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[...]no consensus has been reached by WHO and scholars as to causality or explanatory mechanism [4, 6]. [...]questioning an assumption of cause and effect between FGM/C and certain long-term health difficulties is of considerable scientific value and should, in my view, be seen as the main contribution of the authors’ study. [...]with respect to some forms of FGM/C, such as “nicking” (or other forms that might be categorized within WHO Type 4 or 1a), there are essentially no data available with which one could even begin to assess a relationship between childhood exposure to the procedure and any long-term outcomes [5, 7]. [...]systematic reviews of other forms of FGM/C reveal an overall high frequency of poor quality data coming from studies of low methodological rigor [8, 9–10], while meta-analyses that have pooled data with the ambition to present more stable results than can be derived from any single study confirm that “the quality of evidence for all outcomes as being too low to warrant conclusions about a causal relationship between FGM/C and obstetric complications” [11]. [...]to assess everyday experiences of discrimination, participants were asked to report the frequency with which they recalled having had certain experiences, as follows: “treated with less courtesy/respect than other people; poorer service than others at restaurant/store; people act afraid of you; threatened/harassed; people act as if they think you are not smart” (https://doi.org/10.1017/S1742058X11000087).

Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden. To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective. We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records. The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980-2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3-7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up. Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.

Background The prevalence of mental health disorders is known to be high among university students globally. Currently there are only a few studies on depression among university students in Sri Lanka. The aim of this study was to screen for the prevalence of Major Depressive Disorder (MDD) and other forms of depression, and to evaluate the factors associated with MDD. Methods A cross sectional survey using the Patient Health Questionnaire (PHQ-9) was conducted among 637, second-year students from the faculties of Management Studies & Commerce, Science and Medicine at the University of Jaffna, during the Coronavirus (COVID-19) pandemic. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Results MDD was considered to have been experienced by 31% of the students. From all three faculties, 70% of the students claimed to have experienced some form of depression ranging from mild to severe. The factor associated with MDD was the students’ ethnicity. Conclusion Due to the high MDD risk among university students, it is imperative to develop psychosocial interventions to ensure early detection of mental health disorders and provide adequate support to safeguard this vulnerable population.

Background It is widely recognized that migrant women from low-income countries are considered to be a group with increased obstetric challenges. To address these challenges, cultural doulas were introduced to provide continuous emotional and practical support during childbirth in Sweden. Leveraging their shared cultural background, language skills, and understanding, the idea behind these doulas was supposed to facilitate effective communication between the woman, her partner, and healthcare staff, with the assumption that this would lead to better maternity care for migrants. The aim of this study was to explore healthcare providers reflections on the role of cultural doulas and to explore their perceptions of cultural doulas’ impact on childbirth. Methods A qualitative study was conducted in 2022, involving semi-structured interviews with 18 healthcare providers; obstetricians and midwives from two Swedish counties. The data was analyzed using reflexive thematic analysis and discourse analysis, guided by Bacchi’s ‘What Is the Problem Represented to Be?’ approach. Results Using Bacchi’s ‘What Is the Problem Represented to Be?’ approach, the analysis highlights how healthcare providers interpreted cultural doulas as an asset in relation to problems in migrants’ maternity care. Three key discourses that emerged were: underlying social and cultural factors, assumptions of improved outcomes and integration, and cultural doulas as informal interpreters. Instead of emphasizing medical risks, healthcare providers focused on social risks and overlooked the importance of professional training. Conclusions Cultural doulas are recognized as valuable in addressing gaps in migrant maternity care, yet their role presents a paradox. Entrusting the care of high-risk migrant women to minimally trained non-medical professionals paradoxically risks miscommunication and compromised care quality. Insufficient training, unclear roles, and the overextension of cultural doulas further exacerbate this issue, underscoring the need for systemic reforms. To resolve this paradox and improve maternal outcomes, the maternity care system must redefine the role of cultural doulas, prioritize professional interpretation services, and implement integrated care models tailored to the evidence based medical needs of migrant women.

Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. A facility-based cross-sectional study was conducted in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. All maternal near-miss cases admitted to the selected hospitals during the study period were prospectively recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant's record. During the one-year period, there were a total of 238 maternal near-miss cases and 29,697 live births in all participating hospitals, which provides a maternal near-miss incidence ratio of 8.01 per 1000 live births. The underlying causes of the majority of maternal near-miss cases were hypertensive disorders and obstetric hemorrhage. Anemia was the major contributing cause reported for maternal near-miss. Most of the maternal near-miss cases occurred before the women's arrival at the participating hospitals. The study demonstrated a lower maternal near-miss incidence ratio compared to previous country-level studies. The majority of the near-miss cases occurred before the women's arrival at the participating hospitals, which underscores the importance of improving pre-hospital barriers. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization.

Concerns have been raised that immigrants coming to Europe bring fundamentally different social values, affecting the more liberal receiving societies negatively. However, the topic of immigrants’ social values is understudied, and much research studies only one issue at a time, lacking a systematic approach to compare immigrants and native-born across issues. We study the social values of immigrants in Sweden using a large sample of newly arrived immigrants and their opinions on 35 different moral issues. Our results indicate a large heterogeneity across different issues, with, on average, a general tendency towards liberal social values among immigrants. We find that individual characteristics are more important than characteristics of the country of origin in explaining variation of social values between immigrants. Religiosity has the largest effect, with more religious individuals having more conservative stances. Using external data sources, we compare immigrants with native-born regarding both average positions on different issues, and the correlation between issue positions. Compared with the native-born, immigrants have, on average, somewhat more conservative values, but the underlying values structure is the same.

Initiation rituals such as hazing, bullying, and ragging, as it is referred to in Sri Lanka, is a global phenomenon and has become a serious public health problem. Students are bullied and harassed by senior students causing them to suffer severe adverse consequences including depression, increased university dropouts and suicide. Although this has led to a significant burden on the country, research on ragging is scarce. The aim of this study was to explore the perceptions of students concerning the phenomenon of ragging and to understand how ragging affects student life and culture at the University of Jaffna, Sri Lanka. This paper is based on 17 focus group discussions with male and female students of Sinhalese, Tamil, and Muslim ethnicity. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. The findings revealed how students perceived ragging differently; as an expression of power to initiate order and as a way to express dissatisfaction towards social inequalities occurring within the larger society or to facilitate bonds between university students. Students trivialized violence related to ragging and accepted it as a part of the university subculture despite being aware of the dire consequences. There was a described cyclical nature to ragging whereby victims become perpetrators. The student’s perspective appeared to be a missed opportunity in finding feasible solutions to a societal problem that must take all parties involved, into consideration.

Background Stereotypes about immigrant patients in healthcare can hinder effective communication, erode trust, and contribute to discrimination and poorer health outcomes. Culturally competent healthcare aims to improve communication and build trust by acknowledging patients’ cultural backgrounds, but it also risks overemphasising cultural differences and reinforcing stereotypes. To address this tension, this study examines how healthcare providers in Sweden perceive the values of immigrant patients regarding sexual and reproductive rights and compares these perceptions with the actual values held by newly arrived immigrants. Methods The study draws on two large-scale surveys conducted in 2020–2021. The first survey was conducted among newly arrived immigrants in Sweden and included eighteen questions on moral issues related to sexual and reproductive rights, such as abortion, contraception, and sex before marriage. Responses from newly arrived immigrants originating from the Middle East, North Africa, and the Horn of Africa ( N  = 992) were used in this study. The second survey was conducted among healthcare providers working in sexual and reproductive healthcare ( N  = 1,041) and asked how they believed immigrant patients from corresponding regions would respond on the same set of issues. Results from the two surveys were compared using three complementary approaches: examining the distribution of healthcare providers’ perceptions, assessing their accuracy relative to immigrants’ self-reported values, and testing for systematic biases in the direction of these perceptions. Results Of the eighteen included issues, healthcare providers’ perceptions aligned with immigrants’ self-reported issue positions in only six cases. The greater the proportion of immigrants holding liberal rather than conservative positions, the more often providers’ perceptions were incorrect (Pearson’s r = -0.73). Healthcare providers often erroneously assumed that immigrant patients hold very conservative values, a pattern most pronounced on issues where immigrants held the most liberal views. Conclusions To avoid stereotypes and promote equitable, culturally competent healthcare, providers need to develop a better understanding of immigrants’ values and how these are shaped. Our findings reveal a tendency to underestimate the liberal values of immigrant patients, particularly on issues related to sexual and reproductive rights, thereby reinforcing bias and contributing to essentialist thinking in clinical practice. Plain language summary When people move to a new country, they often face challenges in getting the healthcare they need, especially when doctors or nurses make assumptions about their cultural or moral beliefs. In Sweden, like in many other countries, healthcare providers are encouraged to offer culturally competent care. This means they should try to understand and respect patients’ different backgrounds. However, if providers rely too much on general ideas about where someone comes from, they may end up using stereotypes instead of seeing the individual. This study looks at how healthcare providers in Sweden think about the values of immigrant patients from the Middle East, North Africa, and the Horn of Africa, specifically on issues related to sexual and reproductive rights, such as abortion, contraception, or sex before marriage. We compared what healthcare providers believe such immigrant patients think with what immigrants from these regions actually answered in two recent surveys. The results show that healthcare providers often assume that immigrant patients have overly conservative views. This mismatch was most striking on the topics where the patients were the most socially liberal. These misunderstandings can affect the quality of care that immigrant patients receive. To avoid this, healthcare workers need better knowledge of the real beliefs and experiences of their patients. This would help ensure respectful, equitable, and inclusive healthcare for everyone.

Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.