Reproductive agency and the value of reproductive choice among migrants from the Middle East and North Africa and Sub-Saharan Africa living in Sweden–a cross-sectional analysis of the Migrants World Values Survey

Abstract

Abstract Background Sweden has a longstanding history of promoting sexual reproductive health and rights. Reproductive decision-making is a fundamental right, but an individual’s decision-making power differs across contexts. We examined self-reported reproductive agency and the value individuals place on reproductive choice among migrants in Sweden originating from the Middle East or North Africa (MENA) and Sub-Saharan Africa (SSA).Methods This cross-sectional study used face-to-face interview data from the 2018–2019 Migrant World Values Survey (MWVS) and included individuals 18–49 years old who migrated to Sweden from MENA or SSA. Partial proportional odds models were used to estimate adjusted odds ratios (aOR) and corresponding confidence intervals (CI) of associations between sociodemographic factors and two outcomes: 1) reproductive agency (decision-making power on when, with whom, and how many children to have), measured on a 10-point scale categorized as low (1–4), moderate (5–7), and high (8–10); and 2) the value of reproductive choice, measured by the WVS choice index comprising the justifiability of divorce, abortion, and homosexuality, categorized as 0-<0.4 (low), 0.4-<0.7 (moderate), and 0.7-1.0 (high).Results Between September 2018 and November 2019, 7991 participants responded to the MWVS, of whom 4669 met the inclusion criteria. Less than five per cent of respondents placed a high value on reproductive choice, whereas 73% expressed a high degree of reproductive agency. Living in Sweden ≥ 4 years was associated with a high value of reproductive choice (aOR 1.76, 95% CI 1.15–2.67), but not with reproductive agency. Identifying as Muslim was associated with a lower likelihood of valuing choice (aOR 0.44, 95% CI 0.32–0.63) but was not associated with reproductive agency (aOR 1.40, 95% CI 0.87–2.24). Neither age nor reason for migration (family reunification or as a refugee) were associated with either outcome.Conclusion Our study found that migrants from MENA and SSA expressed a high degree of reproductive agency. Migrants placed a low value on reproductive choice; however, this increased with time spent in Sweden. Understanding factors associated with migrants’ sense of reproductive agency and their values and how these change over time in Sweden provides a foundation for working towards equitable sexual and reproductive health and rights.