Experiences of providing abortion care and contraceptive counselling to immigrant women in Sweden
Elin C. Larsson1, Kristina Gemzell-Danielsson1, Birgitta Essén2, Marie Klingberg-Allvin1 ,3 1Dept of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden, 2Dept of Womens and Childrens Health,Uppsala University, Uppsala, Sweden, 3Dalarna University, Falun, Sweden - firstname.lastname@example.org
Universal access to health care services is a public health goal in Sweden and one cornerstone is to promote universal access to safe and secure sexuality and good reproductive health. Immigrants represent 15% of the total Swedish population. Evidence suggests that immigrants might have different sexual and reproductive health (SRH) care needs as compared to non-immigrants. Previous research indicates sub-optimal reproductive health care and adverse SRH outcomes among immigrants living in high-income settings. Family size and contraceptive use is marked by deeply rooted cultural values and norms. A culturally competent approach in service provision has been described to improve reproductive health care utilization among immigrant women. Unintended pregnancies and induced abortions are considered a public health problem and add substantial costs to both the individual women and society at large. Research from Nordic settings has shown higher rates of induced abortion among immigrant women as compared to native-born women. Objective: The aim of this ongoing study is to explore health care providers’ experiences of abortion care and contraceptive counselling to immigrant women in Sweden. Method: Data collection will be completed in September 2014. Individual interviews are carried out to reach a total of approximately 30 health care providers involved in abortion care. A purposive sampling technique is being used to recruit participants with a variety of backgrounds. An inductive approach, using thematic analyses will be applied. Conclusions: Healthcare providers experiences of abortion care and contraceptive counselling has not been described earlier. Healthcare providers are key actors in order to achieve equity in SRH. The results from this study will be used to revise health promotion programmes and healthcare provision to meet immigrant women’s needs and is expected to increase equity within the healthcare system in Sweden.
Are women with a foreign background more likely to have an induced abortion as compared to nonimmigrant women? A study conducted in Stockholm, Sweden
Elin Larsson1 ,2, Karin Emtell-Iwarsson1, Kristina Gemzell-Danielsson1, Birgitta Essén2, Marie Klingberg-Allvin1 ,3
1Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden, 22Department of Women’s and Children’s health/ IMCH, Uppsala University, Uppsala, Sweden, 33School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
Objectives: To examine if women with a foreign background were more likely to have an induced abortion as compared to nonimmigrant women.
Methods: A cross sectional study conducted in eight abortion clinics in Stockholm County during January to April 2015. The eight clinics conduct more than 90% of all abortions in Stockholm County. Inclusion criteria were all pregnant women 18 years old or above, seeking for induced abortion. Exclusion criteria were individuals under 18, not decided about having an abortion and women who had travelled to Sweden only to have an abortion. Midwives at the clinics interviewed the women in the end of the first visit, using a standardised questionnaire that they filled in. When needed a professional interpreter was used.
Results: A total of 787 women were included in the study, 67% of the participants were nonimmigrants, 23% were foreign born and 10% were second-generation immigrants. These proportions were significantly different from the general population. There was a significant higher incidence of abortion among second-generation immigrants. Immigrant women were older as compared to non-immigrant women. However, immigrant status was not a significant predictor for having a subsequent abortion. However, immigrant women from certain countries were over represented among the women seeking abortion care and did not correspond to the proportion in the general population. In addition, contraceptive use ever in life, and at time of conception was lower among immigrant women as compared to non-immigrant women.
Conclusions: Contrary to previous European research immigrants were less likely to have an induced abortion as compared to non immigrants, but the study suggests that second generation immigrants are presenting for induced abortion in higher numbers. More research is needed to understand the reasons for this and why access to contraceptives is lower among immigrant women.