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Åkerman, E., Larsson, E. C., Essén, B. & Westerling, R. (2019). A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sexual & Reproductive HealthCare, 19, 64-70
Open this publication in new window or tab >>A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 19, p. 64-70Article in journal (Refereed) Published
Abstract [en]

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 andreproductive healthcare services among immigrant women in Sweden

Method: A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed amongimmigrants 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 contraceptivecounselling. Experiencing lack of emotional social support and not having had children was associated with thislack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and thiswas associated with not having participated in a health examination. Almost 25% stated that their culture keptthem back from using contraception.

Conclusion: Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrantwomen 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 toincrease knowledge of SRH services among immigrants. Swedish language schools could play an important rolein increasing knowledge of SRH-related information as many new immigrants become students during their firstyears in Sweden.

Keywords
Health services accessibility, Sexual and reproductive health, Contraceptive counselling, Immigrant, Social capital, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-376260 (URN)10.1016/j.srhc.2018.12.005 (DOI)000465365500011 ()30928137 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2019-02-03 Created: 2019-02-03 Last updated: 2019-05-29Bibliographically approved
Ahrne, M., Shytt, E., Andersson, E., Small, R., Adan, A., Essén, B. & Byrskog, U. (2019). Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives. Midwifery, 74, 107-115
Open this publication in new window or tab >>Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed) Published
Abstract [en]

Objective:

To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

Design:

Eight focus group discussions with 2-8 participants in each were conducted, three with Somaliborn mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".

Setting:

Two towns in mid-Sweden and a suburb of the capital city of Sweden. Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

Findings:

Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

Key conclusions:

ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. (c) 2019 The Authors. Published by Elsevier Ltd.

Keywords
Antenatal care, Group antenatal care, Migrant, Mother, Father, Midwife, Focus group discussions
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-384054 (URN)10.1016/j.midw.2019.03.022 (DOI)000465986700014 ()30953966 (PubMedID)
Funder
Swedish Research Council, 2015-02470Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00957
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-06-20Bibliographically approved
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
Open this publication in new window or tab >>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
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed) Published
Abstract [en]

Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

Keywords
Muslim women, Immigrant women, Contraceptive use, Reproductive health, Denmark, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-388751 (URN)10.1016/j.midw.2019.03.017 (DOI)000470962400011 ()31005014 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4576
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-09-05Bibliographically approved
Saleh Gargari, S., Essén, B., Fallahian, M., Mulic-Lutvica, A. & Mohammadi, S. (2019). Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss. International Journal of Gynecology & Obstetrics, 144(1), 49-55
Open this publication in new window or tab >>Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss
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2019 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 144, no 1, p. 49-55Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate appropriateness of cesarean delivery and cesarean delivery‐related morbidity among maternal near misses (MNMs) using the Robson ten‐group classification system.

Methods: In the present audit study, medical records were assessed for women who experienced MNM and underwent cesarean delivery at three university hospitals in Tehran, Iran, between March 1, 2012, and May 1, 2014. Local auditors assessed cesarean delivery indications and morbidity experienced. All records were re‐assessed using Swedish obstetric guidelines. Findings were reported using the Robson ten‐group classification system. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Of the 61 women included, cesarean deliveries were more likely to be considered appropriate by local auditors compared with Swedish ones (OR 2.7, 95% CI 1.3–5.7). Cesarean delivery‐related morbidity was attributed to near‐miss events for 10 (16%) MNMs and was found to have aggravated 25 (41%). Of 16 women classified as Robson group 1–4, cesarean delivery‐related MNM was identified in 15 (94%), compared with 13 (43%) of 30 women in group 10. Cesarean delivery with appropriate indication was associated with very low likelihood of cesarean delivery‐related MNM (OR 0.2, 95% CI 0.1–0.6).

Conclusion: Cesarean delivery in the absence of appropriate indication could be an unsafe delivery choice. Audits using the Robson classification system facilitate understanding inappropriate cesarean delivery and its impact on maternal health.

Keywords
Cesarean appropriateness, Cesarean delivery, Clinical audit, Iran, Maternal near miss, Robson classification
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-372020 (URN)10.1002/ijgo.12698 (DOI)000452298100008 ()30353540 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-21Bibliographically approved
Arvidsson, A., Johnsdotter, S., Emmelin, M. & Essén, B. (2019). Being questioned as parents: An interview studywith Swedish commissioning parents usingtransnational surrogacy. Reproductive Biomedicine and Society Online, 8, 23-31
Open this publication in new window or tab >>Being questioned as parents: An interview studywith Swedish commissioning parents usingtransnational surrogacy
2019 (English)In: Reproductive Biomedicine and Society Online, E-ISSN 2405-6618, Vol. 8, p. 23-31Article in journal (Refereed) Published
Abstract [en]

This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

Keywords
assisted reproduction, commissioning parents, transnational surrogacy, parenthood, Sweden, India
National Category
Clinical Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-382882 (URN)org/10.1016/j.rbms.2018.08.001 (DOI)
Available from: 2019-05-05 Created: 2019-05-05 Last updated: 2019-06-19
Emtell Iwarsson, K., Larsson, E. C., 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, 45(2), 118-126
Open this publication in new window or tab >>Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden
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2019 (English)In: BMJ sexual & reproductive health, ISSN 2515-1991, Vol. 45, no 2, p. 118-126Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women.

METHODS: The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015.

RESULTS: The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception.

CONCLUSIONS: Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
contraception, counselling, ethnic minority migrants, induced abortion
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-379917 (URN)10.1136/bmjsrh-2018-200171 (DOI)000471856700007 ()30665889 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2013-2025Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2016-01063
Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-08-05Bibliographically approved
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, 1-20
Open this publication in new window or tab >>Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors
2019 (English)In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, p. 1-20Article in journal (Refereed) Published
Abstract [en]

The abortion discourse in Sweden is marked by historically liberal ideals about women’s inviolable right to make autonomous reproductive decisions. However, to respond to the increase in cultural and religious pluralism building up over several decades, religious organizations have been given opportunities to provide so-called spiritual care in affiliation with Swedish hospitals since the 1980s. In this study we asked: in what ways do religious counsellors, affiliated with Swedish hospitals, construct their ideas on abortion, and how well do their ideas comply with Sweden’s ‘women-friendly’ abortion policies? Through interviews with Protestant, Catho-lic, Muslim, and Buddhist religious counsellors, we wanted to empirically test the presumption underlying the decisions to grant space to religious actors in Swedish healthcare, i.e., that religious counselling serves to complement existing services. We found that it cannot be expected that religious advice on abortion will always comply with Swedish abortion law and with the women-friendly abortion policy that the Swedish state seeks to impose. When policy-makers open up possibilities for diverse norms on abortion to manifest in close affiliation with healthcare institutions, they must be aware that some religious counsellors argue that only God—and not the woman herself—can decide whether a woman can terminate a pregnancy. We argue that the findings in this study speaks to what researchers have referred to as the “diversity-equality paradox”, which highlights the tension between the promotion of religious ideas on abortion on the one hand and the promotion of liberal ideas about women’s reproductive freedom on the other.

Keywords
Abortion, Women’s rights, Religious counselling, Diversity promotion, The diversity–equality paradox, Healthcare, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389908 (URN)10.1007/s12119-019-09614-6 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-07-31 Created: 2019-07-31 Last updated: 2019-09-05
Alosaimi, A. N., Essén, B., Riitta, L., Nwaru, B. I. & Mouniri, H. (2019). Factors associated with female genital cutting in Yemen and its policy implications. Midwifery, 74, 99-106
Open this publication in new window or tab >>Factors associated with female genital cutting in Yemen and its policy implications
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 99-106Article in journal (Refereed) Published
Abstract [en]

Background:

A tremendous number of girls in Yemen are still subjected to female genital cutting (FGC), which carries an increased risk of health complications and violates children's rights. This study describes the prevalence of FGC in four Yemeni provinces and investigates the determinants of FGC.

Methods:

We analyzed data from women aged 15 to 49 years who responded to a sub-national household survey conducted in six rural districts of four Yemeni provinces in 2008-2009. Logistic regression was used to estimate the association between individual and household socioeconomic factors and FGC practices and attitudes.

Results:

The prevalence of women's FGC was 48% while daughters' FGC was 34%. Almost 45.8% of the women surveyed believe the FGC practice should discontinue. Higher odds of FGC practice and positive attitude towards it were associated with older age, family marriage, and lower tertiles of wealth and education indices. Early marriage was also associated with increased odds of FGC practice (p < 0.01).

Conclusions:

Socioeconomic indices and other individual factors associated with FGC are differing and complex. Younger generations of women are more likely to not have FGC and to express negative attitudes towards the tradition. Appropriate strategies to invest in girls' education and women's empowerment with effective engagement of religious and community leaders might support the change of attitudes and practice of FGC in the younger generation.

Keywords
Female genital mutilation, Circumcision, Women's health, Socioeconomic factors, Equity, Yemen
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-384053 (URN)10.1016/j.midw.2019.03.010 (DOI)000465986700013 ()30946983 (PubMedID)
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-06-20Bibliographically approved
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
Open this publication in new window or tab >>From sameness to difference: Swedish Somalis’ post-migration perceptions of the circumcision of girls and boys
2019 (English)In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 21, no 6, p. 619-635Article in journal (Refereed) Published
Abstract [en]

In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis' post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-334699 (URN)10.1080/13691058.2018.1502472 (DOI)000467733900001 ()30411652 (PubMedID)
Funder
Sven Jerring FoundationSwedish Research Council, 2015-03546Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2095Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00771
Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2019-06-13Bibliographically approved
Mgaya, A. H., Kidanto, H. L., Nystrom, L. & Essén, B. (2019). Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting. International Journal of Gynecology & Obstetrics, 144(2), 199-209
Open this publication in new window or tab >>Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting
2019 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 144, no 2, p. 199-209Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the impact of a criteria-based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes.

Methods: A cross-sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013-November 2013 and July 2015-June 2016). Outcomes of fetal distress (baseline CBA, n=248; re-audit, n=251) and obstructed labor (baseline CBA, n=260; re-audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification.

Results: Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09-0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02-1.63) and non-referred (OR 2.78, 95% CI 1.98-3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56-0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25-0.39), and non-referred preterm pregnancies (OR 0.26, 95% CI 0.18-0.36).

Conclusion: Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.

Keywords
Cesarean delivery, Criteria-based audit, Fetal distress, Low-resource setting, Obstructed labor, Robson classification
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-374421 (URN)10.1002/ijgo.12726 (DOI)000454953100012 ()30499099 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-01-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2900-2849

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