Birgitta Essén

Uppsala University | UU · Department of Women's and Children's Health/IMCH

Background Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, vio...

Background The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease th...

The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence...

Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations sp...

Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. A subset of maternal deat...

Background Experiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is exp...

Introduction Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to t...

Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural comp...

Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public antenatal care clinic. Seven 60-minute sessions were offered, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-minute individual appointment before or after. The aim was to assess the...

Objective Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to...

Swedish healthcare providers must comply with the Patient Act's principles of equal and accessible care and account for patients’ religious backgrounds by offering culturally sensitive care. This chapter explores what characterizes patients’ and their relatives’ expectations in healthcare encounters perceived as religiously discriminatory in the di...

Introduction A dominant narrative, referred to as “the standard tale,” prevails in popular representations about female genital cutting (FGC) that often contrast with how cut women traditionally narrate their FGC experience as meaningful in contexts where FGC is customary. However, scholarship has increasingly highlighted how global eradication cam...

Objectives Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures. Design A quasi-experimental trial with one intervention and one historical control group, nested in...

Concerns have been raised that immigrants coming to Europe bring fundamentally different social values, affecting the more liberal receiving societies negatively. However, the topic of immigrants’ social values is understudied, and much research studies only one issue at a time, lacking a systematic approach to compare immigrants and native-born ac...

Objective This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in Somaliland. Methods An exploratory qualitative approach using focus group discussions was employed at the...

Objectives: Women's healthcare is a potential source of cross-cultural conflicts. Diverging values between healthcare providers and patients challenges the provision of culturally sensitive care and meeting migrant women's needs. The aim is to investigate healthcare providers' values in relation to sexual and reproductive rights, gender equality, m...

FGM/C type IIIb in a 16-month old girl from Mali ( a , b ), admitted with acute retention of urine and acute renal failure, Mali.

Femawle Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e. performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedure...

Labial and Clitoral adhesion. Examples of convergence of inner labia under the glans and intersection with clitoral hood.

Pictures without FGM/C and without lesions. This chapter will help the physician:

Informed consent is essential to ensuring a trauma-informed, survivor-centered, ethical process that respects the (developing) autonomy of a patient.

Please note that when WHO refers to labia minora and majora such terms are now replaced by inner and outer labia.

In Sweden, as well as in an international context, professionals are urged to acquire knowledge about possible health effects of female genital cutting (FGC) in order to tackle prevention and care in relation to the practice. While professionals are guided by policies and interventions focusing on medical effects of FGC, some scholars have cautione...

Background: Immigrants are at increased risk of HIV infection in Europe and at risk of delayed diagnosis. In Sweden, Thailand belongs to one of the three most common countries of origin among immigrants diagnosed with HIV. This study investigated the need and use of sexual and reproductive health (SRH) services among Thai women residing in Sweden....

Introduction: In Sweden, the law treats female genital cutting (FGC) different from male genital cutting (MGC). However, the comparability of medical, ethical and legal aspects of genital cutting of girls and boys are increasingly discussed by scholars, yet little is known about how practicing communities view these aspects. This study aimed to ex...

Background: Severe obstetric morbidity and mortality remain a serious challenge in developing countries such as Somaliland. Despite the wide implementation of comprehensive emergency obstetric care in Sub-Saharan Africa, including Somaliland, the reduction of severe maternal morbidity and mortality has been slow. Aim: This study aims to explore the...

“It is the task of scholars working on the topic of female genital cutting not only to provide perspectives to reduce ethnocentrism, but also to offer ideas for generating acceptable changes for immigrants and their new countries, informed by reasonable approaches that do not rely on inflamed rhetoric or distorted science. The work of scholars, suc...

Background It has been argued that Islamic leaders’ views are of utmost importance to designing a comprehensive sexual education (CSE) curriculum. Therefore, this study explored how Islamic leaders in Bangladesh present, argue for and against, and negotiate views on sexual and reproductive health (SRH) education for adolescents. Methods Semi-struct...

Background Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully ex...

[This corrects the article DOI: 10.1371/journal.pone.0225629.].

Background The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. Methods In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement...

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 aff...

Objective: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. Design: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth inter...

Introduction Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes. Overall aim To d...

Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western,...

Objective: To explore Somali-born parents’ experiences of antenatal care in Sweden, antenatal care midwives´ experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents. Design: Eight focus group discussions with 2–8 participants in each were conducted, three with Somali-born mothers,...

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 wa...

Introduction The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended f...

Objective To evaluate the impact of a criteria‐based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. Methods A cross‐sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013–November 2013 and July 2015–June 2016). Outcomes of fe...

Objective Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access, or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual and reproductive healthcare services among immigrant women in Sweden. Method A cross-sectional study of 288 immigrant women. A structur...

In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis’ post-migration perceptions of FC and MC, while...

Objective To evaluate appropriateness of cesarean delivery and cesarean delivery‐related morbidity among maternal near misses (MNMs) using the Robson ten‐group classification system. Methods In the present audit study, medical records were assessed for women who experienced MNM and underwent cesarean delivery at three university hospitals in Tehra...

This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process of parenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additional couples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in...

Background: Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. The study aimed to ascertain the effect of maternal near-miss on the risk of adverse perinatal outcomes in Ethiopia. Methods: A prospective cohort study was cond...

Background: Ethiopia is one of the sub-Saharan Africa countries with the highest maternal mortality. Maternal near-misses are more common than deaths and statistically stronger for a comprehensive analysis of the determinants. The study aimed to identify the factors associated with maternal near-miss in selected public hospitals of Addis Ababa, Et...

Background Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods In a cross-sectional design, attitudes and knowledge regardin...

Objectives To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. Design Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as faci...

Abstract Background: Worldwide Intimate Partner Violence (IPV) is a major public health problem, affecting all women and vulnerable groups such as HIV-infected women. This study aimed to test the applicability of assessment of IPV using a simple screening tool, among women giving birth at Muhimbili National Hospital in Tanzania, to estimate the pre...

Background Providing equitable maternal care to migrants is a seriously challenging task for hosting countries. Iran, the second-most accessed country for refugees from Afghanistan, has achieved maternal health improvement. However, Afghan women with near-miss morbidity faced pre-hospital delays and disparity in maternal care at hospitals. This stu...

Background: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settin...

Background Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. Methods A facility-based cross-sectional study was conducted in five select...

Identification criteria of maternal-near miss as used by the WHO, 2009 and 2011. (DOCX)

Method: A facility-based study of all maternal near-miss and mortality cases over 5months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with seve...

( Acta Obstet Gynecol Scand . 2016; 95(7):777–786) An important cause of maternal health concern, cesarean section (CS) is known to have some correlation with maternal near-miss (MNM). The objective of this study was to investigate the frequency, causes, risk factors, and perinatal outcomes of MNM. Between March 2012 and May 2014, this incident cas...

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 individualiz...

Background Perinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals. Methods Perinatal audits were c...

Objectives: We used qualitative research design to discursively explore expectant fathers’ perceptions of chlamydia and HIV, and their masculinity constructions about testing, and explored how they talked about their potential resistance towards testing and their pre-test emotions. Study design: Twenty men were offered chlamydia and HIV testing at...

Background Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable a...

The aim of this study is to explore women’s experiences and perceptions of home use of misoprostol and of the self assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcom...