Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden

ABSTRACT

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.

KEYWORDS:

• Culture
• quality of healthcare
• sexual education
• cultural sensitivity
• youth

Responsible Editor Maria Emmelin

Responsible Editor Maria Emmelin

Acknowledgments

I would like to acknowledge the supervisors of the thesis Prof. Anna-Karin Hurtig and Prof. Isabel Goicolea.

Authors contributions

The author wrote this PhD review article based on key findings from his PhD thesis and the four original articles attached to the thesis where he was the first author.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethical approval was granted by the Regional Ethics Committee at Umeå University [Dnr 2015–190-31O, 2017/515–31, and 2020–02816]. Informed consents were collected from all participants in the national survey, the youth clinics survey, and the qualitative study.

Paper context

We conducted a mixed method study to explore young migrants’ sexual and reproductive health which is understudied in Sweden. We found higher sexual rights’ violations and less access to services among young migrants. The access was facilitated by the ‘open environment’ and the availability of good quality services; however, serious barriers exist such as limited access to information concerning the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

Additional information

Funding

The national survey was funded by the Public Health Agency of Sweden and the youth clinics survey was partly supported by the Swedish Research for Health, Working Life and Living Conditions (FORTE) [Grant Number 2014-0235]. The qualitative study and this paper did not receive any external funding.