The health and working conditions of female immigrants in Sweden

Sweden is one of the European countries that has gradually changed from a mainly ethnically homogeneous society into a multi-ethnic society. This change began in the late 1940s and has increased in pace, especially since the early 1960s. The overall aim of this thesis is to understand, describe and analyze the factors that contribute to poor health among female immigrants in Sweden, from the perspectives of class, gender and ethnicity.

This thesis is based on four different studies. The first study had a qualitative, longitudinal design. It was based on semi-structured interviews with ten (10) female Iranian immigrants aged 25-50 years old. The interviews were conducted on two occasions, in 1996 and 2002. The purpose was to identify and analyze the women's perception of various factors which had influenced their health over time. The second study had a cross-sectional design and consisted of 60 unemployed with immigrant or refugee backgrounds, 30 women and 30 men. The aim was to analyze the health of immigrants in relation to unemployment status and sick leave absences from a gender perspective. Both qualitative and quantitative methods were used for data collection. The third study was cross-sectional in design and consisted of 2,429 native and immigrant female employees in a municipality in the suburbs of Stockholm, in Sweden. The purpose was to study the work-related factors that influenced the health of female immigrants. The fourth study combined an explanatory approach with a cross-sectional design using qualitative data from semi-structured interviews. The studied group consisted of twenty (20) female immigrants who worked in different departments of a municipality in the suburbs of Stockholm. The aim of the study was to explore the work-related factors that affected the health of female immigrants.

The main findings in this thesis show that there is an interaction between health, work and migration. Adverse health was more evident among female immigrants who were either unemployed or on sick leave, than among male immigrants in a similar position. There was a strong association between the work-related health of female immigrants and social class. The three aspects based on class were wages, professional status and position in the hierarchical work organization. This thesis shows that the health of female immigrants cannot be attributed solely to "cultural differences", but that it must also be viewed within the contexts of class, gender and ethnicity. From the accounts of the interviewed women, two new insights on the factors that influence the health of female immigrants during the postmigration period can be put forward. Firstly, female immigrants may overcome some healthrelated factors such as domestic violence or experiences of traumatic events during the first decade of the post-migration period. However, the effects of other health determinants such as unemployment or experiences of discrimination and racism were observed even two decades after migration. Secondly, the impact of ethnic discrimination on health is not alleviated by the length of stay in the host country or by higher socioeconomic status. The only aspect that may have changed concerns the strategies used in coping with discrimination. The length of stay, entering the labor market and a more favorable socioeconomic status seem to result in better management and improved strategies for coping with ethnic discrimination. The thesis contributes new insights on the ethnic and gender discrimination that occurs regardless of a female immigrant's position in the organizational hierarchy. Nevertheless, the mechanism of discrimination can be different for those who are employed in low-status professions. This shows that class still matters and is a very important factor in public health research. As such, it should not be ignored in studies on health in relation to ethnicity.

The public health implications of the findings in this study suggest that public health policies aimed at female immigrants should provide a good introduction and access to health information to new arrivals. Specific measures are needed to recognize female immigrants' pre-migration work experience and academic qualifications in order to counteract the deskilling process, a process which results in unemployment, long-term social exclusion or employment in low-status professions with low incomes. Strategies for tackling ethnic discrimination/racism are needed, particularly on the labor market and in workplaces. Policies to stimulate an increase in the opportunities for mobility for female immigrants on the labor market are needed, especially for those who work in jobs with low status and low pay.

List of scientific papers

I. The health of female Iranian immigrants in Sweden - A qualitative six-year follow-up study (2006). Akhavan S, Bildt CO, Wamala S. [Accepted]
https://doi.org/10.1080/07399330701206240

II. Akhavan S, Bildt CO, Franzen EC, Wamala S (2004). Health in relation to unemployment and sick leave among immigrants in Sweden from a gender perspective. J Immigr Health. 6(3): 103-18.
https://pubmed.ncbi.nlm.nih.gov/15269514

III. Akhavan S, Bild CO, Wamala S (2006). Work-related health factors among female immigrants in Sweden - A qualitative study on a sample of twenty workers. [Accepted] 
https://doi.org/10.2427/5951

IV. Akhavan S, Bild CO, Wamala S (2005). Work-related health factors among female immigrants in Sweden. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/17312345