Migration and equity in sexual and reproductive health

What is the project about?

The overall goal for the project is to contribute to improved care for migrants from the Middle East and Somalia by increasing the knowledge of how value conflicts and cultural change are to be managed in the health care sector.

International comparisons show that Swedes' values are liberal, individualistic and pro equality to a greater extent than other populations. This means that their values in sexual and reproductive health and rights (SRHR) can be quite different from the dominant values of other countries. These values are also evident in the Swedish laws, such as the right to deny sex between spouses.

Swedish values are also evident in Swedish institutions, e.g. youth clinics where minors can receive sexual counseling and contraception without parental consent. Sweden is a multicultural country where many residents come from the Middle East region and Somalia, areas where commonly held values can stand in sharp contrast to those on which Swedish society, public health efforts and care are based. From previous research, we know that migrant women from these areas have poorer delivery outcomes, lower contraceptive use and more abortions than Swedish women.

According to current policy documents, staff in reproductive healthcare are encouraged to incorporate gender equality perspectives, while at the same time providing culturally sensitive care. It has proved challenging for healthcare professionals to provide care in meetings with individuals with values that differ from those on which Swedish society is based. In the healthcare provider and patient appointment sensitive topics such as reproduction, sex and cohabitation can lead to tensions, misunderstandings and ultimately a deterioration in appropriate care. Research on how healthcare systems handle these challenges is scarce. One explanation for this may be that research questions include difficult topics to study in an academic discipline alone, and require knowledge from both medical and social science research, which we hope the proposed research environment will remedy.

Research questions

• How and when do gender-related values change among newly arrived Middle East migrants?
• How could sexual and reproductive health (SRH) care be tailored, involving all relevant stakeholders, to best address value conflicts in clinical encounters with migrants?
• Can a participatory community based intervention involving the Swedish Somali diaspora change attitudes towards FGC among practicing families in Somalia?
  

To answer these questions, the research program uses both quantitative and qualitative methods. The data will be collected via surveys and focus group discussions between healthcare providers and migrants from the Middle East and Somalia.

Participants

• Uppsala University
• Institute for Future Studies
• Malmö University
• Karolinska Institutet
• Dalarna University

The project is interdisciplinary and conducted in collaboration between researches in Reproductive Health, Anthropology, Social Work and Norm Research. Both senior and junior researchers are included in the research environment, some with unique expertise based on their background in the Middle East and Somalia.

The research will be co-produced with health care providers and migrants from the Middle East and Somalia.

Publications

Arousell, J., Carlbom, A., Johnsdotter, S., Essén, B. (2019). Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research. Midwifery, 75: 59-65 https://doi.org/10.1016/j.midw.2019.03.017

Arousell, J., Carlbom, A., Johnsdotter, S., Essén, B. (2019). Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors. Sexuality & Culture, 23(4): 1230-1249 https://doi.org/10.1007/s12119-019-09614-6

Palm, C., Essén, B., Johnsdotter, S. (2019). Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind-body dualism affecting social and health care professionals' perspectives. Sexual and reproductive health matters, Taylor & Francis Group. 27(1)https://doi.org/10.1080/26410397.2019.1615364

Wahlberg, A., Essén, B., Johnsdotter, S.(2019). From sameness to difference: Swedish Somalis’ post-migration perceptions of the circumcision of girls and boys. Culture, Health and Sexuality, 21(6): 619-635 https://doi.org/10.1080/13691058.2018.1502472

Wahlberg, A., Johnsdotter, S., Ekholm Selling, K., Essén, B.(2019). Shifting perceptions of female genital cutting in a Swedish migration context.PLoS ONE, 14(12)https://doi.org/10.1371/journal.pone.0225629

Emtell Iwarsson, K., Larsson, E., Gemzell-Danielsson, K., Essén, B., Klingberg-Allvin, M. (2019).Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden. BMJ sexual & reproductive health, BMJ Publishing Group Ltd. 45(2): 118-126. https://doi.org/10.1136/bmjsrh-2018-200171

Essén B. One Genital, Two Judgments: Why Do “Expert Witnesses” Draw
Different Conclusions in Suspected Cases of Illegal Cutting of Girls’ Genitals? In Johnsdotter S. (Ed.), Female Genital Cutting. The Global North and South pp. 259–287. 2020. DOI: 10.24834/isbn.9789178771240. Malmö: Malmö University. https://www.diva-portal.org/smash/get/diva2:1508633/FULLTEXT01.pdf

Essén B, Mosselmans L. How to ensure policies and interventions rely on strong supporting facts to improve women’s health: the case of Female Genital Cutting, using Rosling’s Factfulness approach. Acta Obstet Gynecol Scand. 2021 Apr;100(4):579-586. DOI: 10.1111/aogs.14059.

Palm C, Johnsdotter S, Elmerstig E, Holmström L, Essén B. Adolescent sexual and reproductive health counselling in relation to female genital cutting: Swedish professionals’ approach to menstrual pain as an empirical example. Sexuality & Culture, 2021, DOI: 10.1007/s12119-021-09895.

Hanberger A, Essén B, Wahlberg W. Attitudes towards comparison of male and female genital cutting in a Swedish Somali population. Acta Obstet Gynecol Scand, Apr;100(4):604-613, 2021, DOI: 10.1111/aogs.14114.

Åkerman E, Larsson E, Essén B, Westerling R. Understanding the needs and use of sexual and reproductive health services among Thai women: A descriptive cross-sectional study in Sweden. Sex Health. 2021 Jul;18(3):203-211. DOI: 10.1071/SH20184.