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Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers' experiences
Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS). Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0002-4551-0202
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, p. 1562-, article id 1562Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While a large body of research has focused on the challenges experienced by healthcare staff when providing sexual and reproductive health services, little attention has been paid to the ways healthcare providers navigate these challenges. This study examined healthcare providers' accounts of encounters when providing sexual and reproductive health (SRH) services to migrants in Southern Sweden. It sought to examine challenges and dilemmas experienced by healthcare providers, strategies used to navigate these challenges and dilemmas, and assumptions underlying participants' accounts.

METHODS: The data collection was conducted between September 2020 and March 2021. Qualitative thematic analysis was used to analyze thirty-one interviews with healthcare providers working in youth clinics and women healthcare clinics. The analysis was guided by a conceptual framework combining person-centered care approach, Foucault's concepts on power/knowledge, and theories to navigate diversity in healthcare setting: cultural competency and cultural humility.

RESULTS: Three themes were identified in the analysis: 1) Between person centeredness and cultural considerations; 2) Knowledge positions and patient involvement; and 3) beyond the dyadic interaction healthcare provider-patient. Some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, whereas others tended to highlight this influence. Many participants viewed the influence of culture as primarily driven by migrants' cultural backgrounds, and as a source of challenges and dilemmas. Participants' strategies to navigate these perceived challenges and dilemmas included practicing cultural humility and seeking cultural competency. Knowledge positions also emerged as an important aspect of participants' accounts of encounters with migrants. Many participants experienced that migrant patients were lacking knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. Additionally, the study shows how participants placed their experiences in a broader organizational and social context. Participants highlighted several organizational challenges to encountering migrants and discussed dilemmas stemming from the interplay between migrants' structural and individual disadvantages.

CONCLUSIONS: The study findings illuminate the complex links between person-centered care and two important dimensions of the encounters with migrants: culture and knowledge positions. They also shed the light on the organizational and structural challenges surrounding these encounters. These findings suggest that multilevel strategies are needed to improve the quality of encounters when providing SRH services to migrants. These strategies could include ensuring universal access to SRH services to migrants, adjusting the encounter duration when interpretation is needed, and providing necessary resources to healthcare providers to build their structural competency.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 22, no 1, p. 1562-, article id 1562
Keywords [en]
Diversity, Healthcare encounter, Migrants, Person-centered care, Qualitative thematic analysis, Sexual and reproductive health and rights
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:mau:diva-56987DOI: 10.1186/s12913-022-08967-3ISI: 000905362400004PubMedID: 36544131Scopus ID: 2-s2.0-85144513667OAI: oai:DiVA.org:mau-56987DiVA, id: diva2:1723067
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2024-10-25Bibliographically approved
In thesis
1. Sexual and reproductive health equity in Sweden: From policy to the perspectives of young people with migration experience, and healthcare providers
Open this publication in new window or tab >>Sexual and reproductive health equity in Sweden: From policy to the perspectives of young people with migration experience, and healthcare providers
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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. 

Abstract [sv]

Det övergripande målet i den svenska nationella strategin för sexuell och reproduktiv hälsa och rättigheter (SRHR) är en god, jämlik och jämställd sexuell och reproduktiv hälsa i hela befolkningen. Denna avhandling belyser eventuella utmaningar med jämlik och jämställd sexuell och reproduktiv hälsa (SRH) med fokus på unga med migrationserfarenheter. Avhandlingen består av tre studier.

Den första studien är en policyanalys där 54 policydokument granskades. Resultaten visar att migranter ofta presenteras som en särskilt utsatt grupp i svenska SRHR-relaterade policydokument. Att betona utsatthet kan vara problematiskt eftersom utsatthet kan kopplas till social kontroll, stigmatisering och maktlöshet. Dessutom framträder en diskurs där migranter framställs som ”den andra” när hedersrelaterat våld och förtryck diskuteras. De svenska SRHR- relaterade policydokumenten bygger på ett människorättsbaserat arbetssätt. Trots detta bortses relevanta strukturella faktorer (ex. migrationslag och migrationspolitik) i de policydokument som diskuterar migration och SRHR- frågor, som till exempel människohandel eller HIV och Aids.

Den andra studien är baserad på intervjuer med 20 unga med migrationserfarenhet och består av två delar. I den första delen visar resultaten att de flesta deltagarna inte har haft erfarenhet av att använda SRH-tjänster, såsom ungdomsmottagningar. Olika faktorer kan förklara detta, till exempel att ungdomsmottagningen ansågs vara stigmatiserad och svårtillgänglig samt att SRH-tjänster generellt ansågs vara irrelevanta. Resultaten visar också att erfarenheter av om sexual undervisning varierar mellan deltagarna. Några såg undervisningen som en ögonöppnare, medan andra beskrev sitt ointresse i klassrummet. Dessutom belyser resultaten ytterligare källor till SRH-information såsom familj, vänner och internet. Den andra delen fokuserar på diskurser kring sexualitet bland unga med migrationserfarenhet. Resultaten visar hur sexualitet framställs på olika sätt bland deltagarna. Sexualitet framställs som en markör som skiljer mellan svenskar från personer med migrationserfarenhet, där svenskhet som idén ofta kopplas till öppenhet. Dessutom ansågs sex vara en risk och associeras med problem såsom sexuellt överförda infektioner och oönskad graviditet. Vidare framställs sexualitet som en domän där aktörskap förhandlas genom att navigera mellan olika sociala normer och att prioritera samtycke.

Den tredje studien är baserad på intervjuer med 31 vårdgivare på ungdomsmottagningar och kvinnokliniker. Några deltagare betonade vikten av att fokusera på individen och ansåg att kulturens inflytande på mötet borde tonas ner, medan andra tenderade att lyfta fram detta inflytande. Många deltagare relaterade kulturens inflytande på mötena till olika utmaningar och dilemman. Deltagarnas strategier för att navigera upplevda utmaningar och dilemman pendlade mellan att utöva kulturell ödmjukhet och att söka kulturell kompetens. Relationen mellan kunskap och makt uppstod också som en viktig aspekt i mötena med migranter. Migranterna framställdes som en grupp som saknar ”grundläggande kunskaper” om kropp och sexualitet. Denna kunskapsposition återspeglades i maktdynamiken i mötet och kunde utmana migranters engagemang i vården. Dessutom visar studien hur deltagarna placerade sina erfarenheter i ett bredare organisatoriskt och socialt sammanhang. Därtill lyfte deltagarna fram flera organisatoriska utmaningar och diskuterade dilemman som härrörde från samspelet mellan migranters strukturella och individuella ogynnsamma omständigheter.

Denna avhandling bidrar till ökad förståelse för upplevelser och erfarenheter av sexuell och reproduktiv hälso- och sjukvård i Sverige bland unga med migrationserfarenhet samt förekommande diskurser om sexualitet. Denna förståelse kan användas för att utveckla anpassade strategier och initiativ för att främja SRHR bland denna grupp. Avhandlingen bidrar också med fördjupad kunskap om vissa utmaningar med jämlik och jämställd SRH i policydiskurser samt i mötet mellan vårdgivare och personer med migrationserfarenhet som lyfts i den första och den tredje studien.

Abstract [ar]

ﻳﺘﻤﺜﻞ ﺍﻟﻬﺪﻑ ﺍﻟﻌﺎﻡ ﻟﻺﺳﺘﺮﺍﺗﻴﺠﻴﺔ ﺍﻟﻮﻁﻨﻴﺔ ﻟﻠﺼﺤﺔ ﻭﺍﻟﺤﻘﻮﻕ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ ﻓﻲ ﺗﺤﻘﻴﻖ ﺻﺤﺔ ﺗﺴﻠﻂ ﻫﺬﻩ ﺍﻷﻁﺮﻭﺣﺔ ﺍﻟﻀﻮء ﺟﻨﺴﻴﺔ ﻭﺇﻧﺠﺎﺑﻴﺔ ﺟﻴﺪﺓ، ﻣﺘﺴﺎﻭﻳﺔ ﻭﻣﻨﺼﻔﺔ ﻟﺪﻯ ﺟﻤﻴﻊ ﺍﻟﺴﻜﺎﻥ ﺑﺎﻟﺴﻮﻳﺪ. ﻋﻠﻰ ﺍﻟﺘﺤﺪﻳﺎﺕ ﺍﻟﻤﺤﺘﻤﻠﺔ ﻟﺘﺤﻘﻴﻖ ﺫﻟﻚ ﺍﻟﻬﺪﻑ، ﻣﻊ ﺍﻟﺘﺮﻛﻴﺰ ﻋﻠﻰ ﺍﻟﺸﺒﺎﺏ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ.  

ﺗﺘﻜﻮﻥ ﻫﺬﻩ ﺍﻷﻁﺮﻭﺣﺔ ﻣﻦ ﺛﻼﺙ ﺩﺭﺍﺳﺎﺕ.

ﺗﺘﻤﺜﻞ ﺍﻟﺪﺭﺍﺳﺔ ﺍﻷﻭﻟﻰ ﻓﻲ ﺗﺤﻠﻴﻞ ﻟﻠﺴﻴﺎﺳﺎﺕ، ﺣﻴﺚ ﺗﻢ ﻣﺮﺍﺟﻌﺔ 54 ﻭﺛﻴﻘﺔ ﻣﺘﻌﻠﻘﺔ ﺑﺴﻴﺎﺳﺔ ﺍﻟﺼﺤﺔ ﻭﺍﻟﺤﻘﻮﻕ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ. ﺃﻅﻬﺮﺕ ﺍﻟﻨﺘﺎﺋﺞ ﺃﻥ ﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻏﺎﻟﺒًﺎ ﻣﺎ ﺗﻢ ﺗﻘﺪﻳﻤﻬﻢ ﻛﻤﺠﻤﻮﻋﺔ ﻫﺸﺔ ﻓﻲ ﻫﺬﻩ ﺍﻟﻮﺛﺎﺋﻖ. ﺇﻥ ﻫﺬﺍ ﺍﻟﺘﺮﻛﻴﺰ ﻋﻠﻰ ﻫﺸﺎﺷﺔ ﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻗﺪ ﻳﻤﺜﻞ ﺇﺷﻜﺎﻟﻴﺔ، ﺇﺫ ﻳﻤﻜﻦ ﻟﻬﺬﻩ ﺍﻟﺼﻔﺔ ﺃﻥ ﺗﺮﺗﺒﻂ ﺑﺎﻟﺮﻗﺎﺑﺔ ﺍﻹﺟﺘﻤﺎﻋﻴﺔ ﺃﻭ ﺍﻟﻮﺻﻢ. ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻚ، ﻛﺜﻴﺮ ً ﺍ ﻣﺎ ﺗﻢ ﺗﺼﻮﻳﺮ ﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻋﻠﻰ ﺃﻧﻬﻢ "ﺍﻵﺧﺮ" ﻋﻨﺪ ﻣﻨﺎﻗﺸﺔ ﺍﻟﻌﻨﻒ ﻭﺍﻟﻘﻤﻊ ﺍﻟﻤﺮﺗﺒﻄﻴﻦ ﺑﻘﻴﻢ ﺍﻟﺸﺮﻑ.ﻭ ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺍﺭﺗﻜﺎﺯ ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﺴﻴﺎﺳﻴﺔ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺼﺤﺔ ﻭﺍﻟﺤﻘﻮﻕ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ ﻋﻠﻰ ﻧﻬﺞ ﻗﺎﺋﻢ ﻋﻠﻰ ﺣﻘﻮﻕ ﺍﻹﻧﺴﺎﻥ، ﺇﻻ ﺃﻧﻪ ﺗﻢ ﺗﺠﺎﻫﻞ ﻋﻮﺍﻣﻞ ﻫﻴﻜﻠﻴﺔ ﻣﻬﻤﺔ )ﻣﺜﻞ ﻗﺎﻧﻮﻥ ﻭﺳﻴﺎﺳﺔ ﺍﻟﻬﺠﺮﺓ( ﻓﻲ ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﺘﻲ ﺗﻨﺎﻗﺶ ﺍﻟﻬﺠﺮﺓ ﻭﻗﻀﺎﻳﺎ ﻣﺜﻞ ﺍﻻﺗﺠﺎﺭ ﺑﺎﻟﺒﺸﺮ ﺃﻭ ﻓﻴﺮﻭﺱ ﻧﻘﺺ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺒﺸﺮﻳﺔ ﻭﺍﻹﻳﺪﺯ.

ﺍﻋﺘﻤﺪﺕ ﺍﻟﺪﺭﺍﺳﺔ ﺍﻟﺜﺎﻧﻴﺔ ﻋﻠﻰ ﻣﻘﺎﺑﻼﺕ ﺃُﺟﺮﻳﺖ ﻣﻊ 20 ﺷﺎﺑًﺎ ﻭﺷﺎﺑﺔ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ، ﻭﺗﻨﻘﺴﻢ ﻧﺘﺎﺋﺞ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ ﺇﻟﻰ ﺟﺰﺋﻴﻦ. ﻓﻲ ﺍﻟﺠﺰء ﺍﻷﻭﻝ، ﺃﻅﻬﺮﺕ ﺍﻟﻨﺘﺎﺋﺞ ﺃﻥ ﻣﻌﻈﻢ ﺍﻟﻤﺸﺎﺭﻛ ﻴﻦ ﻭﺍﻟﻤﺸﺎﺭﻛﺎﺕ ﻟﻢ ﻳﻜﻦ ﻟﺪﻳﻬﻢ/ﻫﻦ ﺧﺒﺮﺓ ﻓﻲ ﺍﺳﺘﺨﺪﺍﻡ ﺧﺪﻣﺎﺕ ﺍﻟﺼﺤﺔ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ، ﻣﺜﻞ ﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺻﺔ ﺑﺎﻟﺸﺒﺎﺏ، ﻭﻳﻤﻜﻦ ﺗﻔﺴﻴﺮ ﺫﻟﻚ ﺑﻌﻮﺍﻣﻞ ﻣﺨﺘﻠﻔﺔ ﻣﺜﻞ ﺍﻋﺘﺒﺎﺭ ﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎ ﺻﺔ ﺑﺎﻟﺸﺒﺎﺏ ﻣﻮﺻﻮﻣﺔ ﻭﺻﻌﺒﺔ ﺍﻟﻮﺻﻮﻝ، ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺍﻋﺘﺒﺎﺭ ﺧﺪﻣﺎﺕ ﺍﻟﺼﺤﺔ ﺍﻟﺠﻨﺴﻴﺔ ﺑﺸﻜﻞ ﻋﺎﻡ ﻏﻴﺮ ﻣﻬﻤﺔ. ﺃﻅﻬﺮﺕ ﺍﻟﻨﺘﺎﺋﺞ ﺃﻳﻀًﺎ ﺃﻥ ﺗﺠﺎﺭﺏ ﺍﻟﺘﺜﻘﻴﻒ ﺍﻟﺠﻨﺴﻲ ﺩﺍﺧﻞ ﺍﻟﻤﺪﺍﺭﺱ ﺗﺨﺘﻠﻒ ﺑﻴﻦ ﺍﻟﻤﺸﺎﺭﻛﻴﻦ ﻭﺍﻟﻤﺸﺎﺭﻛﺎﺕ، ﺣﻴﺚ ﺭﺃﻯ ﺍ ﻟﺒﻌﺾ ﺃﻥ ﺍﻟﺘﺜﻘﻴﻒ ﺍﻟﺠﻨﺴﻲ ﻳﻤﻜﻦ ﺃﻥ ﻳﻮﻓﺮ ﻣﻌﻠﻮﻣﺎﺕ ﻣﻔﻴﺪﺓ، ﺑﻴﻨﻤﺎ ﻭﺻﻒ ﺁﺧﺮﻭﻥ ﻋﺪﻡ ﺍﻛﺘﺮﺍﺛﻬﻢ ﻟﺠﺪﻭﻯ ﻫﺬﻩ ﺍﻟﺪﺭﻭﺱ. ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻚ، ﺗﺴﻠﻂ ﺍﻟﻨﺘﺎﺋﺞ ﺍﻟﻀﻮء ﻋﻠﻰ ﻣﺼﺎﺩﺭ ﺃﺧﺮﻯ ﻟﻠﻤﻌﻠﻮﻣﺎﺕ ﺣﻮﻝ ﺍﻟﺼﺤﺔ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ، ﻣﺜﻞ ﺍﻷﺳﺮﺓ، ﺍﻷﺻﺪﻗﺎء، ﻭﺍﻹﻧﺘﺮﻧﺖ.

ﻓﻲ ﺍﻟﺠﺰء ﺍﻟﺜﺎﻧﻲ، ﺭﻛﺰﺕ ﺍﻟﻨﺘﺎﺋﺞ ﻋﻠﻰ ﺍﻟﺨﻄﺎﺑﺎﺕ ﺣﻮﻝ ﺍﻟﺠﻨﺴﺎﻧﻴﺔ ﺑﻴﻦ ﺍﻟﺸﺒﺎﺏ ﻭﺍﻟﺸﺎﺑﺎﺕ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ. ﺃﻅﻬﺮﺕ ﺍﻟﻨﺘﺎﺋﺞ ﺃﻥ ﺍﻟﺠﻨﺴﺎﻧﻴﺔ ﺗﺘﻤﺜﻞ ﺑﻄﺮﻕ ﻣﺨﺘﻠﻔﺔ ﺑﻴﻦ ﺍﻟﻤﺸﺎﺭﻛﻴﻦ ﻭﺍﻟﻤﺸﺎﺭﻛﺎﺕ. ﻓﺎﻟﺠﻨﺴﺎﻧﻴﺔ ﻣﺜﻠﺖ ﻋﻼﻣﺔ ﺗﻤﺎﻳﺰ ﺑﻴﻦ ﺍﻟﺴﻮﻳﺪﻳﻴﻦ ﻭﺍﻷﺷﺨﺎﺹ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ، ﺣﻴﺚ ﺍﺭﺗﺒﻂ ﻣﻠﺧﺹ ﻣﻔﻬﻮﻡ "ﺍﻟﺴﻮﻳﺪﻳﺔ" ﻏﺎﻟﺒًﺎ ﺑﺎﻻﻧﻔﺘﺎﺡ، ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺗﺮﻛﻴﺰ ﺍﻟﺨﻄﺎﺑﺎﺕ ﺣﻮﻝ ﺍﻟﺠﻨﺴﺎﻧﻴﺔ ﺑﻴﻦ ﺍﻟﺸﺒﺎﺏ ﻭﺍﻟﺸﺎﺑﺎﺕ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ ﻋﻠﻰ ﺍﻋﺘﺒﺎﺭ ﺍﻟﺠﻨﺲ ﺧﻄﺮ ً ﺍ ﻳﺮﺗﺒﻂ ﺑﻤﺸﺎﻛﻞ ﻣﺜﻞ ﺍﻟﻌﺪﻭﻯ ﺍﻟﻤﻨﻘﻮﻟﺔ ﺟﻨﺴﻴًﺎ ﻭﺍﻟﺤﻤﻞ ﻏﻴﺮ ﺍﻟﻤﺮﻏﻮﺏ ﻓﻴﻪ. ﻋﻼﻭﺓ ﻋﻠﻰ ﺫﻟﻚ، ﺗﻤﺜﻞ ﺍﻟﺠﻨﺴﺎﻧﻴﺔ ﻛﻤﺠﺎﻝ ﻳﺘﻢ ﻓﻴﻪ ﺍﻟﺘﻔﺎﻭﺽ ﻋﻠﻰ ﺍ ﺳﺘﻘﻼﻟﻴﺔ ﺍﻟﻘﺮﺍﺭ ﻣﻦ ﺧﻼﻝ ﺍﻟﺘﻌﺎﻣﻞ ﻣﻊ ﻣﻌﺎﻳﻴﺮ ﺍﺟﺘﻤﺎﻋﻴﺔ ﻣﺨﺘﻠﻔﺔ ﻭﺍﻟﺘﺮﻛﻴﺰ ﻋﻠﻰ ﺃﻫﻤﻴﺔ ﺍﻟﻤﻮﺍﻓﻘﺔ.

ﺗﻀﻤﻨﺖ ﺍﻟﺪﺭﺍﺳﺔ ﺍﻟﺜﺎﻟﺜﺔ ﻣﻘﺎﺑﻼﺕ ﻣﻊ 31 ﺃﺧﺼﺎﺋﻲ ﺭﻋﺎﻳﺔ ﺻﺤﻴﺔ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺻﺔ ﺑﺎﻟﺸﺒﺎﺏ ﺃﻛﺪ ﺑﻌﺾ ﺍﻟﻤﺸﺎﺭﻛﻴﻦ ﻋﻠﻰ ﺃﻫﻤﻴﺔ ﺍﻟﺘﺮﻛﻴﺰ ﻋﻠﻰ ﺍﻟﻔﺮﺩ، ﻭﺍﻋﺘﺒﺮﻭﺍ ﺃﻥ ﺗﺄﺛﻴﺮ ﻭﻋﻴﺎﺩﺍﺕ ﺻﺤﺔ ﺍﻟﻨﺴﺎء. ﺍﻟﺜﻘﺎﻓﺔ ﻋﻠﻰ ﺍﻟﻠﻘﺎء ﺑﻴﻦ ﺍﻟﻌﺎﻣﻠﻴﻦ ﻓﻲ ﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻳﺠﺐ ﺃﻥ ﻳﺘﻢ ﺗﺨﻔﻴﻔﻪ، ﺑﻴﻨﻤﺎ ﺫﻫﺐ . ﺁﺧﺮﻭﻥ ﺇﻟﻰ ﺇﺑﺮﺍﺯ ﻫﺬﺍ ﺍﻟﺘﺄﺛﻴﺮ ﻭﺭﺑﻄﻪ ﺑﺘﺤﺪﻳﺎﺕ ﻭﻣﺸﺎﻛﻞ ﻣﺨﺘﻠﻔﺔ ﺗﺮﺍﻭﺣﺖ ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ ﺍﻟﻤﺸﺎﺭﻛﻴﻦ ﻓﻲ ﺍﻟﺘﻌﺎﻣﻞ ﻣﻊ ﻫﺬﻩ ﺍﻟﺘﺤﺪﻳﺎﺕ ﻭﺍﻟﻤﺸﺎﻛﻞ ﺇﻣﺎ ﺑﻴﻦ ﻣﻤﺎﺭﺳﺔ ﺍﻟﺘﻮﺍﺿﻊ ﺍﻟﺜﻘﺎﻓﻲ ﺃﻭ ﺍﻟﺴﻌﻲ ﻛﻤﺎ ﻅﻬﺮﺕ ﺍﻟﻌﻼﻗﺔ ﺑﻴﻦ ﺍﻟﻤﻌﺮﻓﺔ ﻭﺍﻟﺴﻠﻄﺔ ﻛﺠﺎﻧﺐ ﻣﻬﻢ ﻓﻲ ﺍﻟﻠﻘﺎء ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺍﻟﻜﻔﺎءﺓ ﺍﻟﺜﻘﺎﻓﻴﺔ. ﺑﻴﻦ ﺍﻟﻌ ﺎﻣﻠﻴﻦ ﻓﻲ ﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻤﻬﺎﺟﺮﻳﻦ، ﺇﺫ ﺗﻢ ﺗﺼﻮﻳﺮ ﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻛﻤﺠﻤﻮﻋﺔ ﺗﻔﺘﻘﺮ ﺇﻟﻰ "ﺍﻟﻤﻌﺮﻓﺔ ﺍﻷﺳﺎﺳﻴﺔ" ﺣﻮﻝ ﺍﻟﺠﺴﻢ ﻭﺍﻟﺠﻨﺴﺎﻧﻴﺔ، ﻣﻤﺎ ﺍﻧﻌﻜﺲ ﻓﻲ ﺩﻳﻨﺎﻣﻴﺎﺕ ﻋﻼﻗﺎﺕ ﺍﻟﻘﻮﻯ ﻓﻲ ﺍﻟﻠﻘﺎء، ﺣﻴﺚ ﻣﺜﻞ ﻫﺬﺍ ﺍﻟﺘﺼﻮﺭ ﺗﺤﺪﻳًﺎ ﻟﻤﺸﺎﺭﻛﺔ ﺍﻟﻤﻬﺎﺟﺮﻳﻦ ﻓﻲ ﺍﺗﺨﺎﺫ ﺍﻟﻘﺮﺍﺭ ﻓﻴﻤﺎ ﻳﺨﺺ ﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ. ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻚ، ﺃﺑﺮﺯ ﺍﻟﻤﺸﺎﺭﻛﻮﻥ ﺍﻟﻌﺪﻳﺪ ﻣﻦ ﺍﻟﺘﺤﺪﻳﺎﺕ ﺍﻟﺘﻨﻈﻴﻤﻴﺔ ﻭﻧﺎﻗﺸﻮﺍ ﺍﻟﻤﺸﺎﻛﻞ ﺍﻟﺘﻲ ﻧﺸﺄﺕ ﻣﻦ ﺍﻟﺘﻔﺎﻋﻞ ﺑﻴﻦ ﺍﻟﻈﺮﻭﻑ ﺍﻟﻬﻴﻜﻠﻴﺔ ﻭﺍﻟﻔﺮﺩﻳﺔ ﻏﻴﺮ ﺍﻟﻤﻮﺍﺗﻴﺔ ﻟﻠﻤﻬﺎﺟﺮﻳﻦ. ﺗ

ﺗﺴﺎﻫﻢ ﻫﺬﻩ ﺍﻷﻁﺮﻭﺣﺔ ﺃﻭﻻً ﻓﻲ ﺯﻳﺎﺩﺓ ﺍﻟﻔﻬﻢ ﻟﻠﺘﺠﺎﺭﺏ ﻭﺍﻟﺨﺒﺮﺍﺕ ﻓﻲ ﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ ﻓﻲ ﺍﻟﺴﻮﻳﺪ ﺑﻴﻦ ﺍﻟﺸﺒﺎﺏ ﻣﻦ ﺫﻭﻱ ﺗﺠﺎﺭﺏ ﺍﻟﻬﺠﺮﺓ ﻭﺍﻟﺨﻄﺎﺑﺎﺕ ﺣﻮﻝ ﺍﻟﺠﻨﺴﺎﻧﻴﺔ. ﻳﻤﻜﻦ ﺍﺳﺘﺨﺪﺍﻡ ﻫﺬﺍ ﺍﻟﻔﻬﻢ ﻹﺭﺳﺎء ﻭﺗﻄﻮﻳﺮ ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ ﻭﻣﺒﺎﺩﺭﺍﺕ ﻣﺨﺼﺼﺔ ﻟﺘﻌﺰﻳﺰ ﺍﻟﺼﺤﺔ ﻭﺍﻟﺤﻘﻮﻕ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ ﻟﺪﻯ ﻫﺬﻩ ﺍﻟﻤﺠﻤﻮﻋﺔ. ﻭﺛﺎﻧﻴﺎً، ﻓﻲ ﺗﻌﻤﻴﻖ ﺍﻟﻤﻌﺮﻓﺔ ﺣﻮﻝ ﺑﻌﺾ ﺍﻟﺘﺤﺪﻳﺎﺕ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﺘﺤﻘﻴﻖ ﻫﺪﻑ ﺍﻟﻤﺴﺎﻭﺍﺓ ﻓﻲ ﺍﻟﺼﺤﺔ ﺍﻟﺠﻨﺴﻴﺔ ﻭﺍﻹﻧﺠﺎﺑﻴﺔ ﺑﺎﻟﺴﻮﻳﺪ.

Place, publisher, year, edition, pages
Malmö University Press, 2024. p. 158
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383, E-ISSN 2004-9277 ; 2024:13
National Category
Public Health, Global Health, Social Medicine and Epidemiology
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urn:nbn:se:mau:diva-71791 (URN)10.24834/isbn.9789178775316 (DOI)978-91-7877-530-9 (ISBN)978-91-7877-531-6 (ISBN)
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2024-11-22, Auditorium C, NI:CE011, Niagara, Nordenskiöldsgatan 1, 09:15
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Paper III in dissertation as manuscript and not included in the fulltext online.

Available from: 2024-10-25 Created: 2024-10-25 Last updated: 2024-10-25Bibliographically approved

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Amroussia, Nada

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