“One-time interventions, it doesn’t lead to much” – healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden

Abstract

Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.

Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers’ experiences

“…These challenges were mainly centered around the interactions between healthcare providers and migrants and included communication difficulties, perceived cultural differences, and lack of cultural competency, They were compounded by organizational difficulties such as time and resource constraints [ 1 – 6 ]. Similar challenges were also highlighted in studies conducted in Sweden [ 7 – 10 ].…”

Sexual health challenges in migrant, immigrant, and displaced populations 2022–2023

“…Low motivation, lack of knowledge about testing and competing patient health priorities were cited as some of the reasons why health professionals are often unable to motivate migrant people in the EU/EEA to be screened for HBV/HCV [41]. Similar conclusions were reached by studies of Syrian migrants in high-and middle-income settings (Sweden and Turkey), where awareness and utilisation of protective sexual health services and STI/HIV-testing was notably low and appeared to be motivated by sexual exposure risk awareness [42–44].…”

“…Sexual health interventions require involvement from civil society, stakeholders and MIDP themselves. Therefore, a co-design policy approach that encourages community involvement and provides social protections is essential for allowing MIDP to take ownership of their health, better understand their rights, improve reporting rates for GBV and enhance trust in public health services [43,85 ▪ ,86]. Furthermore, disparities in funding for HIV-focused initiatives compared to other common STIs remain – patient advocacy groups for infections such as HBV, HCV and syphilis may lack the same traction as for HIV; more prospective studies are needed to allow investigation of the interplay between these infections and social determinants of health to better understand their outcomes within migrant populations and inform more effective messaging [28,87].…”

Barriers to sexual and reproductive health and rights of migrant and refugee youth: An exploratory socio-ecological qualitative analysis

“…Based on our findings, the lack of confidentiality and trust at the mesosystem level can also foster feelings of isolation and anxiety among MRY. This claim is supported by several studies (Lynch et al, 2021;Maheen et al, 2021;McCann et al, 2016;Zelalem Birhanu Mengesha et al, 2018;Tirado et al, 2022). The absence of trusted guidance or representation can complicate MRY's navigation of SRHR, particularly considering cultural safety and fear of judgement.…”

“…To tackle this issue, the SRHR of MRY must be established and promoted through a blend of system improvements and targeted services (Ussher et al, 2017). Service providers should create culturally safe health promotion strategies that are sensitive to the unique challenges faced by MRY, and integrate sexual health promotion into the early resettlement process (Fair et al, 2021;Tirado et al, 2022). Such strategies should encompass clear information regarding consent and other SRHR To implement these strategies, professionals who interact with MRY should be trained in cultural safety and competency to adequately understand and support MRY's unique SRHR needs (Botfield et al, 2016;Zelalem Birhanu Mengesha et al, 2018).…”