Reproductive agency and the acceptability of divorce, abortion, and homosexuality among migrants from the Middle East and Africa living in Sweden-a cross-sectional analysis.

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 acceptability of divorce, abortion and homosexuality 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 Choice Sub-Index (CSI), a composite index of the acceptability 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. Almost 3/4 (73%) of respondents expressed a high degree of reproductive agency, but less than five per cent of respondents had a high value on the CSI. Living in Sweden ≥ 4 years was associated with higher values on the CSI (aOR 1.76, 95% CI 1.15-2.67), while identifying as Muslim was associated with having a low value on the CSI (aOR 0.44, 95% CI 0.32-0.63). Neither duration of time in Sweden nor identifying as Muslim were associated with reproductive agency. Age and reason for migration (family reunification or as a refugee) were not associated with either outcome.

Conclusion: Our study found that migrants from MENA and SSA expressed a high degree of reproductive agency. Migrants had low values of a combined measure of the acceptability of divorce, abortion and homosexuality; however, acceptance 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.