Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey.

Mazen Baroudi,Faustine Nkulu Kalengayi,Miguel San Sebastian,Isabel Goicolea,Robert Jonzon,Anna-Karin Hurtig

doi:10.34172/ijhpm.2020.123

Abstract

Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

Highlights

Migrants usually bear an increased burden of sexual and reproductive ill health and tend to live in a vulnerable situation regarding sexual and reproductive rights
The knowledge of migrant youths about available health services and how to access them should be increased through, for example, the introductory health examination. Another measure to improve migrant youths’ access could include increasing the services’ acceptability through improved cultural competence of youth clinics’ staff and ensuring good quality language assistance services. These measures should target all migrant youths, but more focus is needed on the following groups: men, non-binary, those born in South Asia, those waiting for a residence permit and those with low economic status
Low Ability to fulfil Sexual and Reproductive Healthcare Needs Our study showed that only 14% of all participants had utilised sexual and reproductive healthcare (SRHC) during the last year, and only 4.5% of youth had visited youth clinics

Summary

Introduction

Migrants usually bear an increased burden of sexual and reproductive ill health and tend to live in a vulnerable situation regarding sexual and reproductive rights. Migrants in high-income countries have worse maternal health outcomes, higher risk of HIV, and higher risk of sexual violence than native populations.[1,2,3,4] They receive worse healthcare compared to people born in the hosting countries.[5,6]. While labour market migrants were the main group of migrants before the 1970s, refugees and asylum seekers have become the main group over the last years, and among them a significant number of unaccompanied minors. The number of new migrants in Sweden reached its peak in 2016, when around 163 000 migrants were registered, 35 000 of them unaccompanied minors. Around 19% of young people 16-29 years-old in Sweden are foreign-born. The largest groups of migrant youths in Sweden are born in Syria, Afghanistan, Iraq, Somalia, Eritrea, Poland, Thailand, and Iran, which reflects the heterogeneity in ethnicity and religion of this population.[7,8]

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Conclusion