Sexual and reproductive health and rights among newly arrived migrants in Sweden : knowledge gaps and healthcare challenges

Abstract

Introduction: Migration is one of today’s most pressing issues, especially concerning sexual and reproductive health and rights (SRHR) and human rights. Migrants may face heightened health vulnerabilities due to challenges such as legal status, language, and cultural differences, which can further restrict their access to sexual and reproductive healthcare (SRH) services in a new country. In addition to these challenges, newly arrived migrants in Sweden, especially the youth, face more significant risks of SRHR violations and experience greater inequities in accessing SRH services due to issues such as unfamiliarity with the Swedish health system, long waiting times, language barriers and costs. Another issue is that migrants in Sweden often delay accessing these services until it is critical, contributing to challenges such as late HIV diagnoses among this group.

Aim: To identify the knowledge gaps and barriers affecting the utilisation of sexual and reproductive healthcare services and provide a comprehensive understanding of the identified challenges and needs related to SRHR among migrants in Sweden.

Methods: Study I. Perspectives of Healthcare Providers - was a qualitative study involving midwives, nurses, and counsellors providing SRH services in Stockholm. This study aimed to understand their experiences and perspectives on barriers and their strategies for improving the provision of sexual and reproductive health to young migrants. Twelve interviews were transcribed and analysed using an inductive content analysis. Study II. Knowledge of SRHR-related laws - was a large anonymous cross-sectional survey conducted primarily at Swedish language schools (SFI) among over 6000 newly arrived migrants in Sweden during 2018-2019. This study aimed to assess factors related to incorrect knowledge of the Swedish abortion law and other key legal issues of SRHR among recently arrived migrants in Sweden. Descriptive statistics were computed, and multivariable logistic regression (including n=3,557 with complete answers for the question on the Swedish abortion law) was used for analysis. Similarly, Studies III and IV used the same primary survey data described above. In Study III, we aimed to assess sociodemographic differences and determinants of knowledge about condoms, contraception, and HIV to identify information needs on SRHR among recently arrived migrants, using descriptive statistics and multivariable logistic regression (n=3,433). In Study IV. Social and cultural norms on SRHR-related areas, we aimed to assess how sociodemographic factors have influenced recently arrived non-European migrants’ perspectives on gender norms, including eight statements on attitudes towards contraception and marriage (e.g. Contraceptives should only be available to those who are married). This cross-sectional study assessed the responses (n=4,473) using descriptive statistics, Kruskal-Wallis/Mann-Whitney tests, and logistic regression.

Findings: Healthcare providers encounter numerous challenges in the provision of SRH services to young migrants, mainly due to a lack of awareness about SRHR among migrants, trust issues, language barriers, and the need for enhanced collaboration. To overcome these challenges, the providers proposed several suggestions and improvements, including how to build trust through cultural organisations, ensure consistent interpreters, integrate sexual and reproductive health services with wider healthcare networks, and establish direct connections with migrants in their communities (Study I). A lack of knowledge among newly arrived migrants regarding the Swedish abortion law and other SRHR-related laws in Sweden was found. The factors contributing to this incorrect knowledge were having religious beliefs, originating from a country with restrictive abortion laws, having lower education levels, and having a temporary residence permit (Study II). There is a lack of knowledge among women and younger migrants on the preventative measures of condoms against HIV, as well as those with low education levels and no previous sexual health education. We found that approximately 42% of the respondents were unaware that condom use could lower the risk of HIV infection, while surprisingly, 39% did not know that they could prevent pregnancy the use of condom. Migrants from South Asia and the Americas had particularly greater knowledge gaps on HIV, and more than half (64%) of the migrants expressed a need for more information on SRHR (Study III). The eight statements from the gender norms module on marriage and attitudes towards contraceptives were assessed individually, and differences in perspectives were mainly found among young age groups (15-19 years) and those aged 40 years or older. Short duration in Sweden and those without a residence permit were associated with decreased odds by 63% and 87%, respectively, to show supportive attitudes (i.e. access to contraceptive methods) related to the gender norms in the module. One-fifth (20%) of respondents strongly agreed that contraceptive use should be limited to married couples, and 11% believed that girls are ready for marriage after menstruation. Approximately one-third (30%) of the respondents selected don’t know or do not want to answer to the gender norms-statements on contraception and marriage. (Study IV).

Conclusion: Engaging newly arrived migrants with sexual and reproductive health services in Sweden presents both challenges and opportunities. A primary obstacle is the limited awareness of SRHR, specifically on the legal aspects such as abortion and sexual consent, contraceptive methods, and HIV within the migrant community. Secondly, healthcare providers face difficulties fully or accurately translating sensitive information and establishing trust with this group. Healthcare providers recommended forming strategic connections with networks within migrant communities and employing experienced interpreters who can assist in communicating sexual and reproductive health services to young migrants in Sweden. There are considerable knowledge gaps among migrants about Sweden’s SRHR laws, which were found to be associated with factors such as religious beliefs, educational backgrounds, and legal status. Specifically, women and younger migrants had a limited understanding of SRHR topics, including HIV, highlighting a need for targeted educational interventions. Furthermore, there is an identified need for further research to explore the positive attitudes towards SRHR within migrant communities, especially among those who have recently arrived in Sweden, and how these can facilitate better engagement with sexual and reproductive health services.