Sexual and reproductive health equity in Sweden : From policy to the perspectives of young people with migration experience, and healthcare providers
Authors:   , Amroussia Nada 
Published: October 2024

This thesis explores potential challenges to achieving sexual and reproductive health (SRH) equity in Sweden, focusing on young people with migration experience. It includes three qualitative studies, each addressing a specific aim. The findings of these studies are presented in four papers. Study I is a policy analysis that aims to examine how migrants were represented in the discourses embedded within Swedish sexual and reproductive health and rights (SRHR)-related policies, and how migrants’ SRHR-related issues were framed and addressed within these discourses. To this end, 54 policy documents were critically examined and the results are presented in Paper I. The results show how migrants’ discursive representation in Swedish SRHR-related policies is often associated with the concept of vulnerability. Moreover, a discourse of otherness appears when discussing what is defined as honor-related violence and oppression. The results also indicate that framing migrants’ issues with regard to SRHR oscillates between two competing discourses. The first one tends to prioritize the structural level, as mainly reflected in adopting the human rights- based discourse, whereas the second tends to frame migrants’ SRHR issues and needs as individual issues requiring individual-level solutions. Study II builds on interviews with 20 young people with migration experience. It aims to explore accounts of encounters of young people with migration experience with SRH services, and discourses on sexuality. The first part of the results is outlined in Paper II. It highlights how the interplay between participants’ negative perceptions of youth clinics, difficult access, and the perception of the irrelevancy of SRH services contributed to low service use. The first part of the results also shows how the experiences and attitudes toward school-based sexuality education differed substantially among participants, ranging from positive to less positive or negative. The second part of the results is presented in Paper III. It highlights the various constructions of sexuality in the participants’ discourses. Sexuality was constructed as a border marker that contributes to making a distinction between discursive constructions of mainstream Swedish society and ethnicized migrant communities. It was also constructed as a domain for negotiating risk, where sex was depicted as a risk associated with negative SRH outcomes. Finally, sexuality was constructed as a domain for negotiating sexual agency at the societal and interpersonal levels. Study III is based on interviews with 31 healthcare providers. It aims to examine healthcare providers’ accounts of encounters with migrants when providing SRH services in Sweden. The results are presented in Paper IV. They illuminate the complex relations between person-centered care, culture, and knowledge positions that underlay the participants’ accounts. While some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, others tended to highlight this influence. Participants related this influence to different perceived dilemmas and described strategies to navigate them. The main strategies involved practicing cultural humility (e.g., self-reflection, self-critique, and openness) and seeking cultural competency. Moreover, many participants experienced that migrant patients lacked knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. The results also pointed to several organizational challenges as well as dilemmas stemming from the interplay between migrants’ structural and individual disadvantages. The results of the three studies are integrated using a theoretical framework combining Fraser’s theory of justice and concepts of equity, othering, and belonging, along with a proposed concept of sexual-cultural citizenship. The thesis argues that the challenges to SRH equity highlighted in these studies represent forms of injustice stemming from either misrecognition, maldistribution, or misrepresentation, or an interplay of two or more of these dimensions of injustice. These challenges contribute to contesting the full sexual- cultural citizenship of young people with migration experience.