Beth Maina Ahlberg

Gendered Construction of Sexual Risks: Implications for Safer Sex Among Young People in Kenya and Sweden

Abstract This study compared perceptions of sexual risk and sexual practices among youth in Kenya and Sweden. Self-generated questions on the body, perceptions of sexual risk and sexual practices were collected in Kenya while focus group discussions and individual interviews on these same issues were used in Sweden. The most striking differences between the two countries were in the level of knowledge on matters of sexuality and the ability to talk with ease on these matters. The refusal in Kenya to provide adolescents with information and services has left the ‘safe period’ as their only protective option and pregnancy as the overriding concern. Communication at the partner level and lack of condom use are problematic in both countries and even where access to information and preventive services exist these may not be used optimally. In both countries, boys had more sexual freedom, while girls were controlled through labelling and rumours, and girls were assigned responsibility for safer sex. We conclude that sexual education should be based more broadly on an understanding of the social norms defining sexual behaviour. It is at the level of sexual relations that the tensions between culturally-defined sexual and gender norms and public health assumptions should be addressed, a level at which health policy and education are silent in both countries.

Constructing interorganizational collaboration The action researcher as boundary subject

This article aims to explore critically the role of an action research team in the social construction of interorganizational collaboration aimed at transgressing organizational and professional boundaries. We argue that the new relationships, actor conceptions and in some cases forms of work organization arising from the change process have been socially constructed through the discursive interventions of the researchers. This has largely occurred through informal interaction with and between the actors engaged in the development process. The action researcher, rather than being a neutral discursive gatekeeper in collaborative development projects, is an active constructor of the discourse shaping the collaboration. A case is presented showing how the researcher role is thus better seen as being an active boundary subject mediating across various professional and organizational perspectives rather than a passive boundary object. Accordingly, by focusing on the discursive role of active researchers as boundary subjects, we can reflect more critically on the roles we adopt in our intervention endeavours and their inevitably political nature.

“It is a challenge to do it the right way”: an interpretive description of caregivers’ experiences in caring for migrant patients in Northern Sweden

BackgroundExperiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice.MethodsWe used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis.ResultsWe found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system.ConclusionsThe study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers’ contextual understanding of migrant groups and their needs, (d) and improve migrants’ health literacy through strategies such as community based educational outreach.

‘It’s Only a Tradition’: Making Sense of Eradication Interventions and the Persistence of Female ‘Circumcision’ within a Swedish Context

This paper questions why female circumcision (FC) persists despite eradication interventions and the migration of people to non-practising countries and discusses the reasoning of Somali immigrants on female circumcision. It is based on interviews with diverse groups and individuals in the Somali community, mostly refugees in Sweden. Paradoxes implying denial and avoidance emerged. Female circumcision was described, as just ‘a tradition’ that has little to do with Islam. The fear of bringing up an uncircumcised daughter in the liberal sexual morality of Sweden was mentioned as a dilemma. Circumcised women said the health care they received during pregnancy and childbirth was poor while the law failed to take account of the experiences of the Somali people. We conclude that rather than eradication, interventions seem to have silenced and stigmatized the practice due to their failure to take account of its meanings, organization and contexts, including the diasporic dynamics within which immigrants negotiate identities.

Becoming and Being a Teenage Mother: How Teenage Girls in South Western Sweden View Their Situation

Our aim in this study was to describe the perspectives, experiences, and reasonings about becoming and being a teenage mother by Swedish teenage girls. Twenty pregnant and parenting teenage girls, aged 15 to 19 years, were interviewed. The teenagers described a pattern of early childbirth in their families, lack of opportunity in life, and ambivalence in contraceptive use as reasons for becoming a teenage mother. They experienced being pregnant and a teenage mother as both a positive transition into adulthood but also as a physiological and psychological hardship. Furthermore, the teenagers emphasized the importance of supportive relationships with families, friends, and society as a prerequisite for successful parenting. The results of our study may be viewed as generating a working hypothesis that can be transferred to other settings on the basis of the information gathered.

Battles on women's bodies: War, rape and traumatisation in eastern Democratic Republic of Congo

Abstract Rape has been used as a weapon in the conflict in eastern Democratic Republic of Congo (DRC) in unprecedented ways. Research into the phenomenon of war-rape is limited, particularly in this context. The aim of this study was to explore perceptions of local leaders in eastern DRC concerning rape and raped women in the war context. Local leaders were chosen for their ability to both reflect and influence their constituencies. Interviews were conducted with 10 local leaders and transcripts subjected to qualitative content analysis. The study suggests that mass raping and the methods of perpetration created a chaos effectively destroying communities and the entire society and that humanitarian aid was often inappropriate. Furthermore, an exclusive focus on raped women missed the extent of traumatisation entire communities suffered. More significantly, the lack of political will, corruption, greed and inappropriate aid creates a tangled web serving to intensify the war. This complexity has implications for humanitarian interventions including public health.

Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): An ethical analysis:

Aims: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous. Methods: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used. Results: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word. Conclusions: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.

Peer but not peer: considering the context of infant feeding peer counseling in a high HIV prevalence area.

Postnatal transmission of HIV through breastfeeding remains an unsolved problem in resource poor settings, where refraining from breastfeeding is neither feasible nor safe. This study describes how women experienced infant-feeding peer counseling within a community-based intervention trial in 3 settings in South Africa. In total, 17 interviews and 10 observations were done with HIV-infected and uninfected women. The findings raise questions on the concept of “peer.” Some women feared the peer counselor visits and questioned their intentions. Others, especially HIV-infected women, valued peer counseling for the emotional support provided. Being HIV infected with limited or no network of support appeared stressful for most women. The effects of data collection on the delivery and uptake of peer counseling are discussed. The findings underline the contextual barriers facing peer counselors and show that these challenges could have important implications for the effectiveness of infant-feeding counseling in high HIV prevalence countries.

Competing Knowledge Claims in the Provision of Antenatal Care: A Qualitative Study of Traditional Birth Attendants in Rural Zimbabwe

In this article we examine the role of traditional birth attendants (TBAs) in their care of women during pregnancy and childbirth, and highlight their views on the training they receive and the application of knowledge they gain. We also discuss the ways women and men reason around the practices of TBAs. Data were generated using focus group discussions and individual interviews with TBAs, women, and men. The accounts of the TBAs, women, and men indicate that the women combined traditional and professional care, reasoning that in this way they get the different forms of assurance that each offers for the proper pregnancy outcome. The accounts, moreover, suggest that little of the knowledge gained from the training, including the referral of women at high risk, was implemented. One reason for this appears to be the failure to reflect on local knowledge and realities in TBA training. We conclude that any efforts or plans to incorporate the two systems of care should acknowledge local knowledge and realities. Only then can the aim of reducing maternal and infant morbidity and mortality be achieved.

Ethics of screening for asymptomatic herpes virus type 2 infection

Commercial tests for herpes simplex virus are now widely available, and some experts have advocated screening. But can screening be ethical when false positive results occur, many infected people are asymptomatic, and no cure is available?