Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

Abstract

Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women’s health at both individual and societal levels. This study explored immigrant women’s perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife’s professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.

Immigrant men ‘s perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study

“…According to our study results, the relation to the midwife was important and the feeling of trust was fundamental for how the contraceptive counselling visit was perceived. This finding is supported by previous research concerning immigrant women in Sweden who described the importance of a trustful relation to the midwife for optimal contraceptive counselling [ 13 ].…”

“…The Swedish language was described as one of the most important enabling factors for being able to receive contraceptive counselling and to increase sexual health literacy. Mistrust towards interpreters’ confidentiality and experiences of incorrect interpretations are reasons previously provided by immigrant women for rejecting the use of interpreters during contraceptive counselling [ 13 ], and the lack of well-educated interpreters with knowledge about sexual and reproductive health in Sweden is a well-known fact [ 50 , 55 ]. Midwives providing antenatal care to immigrant women in Sweden described the complexity of upholding women’s autonomy when husbands who were speaking good Swedish rejected the offer of using interpreter [ 25 ].…”

“…The model has contributed to the lowest maternal and child mortality rates in the world [ 11 ]. However, the Swedish midwife’s professional role and responsibilities are not always well-known to the immigrant population in Sweden [ 13 ].…”

“…Patriarchal structures, misconceptions, values and norms, and law and politics are some of the barriers that are affecting men and women’s access to and knowledge about contraceptives [ 1 ]. Previous research shows that non-western immigrant men in Sweden are accompanying their partners for contraceptive counselling and that their presence is significant and is affecting women’s contraceptive counselling and women’s use of contraceptives [ 13 , 21 , 22 ]. According to midwives providing contraceptive counselling and meeting immigrant women, men are accompanying their partners for contraceptive counselling, despite neither being the midwife’s patient nor her responsibility [ 21 , 23 ].…”

IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it): a protocol for a cluster randomised control trial with a process evaluation

“…For example, in Sweden, structured CC (“the LOWE model” using an educational video, an effectiveness chart, four key questions, and a box with contraceptive models) increased LARC choice, initiation and use, when controlled for migration background [ 27 ]. Immigrant women in Sweden have also expressed the importance of trust in CC encounters, especially since they perceive these as private matters [ 28 ].…”