超越供求关系:理解瑞典年轻移民获得性与生殖健康服务的新生态框架。

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

机构信息

Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.

出版信息

Glob Health Action. 2023 Dec 31;16(1):2251783. doi: 10.1080/16549716.2023.2251783.

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.

摘要

背景

尽管年轻人和移民的性与生殖健康和权利(SRHR)应该优先考虑,但在瑞典,很少有研究关注年轻移民的性健康(SRH)。

目的

探讨年轻移民对性权利的理解和体验,并研究他们对获取性健康服务的看法和体验。

方法

这是一项混合方法研究,包括一项全国性调查,共招募了 1773 名新抵达的年轻移民;一项青年诊所调查,共招募了 1089 名曾到青年诊所就诊的青年;以及一项包括 13 名新抵达的阿拉伯语移民男性的定性研究。结果采用新的获取途径生态框架进行综合,根据生态模型的各个层次和获取途径的五个步骤(可及性、可接受性、充分性、可负担性和质量)来理解影响年轻移民获得医疗保健的因素。

结果

年轻移民认为性健康既是“必不可少的”,也是“一项权利”。与瑞典的其他年轻人相比,他们的性权利更难实现,尤其是男性、非二元性别、LGBTQ+、出生于南亚、没有居留许可和经济条件较差的年轻人。由于近一半有需要的人没有利用这些服务,性健康服务的可及性很低。服务的可接受性主要源于“开放的环境”,但一些年轻移民面临文化敏感性不足、害怕曝光、父母支持不足和等待时间长等问题。性健康服务的质量被认为是好的,但也有负面体验报告,特别是在尊重、公平、隐私、无偏见和咨询质量方面。

结论

年轻移民获得性健康服务的途径是通过“开放的环境”和提供可及且高质量的服务;然而,他们面临着严重的障碍,如获取有关卫生系统的信息有限、全面的性教育不足、缺乏文化敏感性以及文化种族主义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/80f0/10898815/b4574234a7c0/ZGHA_A_2251783_F0001_OC.jpg

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