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Building bridges for empowerment and informed decision-making : A qualitative study of midwives’ reflections on how to optimise contraceptive counselling for immigrant women in Sweden

Kolak, Mia LU orcid ; Agardh, Anette LU orcid ; Hansson, Stefan R. LU orcid ; Rubertsson, Christine LU and Ragnar, Maria Ekstrand LU orcid (2026) In PLOS ONE 21(2).
Abstract

Background Sweden’s National Strategy for Sexual and Reproductive Health and Rights (SRHR) emphasises equitable access to contraception and abortion services. Despite this, immigrant women in Sweden experience lower contraceptive use and higher rates of unintended pregnancies and abortions compared with native-born women. Midwives, as primary providers of contraceptive counselling and prescribing, play a central role in promoting reproductive autonomy and informed choice. Aim To explore midwives’ reflections on how to optimise contraceptive counselling for immigrant women in Sweden. Methods Eleven focus group discussions were conducted with 50 midwives from public and private midwifery clinics in Malmö, where one-third of residents are... (More)

Background Sweden’s National Strategy for Sexual and Reproductive Health and Rights (SRHR) emphasises equitable access to contraception and abortion services. Despite this, immigrant women in Sweden experience lower contraceptive use and higher rates of unintended pregnancies and abortions compared with native-born women. Midwives, as primary providers of contraceptive counselling and prescribing, play a central role in promoting reproductive autonomy and informed choice. Aim To explore midwives’ reflections on how to optimise contraceptive counselling for immigrant women in Sweden. Methods Eleven focus group discussions were conducted with 50 midwives from public and private midwifery clinics in Malmö, where one-third of residents are foreign-born. Data were analysed using qualitative content analysis. Findings The overarching theme, “Building bridges for empowerment and informed decision-making,” captured midwives’ commitment to promoting women’s autonomy while navigating systemic and cultural challenges. Five sub-themes emerged: overcoming the discrepancy between mission and reality; addressing organisational weaknesses in the care chain; enhancing knowledge and capabilities; reinforcing competence and trust in communication; and involving men without undermining women’s autonomy. Midwives highlighted structural barriers, limited resources, and time constraints that hindered person-centred and culturally sensitive care. Conclusion Optimising counselling for immigrant women requires systemic changes, including revised funding structures, expanded multilingual resources and strengthened professional development. Addressing these barriers will enhance women's capabilities and support their reproductive autonomy, aligning with Nussbaum’s Capabilities Approach and promoting gender equality.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLOS ONE
volume
21
issue
2
article number
e0340883
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:105031699703
  • pmid:41758884
ISSN
1932-6203
DOI
10.1371/journal.pone.0340883
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 Kolak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
id
17f51a6f-6bf0-4c39-b4bc-5f7b2db366eb
date added to LUP
2026-04-07 13:32:45
date last changed
2026-08-27 09:05:41
@article{17f51a6f-6bf0-4c39-b4bc-5f7b2db366eb,
  abstract     = {{<p>Background Sweden’s National Strategy for Sexual and Reproductive Health and Rights (SRHR) emphasises equitable access to contraception and abortion services. Despite this, immigrant women in Sweden experience lower contraceptive use and higher rates of unintended pregnancies and abortions compared with native-born women. Midwives, as primary providers of contraceptive counselling and prescribing, play a central role in promoting reproductive autonomy and informed choice. Aim To explore midwives’ reflections on how to optimise contraceptive counselling for immigrant women in Sweden. Methods Eleven focus group discussions were conducted with 50 midwives from public and private midwifery clinics in Malmö, where one-third of residents are foreign-born. Data were analysed using qualitative content analysis. Findings The overarching theme, “Building bridges for empowerment and informed decision-making,” captured midwives’ commitment to promoting women’s autonomy while navigating systemic and cultural challenges. Five sub-themes emerged: overcoming the discrepancy between mission and reality; addressing organisational weaknesses in the care chain; enhancing knowledge and capabilities; reinforcing competence and trust in communication; and involving men without undermining women’s autonomy. Midwives highlighted structural barriers, limited resources, and time constraints that hindered person-centred and culturally sensitive care. Conclusion Optimising counselling for immigrant women requires systemic changes, including revised funding structures, expanded multilingual resources and strengthened professional development. Addressing these barriers will enhance women's capabilities and support their reproductive autonomy, aligning with Nussbaum’s Capabilities Approach and promoting gender equality.</p>}},
  author       = {{Kolak, Mia and Agardh, Anette and Hansson, Stefan R. and Rubertsson, Christine and Ragnar, Maria Ekstrand}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{2}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLOS ONE}},
  title        = {{Building bridges for empowerment and informed decision-making : A qualitative study of midwives’ reflections on how to optimise contraceptive counselling for immigrant women in Sweden}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0340883}},
  doi          = {{10.1371/journal.pone.0340883}},
  volume       = {{21}},
  year         = {{2026}},
}