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

Abstract

Background While a large body of research has focused on the challenges experienced by healthcare staff when providing sexual and reproductive health services, little attention has been paid to the ways healthcare providers navigate these challenges. This study examined healthcare providers’ accounts of encounters when providing sexual and reproductive health (SRH) services to migrants in Southern Sweden. It sought to examine challenges and dilemmas experienced by healthcare providers, strategies used to navigate these challenges and dilemmas, and assumptions underlying participants’ accounts. Methods The data collection was conducted between September 2020 and March 2021. Qualitative thematic analysis was used to analyze thirty-one interviews with healthcare providers working in youth clinics and women healthcare clinics. The analysis was guided by a conceptual framework combining person-centered care approach, Foucault’s concepts on power/knowledge, and theories to navigate diversity in healthcare setting: cultural competency and cultural humility. Results Three themes were identified in the analysis: 1) Between person centeredness and cultural considerations; 2) Knowledge positions and patient involvement; and 3) beyond the dyadic interaction healthcare provider-patient. Some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, whereas others tended to highlight this influence. Many participants viewed the influence of culture as primarily driven by migrants’ cultural backgrounds, and as a source of challenges and dilemmas. Participants’ strategies to navigate these perceived challenges and dilemmas included practicing cultural humility and seeking cultural competency. Knowledge positions also emerged as an important aspect of participants’ accounts of encounters with migrants. Many participants experienced that migrant patients were lacking knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. Additionally, the study shows how participants placed their experiences in a broader organizational and social context. Participants highlighted several organizational challenges to encountering migrants and discussed dilemmas stemming from the interplay between migrants’ structural and individual disadvantages. Conclusions The study findings illuminate the complex links between person-centered care and two important dimensions of the encounters with migrants: culture and knowledge positions. They also shed the light on the organizational and structural challenges surrounding these encounters. These findings suggest that multilevel strategies are needed to improve the quality of encounters when providing SRH services to migrants. These strategies could include ensuring universal access to SRH services to migrants, adjusting the encounter duration when interpretation is needed, and providing necessary resources to healthcare providers to build their structural competency.

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

“…Mpofu’s (2018) research on health and wellbeing among religious adherents in Zimbabwe found that religious beliefs potentially expose women and children to health risks. They potentially pose barriers to services such as contraception and abortion and limit discussions about SRH (Amroussia, 2022; Mpofu, 2018; Mpofu et al, 2014). Our study underscores the need for culturally safe and religiously sensitive health education and services that respect religious beliefs and ensure comprehensive access to SRHRs (Mpofu et al, 2014).…”

“…At the exosystem level, healthcare systems, extended family, and government policies play a role in shaping MRY's approach to SRHR, while the macrosystem level encompasses attitudes, ideologies, culture, and religion, all of which influence MRY's reproductive health decisions in Australia (Napier-Raman et al, 2023). Mpofu (2018) and Amroussia et al (2022) agree on the significant impact religion can have on MRY's SRHR beliefs and behaviours (Amroussia, 2022;Mpofu, 2018). Cultural concentration, in which migrants maintain a connection to their culture while adapting to the host country, can bring both opportunities and challenges for MRY in renegotiating relationships and family structures in a new cultural context (Dune et al, 2017;Rawson & Liamputtong, 2010;Saleem et al, 2017;Villa-Torres & Svanemyr, BARRIERS TO SRHR IN MIGRANT AND REFUGEE YOUTH 7 2015).…”

Sexual and Reproductive Health and Rights for Young Migrants in Sweden: An Ideal-Type Analysis Exploring Regional Variations of Accessible Documents

“…In particular, methods, tools, and materials documents generally either implicitly or specifically targeted young migrants’ SRHR, which might reflect efforts to improve practitioners’ cultural competency. Health practitioners have previously identified lack of cultural competency, knowledge and skills as potential barriers in their encounters with migrant patients [ 25 , 26 ]. Access to continued education and professional development for professionals is included in one of the NAP’s prioritised areas [ 10 ].…”

“…It is essential to recognize that these challenges occur across all cultures and settings. Amroussia et al’s (2022) study emphasises the importance of avoiding othering young migrants in discourse surrounding HRV and oppression [ 25 ].…”

Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America

“…While there is a body of literature documenting the SRH needs of women refugees and migrants in humanitarian settings around the world (8)(9)(10)(11), there is insufficient evidence about migrant women's and girl's SRH needs during the transit phase of migration. This lack, in turn, makes it challenging to develop effective interventions that can support their SRH throughout their journey.…”