Understanding sexual health literacy, gender egalitarian perspectives, and access to SRHR-care among migrants in Sweden

Sammanfattning: Improving access to SRHR-information and care among refugees and migrants remain a central issue. Countries with strong integration policies have significant reductions in the inequities in sexual and reproductive health outcomes. Securing access to SRHR is linked to the extent to which gender equality is fulfilled, including equal rights for men and women to learn the language and participate in society. Sexual health literacy is based on the concept of health literacy. The conceptualization of sexual health is closely related to sexual agency. Lack of contact with the mainstream population distort opportunities for inter-cultural dialogue and opportunities for negotiating cultural norms regarding sexuality. Intercultural mediation may be a useful tool for reaching migrants with SRHR-information early during resettlement. The aim of this doctoral thesis was to conceptualise sexual health literacy among migrants resettling in Sweden, and to further our understanding concerning cultural, social, and contextual factors that influence the direct and indirect access to information on sexual and reproductive health and rights, to prevention, and care. A multifaceted approach was employed, including qualitative studies and quantitative cross-sectional studies. Data was obtained from four sources: in-depth interviews with newly arrived refugee women (Paper I); in-depth interviews with intercultural mediators (Paper II); Migration World Values Survey 2018 (MWVS) on non-European migrants (Paper III); MILSA 2.5 survey 2018 on Syrian and Iraqi migrants (Paper IV). The findings revealed that the conceptualisation of sexuality among refugee women was reflected in a discourse of shame, and hindered uptake of SRHR-information. Sexual health literacy was achieved by facilitating critical discussions about the influence of culture, gender, and power on SRHR, placed in the context of migration and integration. The findings acknowledged the need for investing in training of the intercultural mediators to assure sustainability in activities and take advantage of the potential embedded in the role (Paper I, II). Trust was closely related with gender egalitarian attitudes among migrants in Scania and increased with higher education. The influence of trust was more important for men’s attitudes, suggesting that men may be more sensitive to the perception of the social environment for their approach towards gender equality (Paper III). Education was also directly associated with a higher probability of STI/HIV testing among migrants. This pathway was partially mediated by language skills. The pathways between other predisposing variables (age, marital status, sexuality) were mediated by the indirect effect of exposure to sexual coercion and alcohol consumption, indicating a risk awareness (Paper IV). The findings from this thesis can contribute to improving the quality of implementation of activities aiming at reaching migrants with SRHR-information, to build sexual health literacy, and promote sexual agency. Interventions needs to be placed in a broader framework of gender equality, participation, and integration, with specific approaches for reaching vulnerable migrant subgroups.