We found that approximately three-quarters of first-generation migrants from SSA and MENA in Sweden self-reported a high degree of reproductive agency (i.e., how much can you decide yourself when it comes to having children). At the same time, almost 80% of participants placed a low value on reproductive choice, i.e., one’s values related to homosexuality, abortion, and divorce. Several factors can shape an individual’s value of reproductive choice, including a country’s legal context, social norms, religious beliefs, societal stigmas, and personal experiences [17, 31, 32]. Homosexuality remains criminalized in the countries from which the majority of the study participants originated, such as Syria, Afghanistan, Eritrea, and Somalia [33]. Individuals who identify as LGBTQIA + lack legal protections against discrimination and often face the threat of violence and persecution in these countries [33]. Consequently, migrants may hold more traditional viewpoints that inform their acceptability of homosexuality, thereby setting them apart from social and gender norms prominent in host countries like Sweden [34]. We did find, however, that the longer migrants lived in Sweden, the greater the value they placed on reproductive choice. Our findings are consistent with evidence that migrants’ values change over time in their new destination, during which migrants are exposed to and become familiarized with the destination country’s social norms [26]. An alternative explanation for the association between how long one has lived in Sweden and the greater value placed on reproductive choice is that migrants whose values do not align with Swedish socio-cultural norms leave the country. This is unlikely as emigration is low among those who have come to Sweden as refugees or for family reunification purposes, which is our study population.
The lower value participants placed on reproductive choice may in part be explained by contextual factors in the countries of origin with regards to abortion and divorce, two components of the choice index. Most abortion laws in MENA and SSA are punitive, with many countries only permitting abortion if the mother’s life is in danger [35, 36]. There is greater regional variation between MENA and SSA in the acceptability of divorce. In some parts of SSA where divorce is prevalent, it tends to be more socially acceptable [37]. In the MENA region, divorce laws are predicated on highly gendered roles within a marriage and shari’a-based legal consequences, with conservatives opposing reforms to family law [38]. In countries where divorce is uncommon, it may be perceived as immoral and lead to social isolation and discrimination. Although migrants represent a self-selected sample of their home country population, they may still carry the norms and values of their original societies [37].
Another factor that may contribute to the low value placed on reproductive choice is limited access to sexual education and lack of awareness regarding different reproductive rights in participants’ origin countries [39]. This lack of comprehensive sexual health education may restrict participants’ knowledge and understanding of sexuality and reproduction, contributing to a narrower perspective of reproductive choice and potentially reinforcing traditional norms and beliefs, especially among migrant parents [40]. Such a limited understanding is reflective of a broader issue in that migrants often lack understandable information about the healthcare system, not only how it is organized and the services offered, but also why these services are offered in such a way, and their rights to healthcare in resettlement communities [41, 42].
Sex was associated with reproductive agency insofar as males reported lower reproductive agency than females, but only when low and moderate categories were combined and contrasted with the highest category of reproductive agency. It is possible that males migrating from dominant patriarchal societies to a host country with greater gender equality could experience a diminished sense of reproductive agency. Such a hypothesis could be understood in the context of changing gender relations post-migration. For example, in a Canadian study, Ethiopian men undertook more household responsibilities, while women’s employment outside of the home largely increased. Resistance to these changes was most evident in men, as they felt their previously held power was undermined. However, over time, a shift occurred, resulting in the establishment of routines that diminished the gendered division of labour within the family [43]. Respondents in this study had lived in Sweden for a median time of 3 years, longer studies may reveal whether men’s sense of reproductive agency changes the longer they have lived in Sweden.
We found no differences between males and females in their value of reproductive choice. Previous studies using WVS data have found that females are more accepting of abortion than males [44], and that males are more likely than females to perceive homosexuality as morally wrong [45]. Gender disparities related to household income and the risk of poverty suggest that women may face disadvantages in terms of financial losses during divorce, underscoring the likelihood that men are more accepting of divorce [46] These divergent views on the individual components of the choice index may explain why we found no overall difference between migrant men and women in our study population.
In Europe, there is a clear inverse relationship between age and people’s acceptance of abortion, homosexuality, and divorce [46]. We also expected that younger migrants would place a higher value on choice; however, we found no difference with age, and this may be explained because our study included only adults of reproductive age. There is a lack of research specifically on how migrants’ sense of reproductive agency and reproductive values change over their lifespan. Instead, most studies focus on migrants’ access to sexual and reproductive health services, commodities, and information, in which it has been found that adolescent girls are at greater risk for lack of access compared to women [47]. Furthermore, studies tend not to disaggregate by age, making comparisons challenging.
Migrants from SSA placed a higher value on reproductive choice than those from MENA. This divergence in values of reproductive choice may be attributed to the disparities in cultural norms and values related to family structure, gender roles, and the importance of religion between SSA and MENA. Conversely, we found that migrants from SSA reported lower reproductive agency than those from MENA. Our findings indicate that reproductive values. which may be more constrained by traditional values, do not necessarily correspond to one's sense of reproductive agency. This difference in reproductive agency may be attributed to the restrictions on SRHR commonly found in their countries of origin [9].
We found that migrants with post-secondary schooling had greater odds of reporting a higher sense of reproductive agency compared to migrants with a lower level of education. When individuals have access to education, healthcare services, and economic stability, they are better equipped to make informed decisions about their sexual and reproductive health [48]. Therefore, increased social and economic opportunities benefit both men and women by providing them with the means to have control over their reproductive health and actively participate in this process [48].
Globally, Sweden is positioned at the high end of emancipated values. As individuals migrate from societies characterized by authoritarian values, often intertwined with closed and patriarchal religious structures, they may carry these values with them [27]. Migrating to Sweden and experiencing a cultural shift, which is often defined as acculturation (the process of adapting to the culture of a new host country) [47], can have a profound impact on the values and beliefs of migrants as they become exposed to the more open and egalitarian cultural environment in Sweden. For example, results from the 2019 Swedish MWVS report showed that migrants from seven selected countries living in Sweden since 2010 had greater values of choice compared to migrants who had been living in Sweden since 2018 [27]. Acculturation can also influence people’s views toward sexuality and access to reproductive healthcare services [27]. The fact that our participants placed a low value on choice while still expressing high values of reproductive agency may reflect the influence of the norms and cultural context of their countries of origin together with a greater sense of reproductive freedom living in Sweden.
Ultimately, reproductive agency primarily centers on individuals’ perceptions in making decisions about their reproductive health. Reproductive choice assesses the individual attitudes toward to homosexuality, abortion, and divorce. Both perspectives capture different facets of this complex issue and are vital to our understanding of reproductive decision-making. In addition, other implicit norms and values influence SRHR, such as social hierarchy and political beliefs, and these are frequently overlooked or unacknowledged when migrants resettle in a new country [49]. Placing greater emphasis on integration in the resettlement process can have several benefits for migrants and healthcare providers. For example, it allows for a better understanding of diverse cultures and healthcare practices, which promotes more inclusive and culturally sensitive care, fostering mutual understanding [50]. Therefore, if integration programmes for newly arrived migrants in Sweden and other European countries [51] could provide education and information about reproductive choice and reproductive agency in terms of rights and legalities, along with justifications for their importance, it could substantially contribute to closing the gap between migrants and those born in the host country [52].
To the best of our knowledge, this is the first study to examine both reproductive agency and values placed on reproductive choice among adult first-generation migrant men and women in Europe. The strengths of this study include using a validated measure of reproductive choice, which has proven reliable in different cultural and national settings [53]. Potential limitations include that the study relies on self-reported data, which may have provoked socially desirable responses or be subject to recall bias. We also used a single-item question versus a comprehensive scale to assess reproductive agency. Despite a large sample size, another limitation is missing data, which may have biased our results. Missing data could be attributed to participant fatigue, as the survey was lengthy. It is also possible that participants felt reluctant to answer certain questions related to sexual and reproductive health due to the sensitive nature of the topic [54].
The generalisability of our findings may be limited to migrants originating from MENA and SSA who have moved to high-income countries with similar policies and social norms toward sexual and reproductive health and rights as in Sweden. Extrapolating the results to broader populations or different cultural settings should be approached with caution. Furthermore, the effect of time after migrating to a new country, which includes the impacts of acculturation and the prevailing values in the host country, may affect the value migrants’ place on reproductive choice.