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Sacred Ideals: Diversity and Equality in Swedish Reproductive Healthcare
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (International Maternal and Child Health, IMCH)
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To promote diversity (mångfald) and equality (jämlikhet) is a key task for a wide range of welfare institutions in Sweden. The two terms appeal to several aspects simultaneously: inclusiveness, moral goodness, awareness and willingness to facilitate a positive social change. Diversity and equality have become, as I suggest in this thesis, two sacred ideals in Swedish society today. In the context of reproductive healthcare, various forms of diversity and equality measures are thought of as solutions to, for instance, inequalities between immigrant groups and others, structural discrimination of minority groups, and difficulties faced by the Swedish healthcare system in caring for patients’ diverse needs and preferences in clinical encounters. In this thesis, diversity and equality are analysed as two important governing mechanisms in the organisation of healthcare in multicultural Sweden. The aim was to explore how these ideals contribute to shape the provision of reproductive healthcare, and its consequences.

Paper I shows that targeted interventions towards immigrant women in contraceptive counselling risk singling out some women from standard routes of care because they are categorised as “immigrants” or “Muslims”. Paper II shows that demands upon healthcare providers to accommodate Muslim patients’ presumed needs have the potential of also creating needs that were not there from the start. Paper III shows that many religious counsellors who are affiliated with Swedish healthcare as spiritual advisers present ideas on abortion that are less progressive than what is stipulated in Swedish abortion law. Paper IV shows that imperatives to promote gender equality in contraceptive counselling were taken seriously by providers in their encounters with non-Western women, at the possible expense of respect for relationship structures that do not conform to the ideals of gender equality.

The findings presented in this thesis show that the interventions and initiatives that sought to presumably help disadvantaged groups of people (i.e. Muslims, immigrant women) could, in fact, be obstacles to solving the problems they were meant to address. I argue that the governance of Swedish reproductive healthcare through diversity and equality ideals must be problematised and balanced with regard to their plausible consequences.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 102
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1593
Keywords [en]
diversity, equality, gender equality, religion, reproductive health, migration, multicultural encounters, Scandinavia, Sweden
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-392210ISBN: 978-91-513-0737-4 (print)OAI: oai:DiVA.org:uu-392210DiVA, id: diva2:1347343
Public defence
2019-10-18, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-26 Created: 2019-08-31 Last updated: 2019-10-15
List of papers
1. Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research
Open this publication in new window or tab >>Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed) Published
Abstract [en]

Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

Keywords
Muslim women, Immigrant women, Contraceptive use, Reproductive health, Denmark, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-388751 (URN)10.1016/j.midw.2019.03.017 (DOI)000470962400011 ()31005014 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4576
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-09-05Bibliographically approved
2. Modes of Governing: A Foucaultian Perspective on Encounters between Healthcare Providers and Muslim Women in Swedish Reproductive Healthcare
Open this publication in new window or tab >>Modes of Governing: A Foucaultian Perspective on Encounters between Healthcare Providers and Muslim Women in Swedish Reproductive Healthcare
(English)Manuscript (preprint) (Other academic)
Abstract [en]

There are probably few groups of patients in Sweden today that arouse as much associations and thoughts as do Muslims from the Middle East. The core dilemma in much of these discussions is whether healthcare providers should adjust the provision of care to Muslims’ divergent religious preferences, or if they would be better off to treat Muslims in the same way as other patients. These debates are often entangled with both a concern about politics of equality (i.e. ambitions to treat everyone the same) and politics of diversity (i.e. to treatpeople from ethnic and religious minority groups differently). Inspired by Foucault’s concept of governmentality, we in this study intended to explore the principles of ‘equality’ and 'diversity’ as governing tools for the shaping of healthcare providers and patients’ conduct. We found that although these governing tools are presented as non-conflicting in health policies, there seems to be an often-present trade-off between diversity and equality ideals in their practical implementation. When these policies are assigned meaning and implemented inpractice, they appear to generate unforeseeable consequences, both for healthcare providers and for the patients. It thus appears that the policies that were introduced with the intention of improving the structure of multicultural care encounters, in some cases, had an opposite effect.

Keywords
Muslim, reproductive healthcare, diversity, equality, politics of recognition, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-392207 (URN)
Available from: 2019-08-31 Created: 2019-08-31 Last updated: 2019-09-05Bibliographically approved
3. Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors
Open this publication in new window or tab >>Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors
2019 (English)In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, p. 1-20Article in journal (Refereed) Published
Abstract [en]

The abortion discourse in Sweden is marked by historically liberal ideals about women’s inviolable right to make autonomous reproductive decisions. However, to respond to the increase in cultural and religious pluralism building up over several decades, religious organizations have been given opportunities to provide so-called spiritual care in affiliation with Swedish hospitals since the 1980s. In this study we asked: in what ways do religious counsellors, affiliated with Swedish hospitals, construct their ideas on abortion, and how well do their ideas comply with Sweden’s ‘women-friendly’ abortion policies? Through interviews with Protestant, Catho-lic, Muslim, and Buddhist religious counsellors, we wanted to empirically test the presumption underlying the decisions to grant space to religious actors in Swedish healthcare, i.e., that religious counselling serves to complement existing services. We found that it cannot be expected that religious advice on abortion will always comply with Swedish abortion law and with the women-friendly abortion policy that the Swedish state seeks to impose. When policy-makers open up possibilities for diverse norms on abortion to manifest in close affiliation with healthcare institutions, they must be aware that some religious counsellors argue that only God—and not the woman herself—can decide whether a woman can terminate a pregnancy. We argue that the findings in this study speaks to what researchers have referred to as the “diversity-equality paradox”, which highlights the tension between the promotion of religious ideas on abortion on the one hand and the promotion of liberal ideas about women’s reproductive freedom on the other.

Keywords
Abortion, Women’s rights, Religious counselling, Diversity promotion, The diversity–equality paradox, Healthcare, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389908 (URN)10.1007/s12119-019-09614-6 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-07-31 Created: 2019-07-31 Last updated: 2019-09-05
4. Unintended Consequences of Gender Equality Promotion in Swedish Multicultural Contraceptive Counseling: A Discourse Analysis.
Open this publication in new window or tab >>Unintended Consequences of Gender Equality Promotion in Swedish Multicultural Contraceptive Counseling: A Discourse Analysis.
Show others...
2017 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 10, p. 1518-1528Article in journal (Refereed) Published
Abstract [en]

In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers' ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women's possibilities to obtain adequate support. At the end of the article, we suggest how health care providers' reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.

Keywords
Sweden, contraceptive counseling, cultural diversity, discourse analysis, gender equality, qualitative method, reproductive health, women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-327196 (URN)10.1177/1049732317697099 (DOI)000406057500007 ()28728532 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2019-08-31Bibliographically approved

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