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Introduction: Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to the delivery of suboptimal care. Therefore, the objective of this study was to assess the level of knowledge of Swedish healthcare providers on global and Swedish migrant Sexual Reproductive Health and Rights.

Methods: A national cross-sectional study was conducted using a questionnaire consisting of seven questions related to global and Swedish migrant Sexual Reproductive Health and Rights. The questionnaire was distributed among midwives, nurses, gynecologists and obstetricians, and hospital social workers (N = 731). The analysis was guided by the Factfulness framework developed by Hans Rosling to identify disparities between healthcare providers’ viewpoints and evidence-based knowledge.

Results: There was an overall lack of knowledge among the health care providers on these issues. The highest correct responses were on the question on abandonment of female genital cutting/mutilation after migration (74%). The findings indicated that healthcare providers originating from Sweden, physicians, those with fewer years of clinical experience, and exhibiting more migrant-friendly attitudes, demonstrated a higher level of knowledge regarding global and Swedish migrant Sexual and Reproductive Health and Rights.

Conclusion: This study demonstrates that healthcare providers lacked knowledge of global and Swedish migrant Sexual Reproductive Health and Rights, which was almost uniformly distributed, except among those with more comprehensive and recent education. Contrary to expectations, healthcare professionals did not primarily rely on their education and experiences but were influenced by their personal values and opinions. The study underscores the importance of upgrading knowledge in Sexual Reproductive Health and Rights and encourages policymakers, professionals, and students to base their opinions on well-founded facts, particularly in the context of a diverse and globalized society.

Ragging is an initiation ritual carried out in Sri Lankan universities, where new students are harassed by senior students. This practice has severe adverse consequences including depression, increased university dropouts and suicide. Although this is a significant public health problem and a burden on the country, research on ragging is scarce.

This thesis aimed to investigate and gain a deeper understanding of the phenomenon of ragging, through the various perspectives of students and individuals attached to the University of Jaffna, Sri Lanka. The prevalence of Major depressive disorder (MDD) among the students was also examined. 

Paper I, a cross-sectional survey, demonstrated that 59% of the students from the faculties of Medicine and Technology experienced ragging. Health consequences were experienced by 54% and help was mainly sought from friends and family. The student’s faculty and year of study was associated with ragging.

In Paper II, 17 focus group discussions (FGD) were conducted with students representing all faculties. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. Findings revealed students used ragging as an expression of power to initiate order and express dissatisfaction towards social inequalities. Students trivialized violence despite being aware of the dire consequences.

In Paper III, 11 semi-structured interviews and seven FDGs were conducted with staff and work-affiliated individuals at the university. Foucauldian Discourse Analysis and Bandura’s Moral Disengagement theory were utilized to interpret the findings. The main discourses were; Ragging as normal and necessary, Insecurity and fear of reprisal, and Voices of resistance. Participants felt unsupported and in order to survive in this insecure environment, they adapted their moral judgments.

In Paper IV, Patient Health Questionnaires (PHQ-9) were used to screen for MDD among students (n=637), from Faculties of Management, Science and Medicine. MDD was experienced by 31% of students. Among all the student participants, 70% had experienced some form of depression ranging from mild to severe. MDD was associated with the student’s ethnicity.

Interventions targeting both individual and multisectoral levels are needed in order to curb ragging, and create a safe and nurturing environment for all. 

Initiation rituals such as hazing, bullying, and ragging, as it is referred to in Sri Lanka, is a global phenomenon and has become a serious public health problem. Students are bullied and harassed by senior students causing them to suffer severe adverse consequences including depression, increased university dropouts and suicide. Although this has led to a significant burden on the country, research on ragging is scarce. The aim of this study was to explore the perceptions of students concerning the phenomenon of ragging and to understand how ragging affects student life and culture at the University of Jaffna, Sri Lanka. This paper is based on 17 focus group discussions with male and female students of Sinhalese, Tamil, and Muslim ethnicity. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. The findings revealed how students perceived ragging differently; as an expression of power to initiate order and as a way to express dissatisfaction towards social inequalities occurring within the larger society or to facilitate bonds between university students. Students trivialized violence related to ragging and accepted it as a part of the university subculture despite being aware of the dire consequences. There was a described cyclical nature to ragging whereby victims become perpetrators. The student’s perspective appeared to be a missed opportunity in finding feasible solutions to a societal problem that must take all parties involved, into consideration.

Background

The prevalence of mental health disorders is known to be high among university students globally. Currently there are only a few studies on depression among university students in Sri Lanka. The aim of this study was to screen for the prevalence of Major Depressive Disorder (MDD) and other forms of depression, and to evaluate the factors associated with MDD.

Methods

A cross sectional survey using the Patient Health Questionnaire (PHQ-9) was conducted among 637, second-year students from the faculties of Management Studies & Commerce, Science and Medicine at the University of Jaffna, during the Coronavirus (COVID-19) pandemic. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging.

Results

MDD was considered to have been experienced by 31% of the students. From all three faculties, 70% of the students claimed to have experienced some form of depression ranging from mild to severe. The factor associated with MDD was the students’ ethnicity.

Conclusion

Due to the high MDD risk among university students, it is imperative to develop psychosocial interventions to ensure early detection of mental health disorders and provide adequate support to safeguard this vulnerable population.

Ragging in Sri Lanka is a longstanding initiation ritual, similar to hazing and bullying. The severe harassment of new students by seniors has led to adverse consequences including depression, university dropouts and suicide. Although, a significant problem, research on ragging is scarce. This research aimed to explore how staff and work-affiliated individuals at Jaffna University resonate around the phenomenon of ragging. Seven focus group discussions and eleven semi-structured interviews were conducted. Foucauldian Discourse Analysis and Bandura’s Moral Disengagement theory were used to interpret the data. Three main discourses reflected the context: ragging as normal and necessary, insecurity and fear of reprisal, and voices of resistance. Participants often felt unsupported and therefore adapted their moral compasses to survive in this insecure environment. These findings demonstrate a fragmented approach to ragging that not only diminished any efforts towards elimination but affected how staff were forced to adjust their behavior to work in this environment. To address ragging, there is a need to adhere to a consistent strategy focusing on increasing awareness and supporting staff by holding accountable those at all levels of the administrative hierarchy in promoting a safe working environment for all.

Ragging is an initiation ritual practiced in Sri Lankan universities for generations, although research is scarce. This practice has several adverse consequences such as physical, psychological, and behavioral effects and increased university dropouts. The aim of this study was to investigate the prevalence of different types of ragging: emotional/verbal, physical and sexual ragging, self-perceived health consequences, help-seeking behavior, and factors associated with the experience of ragging. A cross-sectional study was conducted among 623, second- and third-year students from the medical, and technology faculties in Jaffna University. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Ragging was experienced by 59% of the students, emotional/verbal ragging being the most common. A total of 54% of students suffered one or more health consequences and mainly sought help from friends and family, with few seeking formal help. Factors associated with any type of ragging were faculty and year of study. This study emphasizes the urgent need to address this public health problem. It is important that there are adequate student support services, planning and implementation of effective interventions, as well as ensuring that existing policies are strengthened, to reduce or eliminate ragging in Sri Lanka.