negative effects of sex education.

CONCLUSION

The study echoes findings on intergenerational challenges in migrant families surrounding the topic of gender and sex, often brought on by discussions about sex education at schools. Innovative approaches are needed to support migrant parents as part of Sweden's effort to strengthen effectiveness and inclusiveness of sex education.

Understanding the needs and use of sexual and reproductive health services among Thai women: a descriptive cross-sectional study in Sweden

Background Immigrants are at increased risk of HIV infection in Europe and at risk of delayed diagnosis. In Sweden, Thailand belongs to one of the three most common countries of origin among immigrants diagnosed with HIV. This study investigated the need and use of sexual and reproductive health (SRH) services among Thai women residing in Sweden. Use of contraceptives and HIV testing in Thailand was also investigated to understand if this influences utilisation of SRH services in Sweden.

METHODS

A cross-sectional study using postal questionnaire to all Thai-born women (age 23-60) in Stockholm, residing in Sweden since 2014. The response rate was 52.3% (n= 266). Bivariate and multivariate logistic regression analyses were used.

RESULTS

The majority reported a significant need for information related to SRH services. Most of the women using contraception (70%) bought their contraceptives in Thailand. In total, 60% of the women had been HIV-tested at some point in their lives; the majority were tested in Thailand. Women who had been HIV-tested in Thailand were more likely to also have been tested in Sweden. Significant differences in contraception use, participation in contraceptive counselling and having had an HIV test were found between groups of younger and older women.

CONCLUSIONS

Our findings imply that age is an important factor to understand women's need and use of SRH services in Sweden versus Thailand. Furthermore, women's lack of knowledge and reported need for SRH information needs to be considered when making policies and strategies to increase access to SRH services.

Generational differences in current sexual behavior among Georgian reproductive-aged women

Background: Following the collapse of the Soviet Union, there was a pronounced change in the availability of modern contraceptive methods and an accompanying shift in the knowledge and attitudes of Georgian women related to sexual behaviors. This study describes differences in sexual behaviors, condom use and family planning practices among several generations of reproductive-aged Georgian women. Methods: Study participants were recruited from three large cities in Georgia. Women >25 years were recruited from the Cervical Cancer Screening National Program by consecutive sampling; those <25 years were recruited from universities using random sampling. Data collection included self-administered, anonymous surveys. Bivariate analyses were conducted and adjusted prevalence ratios (PR) with 95% confidence intervals were computed. Results: Among the 350 participants, independent predictors of age at first sexual intercourse were age (aPR 0.27; 95% CI 0.12-0.57), level of education (aPR 0.23; 95% CI: 0.11-0.44), marital status (aPR 2.8;95% CI:1.3-6.0) and religion (aPR 4.01; 95% CI:1.17-13.68). Younger women were more likely to have a premarital sexual relationship compared to older women (RR=0.85; 95% CI: 0.80-0.89); older women were also significantly more likely to use family planning methods with a current partner (RR=2.15; 95% CI: 1.48-3.13). Similarly, advanced education was associated with family planning (RR=1.66; CI: 1.13-2.45). Conclusions: This study describes clear generational differences in current sexual behavior among Georgian women of reproductive age and these differences, especially in age at first sexual intercourse, premarital sexual relationship and use of contraceptive methods, are influenced by age, level of education, marital status and religion. This information is vital to designing contextually appropriate strategies to prevent sexually transmitted infections.

Transnational marriages and the health and well-being of Thai migrant women living in Norway

Purpose

The purpose of this paper is to investigate the health and well-being of Thai immigrant women in transnational marriages.

Design/methodology/approach

Interviews with 13 Thai women living in Norway who have (had) a Norwegian spouse/partner were conducted and the transcripts were analysed using thematic analysis.

Findings

Initial culture shock and a mixture of employment issues, transnational ties, marital relationships and social networks intertwined to influence women’s health and well-being over time. Sending financial remittances to family in Thailand could be challenging due to struggles to obtain suitable employment, working in low-paid physical jobs and spouses’ lack of understanding of this cultural practice. Over time, these intertwined factors led to chronic stress and deteriorating health for some. Thai networks and friendships were important for emotional and practical support.

Practical implications

More organised assistance may be beneficial to facilitate integration, reduce social isolation and improve employment opportunities.

Originality/value

Research on Thai women has so far focused on their position as immigrant wives and the vulnerabilities to exploitation and abuse they face. Focusing on only discourses around marital relationships may be limiting when trying to understand factors that influence the health and well-being of Thai immigrant women.

A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden

OBJECTIVE

Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access, or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual and reproductive healthcare services among immigrant women in Sweden.

METHOD

A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed among immigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants. Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests, and logistic regressions were used for the analysis.

RESULTS

About one-third of the immigrant women reported lack of knowledge of where to go for contraceptive counselling. Experiencing lack of emotional social support and not having had children was associated with this lack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and this was associated with not having participated in a health examination. Almost 25% stated that their culture kept them back from using contraception.

CONCLUSION

Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women participating in Swedish language schools for immigrants could be considered as a missed opportunity, as all citizens in Sweden have free access to these services. New health policies and strategies should aim to increase knowledge of SRH services among immigrants. Swedish language schools could play an important role in increasing knowledge of SRH-related information as many new immigrants become students during their first years in Sweden.