Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden

Abstract

Background: Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants' sexual and reproductive health (SRH) is rarely studied in Sweden.

Objectives: To explore young migrants' understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

Methods: This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

Results: Young migrants understood SRH as both 'essential' and 'a right.' Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the 'open environment,' however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services' quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

Conclusion: The access of young migrants to SRH services is facilitated by an 'open environment' and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

Keywords: Culture; cultural sensitivity; quality of healthcare; sexual education; youth.

Figure 1.

Ecological framework of access to healthcare. Reprinted from [53].

Figure 2.

Prevalence of selected indicators of sexual rights among young migrants in Sweden. Stratified by gender, sexual orientation, residence permit and region of birth (MENA; middle East and North Africa. SA; South Asia. SSA; Sub-Saharan Africa). Reprinted from [53].

Figure 3.

Factors related to young migrants’ access to SRH services using the proposed ecological framework of access to healthcare. Reprinted from [53].