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Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden.

Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 86
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1540
Keywords [en]
Immigrant, Migrant, Access, Healthcare, Equal, Social capital, Contraceptive counselling, HIV testing, HIV, Sexual and reproductive health and rights, Sweden.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine; Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-368357ISBN: 978-91-513-0573-8 (print)OAI: oai:DiVA.org:uu-368357DiVA, id: diva2:1285692
Public defence
2019-03-25, A1:111a, BMC, Husargatan, ingång A11, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-03-01 Created: 2019-02-05 Last updated: 2019-03-18
List of papers
1. A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden
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, 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.

Place, publisher, year, edition, pages
The Netherlands: , 2019
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)
Available from: 2019-02-03 Created: 2019-02-03 Last updated: 2019-02-12
2. Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden
Open this publication in new window or tab >>Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden
Show others...
2016 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, article id 25Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.

METHODS: This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.

RESULTS: The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR = 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).

CONCLUSIONS: The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-305856 (URN)10.1186/s12914-016-0100-4 (DOI)000384947700001 ()27724904 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2016-10-23 Created: 2016-10-23 Last updated: 2019-02-05Bibliographically approved
3. Healthcare-seeking behaviour in relation to sexual and reproductive health among Thai-born women in Sweden: a qualitative study
Open this publication in new window or tab >>Healthcare-seeking behaviour in relation to sexual and reproductive health among Thai-born women in Sweden: a qualitative study
2017 (English)In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 19, no 2, p. 194-207Article in journal (Refereed) Published
Abstract [en]

Thailand is one of the most common countries of origin among immigrants in Sweden and Thai immigrants comprise the immigrant group most frequently diagnosed with HIV. Little is known about their healthcare-seeking behaviour and views on HIV prevention. This study explored Thai women's healthcare-seeking behaviour in relation to sexual and reproductive health and their views on HIV prevention. Nineteen in-depth interviews were conducted with Thai-born women in the Stockholm area. Three themes were identified: (1) poor access to healthcare in Sweden, preferring to seek care in Thailand; (2) partners playing a key role in women's access to healthcare; (3) no perceived risk of HIV, but a positive attitude towards prevention. Despite expressing sexual and reproductive healthcare needs, most women had not sought this type of care, except for the cervical cancer screening programme to which they had been invited. Identified barriers for poor access to healthcare were lack of knowledge about the healthcare system and language difficulties. To achieve 'healthcare on equal terms', programmes and interventions must meet Thai women's healthcare needs and consider what factors influence their care-seeking behaviour. Integrating HIV prevention and contraceptive counselling into the cervical screening programme might be one way to improve access.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-312021 (URN)10.1080/13691058.2016.1214746 (DOI)000393781500004 ()27684388 (PubMedID)
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2019-02-05Bibliographically approved
4. Utilisation of two health systems: A cross-sectional study on Swedish-Thai women’s choice of contraceptive counselling and HIV testing
Open this publication in new window or tab >>Utilisation of two health systems: A cross-sectional study on Swedish-Thai women’s choice of contraceptive counselling and HIV testing
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: To investigate the need and use of sexual and reproductive health (SRH) services andanalyses to what extent the use of SRH services in Sweden is associated with healthcarecontact in the country of origin or knowledge of the health system in the new country. Methods: A cross-sectional study using postal questionnaire to all Thai-born women (age 23-60) in Stockholm, residing in Sweden since 2014. Chi-squared and logistic regression wasused for analysis. Results: The response rate was 52.3% (n=266). The majority reported a significant need for information related to SRH-services. Most contraceptive using women (70%) bought theircontraceptives in Thailand. Older women and women who lacked knowledge of where to go for contraceptive counselling were more likely to have bought contraceptives in Thailand.However, use and need of contraceptive counselling in Sweden was higher among younger women. Nevertheless, women who had never been HIV tested in Thailand (40%) continued not to be tested in Sweden. Conclusions: Our findings indicate that the Swedish health system does not correspond to Thai women’s needs for SRH services and information, since the majority bought their contraceptives in Thailand, and those who were never HIV tested continued not to be in Sweden. From a public health perspective and to achieve the goal of “healthcare on equal terms”, future interventions must focus on making health services and information moreaccessible for Thai immigrants.

Keywords
Sweden, migration, Thai women, health services accessibility, sexual and reproductive health, contraceptives, HIV testing
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-376261 (URN)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-12

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