The pros and cons of fertility awareness and information: a generational, Swedish perspective.

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

The construction of intimacy in long-term commercial relationships in Sweden.

Previous research on commercial sex has described fluidity between different forms of relationships, whereby commercial sexual relationships can be both long-term and viewed as intimate from the buyer's perspective. This article explores the construction of intimacy in long-term commercial relationships. More specifically, it examines the meaning of transactions in long-term paid sexual relationships in Sweden. Interviews were conducted with 23 Swedish men with experience purchasing sex as 'regulars'. An inductive thematic analysis was conducted. Findings show that the emotional experience is a key focus for these men when they purchase sex. The emotions involved are not delimited in time and space but are experienced both within and outside of the actual sexual encounter. Such emotions can be understood as the very precondition for the experiences of intimacy, while at the same time they create difficulties for the men who purchase sex. Experiences of intimacy are experienced in the ambiguity between unbounded and bounded authenticity and by not drawing a clear line between emotional subjectivity and consumer subjectivity.

Preconditions to parenthood: changes over time and generations.

Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17-90 years. The analysis of the interviews resulted in six themes: (i) 'Providing security - an intergenerational precondition'; (ii) 'A growing smorgasbord of choices and requirements'; (iii) 'Parenthood becoming a project'; (iv) 'Stretched out life stages'; (v) '(Im)possibilities to procreate'; and (vi) 'Intergenerational pronatalism'. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people's views on their reproductive timeline.

A wonderful experience or a frightening commitment? An exploration of men's reasons to (not) have children.

Research on reproductive decision-making mainly focuses on women's experiences and desire for children. Men included in this type of research usually represent one-half of a heterosexual couple and/or men who are involuntarily childless. Perspectives from a broader group of men are lacking. This study is based on the results of a baseline questionnaire answered by 191 men aged 20-50 years who attended two sexual health clinics in two major Swedish cities. The questionnaire included questions about sociodemographic background, reproductive history and fertility, but also two open-ended questions focusing on reasons for having or not having children. The results of these two questions were analysed by manifest content analysis and resulted in five categories: '(non-)ideal images', 'to pass something on', 'personal development and self-image', 'the relationship with the (potential) co-parent' and 'practical circumstances and prerequisites'. Reasons for having children were mainly based on ideal images of children, family and parenthood. Meanwhile, reasons for not having children usually concerned practical issues. The type of answer given was related to men's procreative intentions but not to background characteristics. In conclusion, men raised many different aspects for and against having children. Therefore, reproductive decision-making should not be considered a non-choice among men.

What do expectant fathers expect of antenatal care in Sweden? A cross-sectional study.

BACKGROUND: In Sweden expectant fathers are now assumed to be active participants in pregnancy and birth, but few studies have focused on fathers' expectations of antenatal care. Knowledge of expectant fathers' views about what is important in antenatal care will enable the design of care that is more inclusive and meets the expectant fathers' needs. OBJECTIVES: To identify expectant fathers' expectations regarding the content of antenatal care during pregnancy and to examine associations between expectations and social factors. METHODS: The current study uses data from a quasi-experimental trial that took place from 2009 to 2010, in which 627 expectant fathers were recruited from different parts of Sweden. RESULTS: Checking the health of the baby (85.3%) and the mother (80.8%) were rated highest in importance by expectant fathers, whereas attending parent classes (14.9%), becoming acquainted with other expectant parents (7.0%) and paying attention to their own emotional well-being (6.9%) were rated lowest. Furthermore, less than half of the expectant fathers had a very high expectation of being treated in a way that made them feel involved (38.5%).First-time fathers, young fathers and fathers with very good emotional health had higher expectations about most aspects of antenatal care. CONCLUSION: Expectant fathers had low expectations of receiving support or of meeting other parents as they thought that antenatal care should have a medical focus. First-time fathers, young fathers and fathers with very good emotional health had higher expectations of antenatal care in most areas.

The problem of non-response in population surveys on the topic of HIV and sexuality: a comparative study.

BACKGROUND: Throughout the Western world, response rates are falling in population surveys. The aim of the study was to explore for the presence of non-response bias in two Swedish research projects on HIV ['HIV in Sweden' (HIS11)] and sexuality ['Sex and health' (UngKAB09)]. METHODS: The study used four data sets (two from each project), each of which had been generated using different methods. By comparing means and percentages on 15 items across the data sets, we explore the potential presence of non-response bias due to interest in the survey topic (topic salience), and discuss the suitability of two increasingly common methods for recruiting respondents: the pre-recruited probability web panel and the self-selected web survey. RESULTS: While a higher proportion of the respondents in the HIS11 substudies had been tested for HIV and were inclined to perceive themselves as being at high risk of HIV infection, the respondents in the UngKAB09 substudies were on average more sexually active. Further, while there was little variation in the results between the HIS11 substudies (postal/web survey and pre-recruited web panel), there were some fairly large differences in the results between the UngKAB09 substudies (web surveys, one of which was based on a self-selected sample). CONCLUSION: The study concludes that (i) there are signs of non-response bias that may be due to topic salience, (ii) while care must be taken when using self-selection sampling methods, the pre-recruited probability web panel might provide a cost- and time-effective alternative for recruiting respondents in future population surveys.

Parenthood, information and support on the internet. A literature review of research on parents and professionals online.

BACKGROUND: The aim of this article was to address questions on how parents use the internet to find information and support regarding children, health and family life. Another aim was to find out how professionals use the internet to provide support and information to parents. This was done by a literature review. METHODS: Articles were searched for in five databases with a search strategy called "building block" approach. RESULTS: The review showed that the majority of today's parents search for both information and social support on the internet. However, there are considerable differences due to gender, age and socio-economic differences. First time middle class mothers aged 30-35 are most active in looking up health and parent information on the internet. In the same time, several studies report diminishing class differences on parent web sites. An important reason to the increasing number of parents who turn to the internet for information and interaction has shown to be the weakened support many of today's parents experience from their own parents, relatives and friends. Professionals have recognized the parents' great interest for going online and offer both information and support on the net. CONCLUSION: Many benefits are reported, for example the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, most studies were empirical and lacked theoretical frameworks which leave questions on how we can more fully understand this phenomenon unanswered.

The experience of Middle Eastern men living in Sweden of maternal and child health care and fatherhood: focus-group discussions and content analysis.

OBJECTIVE: To describe how men from the Middle East experience Swedish maternity and child health care. An integral part of the aim of this study has also been to describe the experiences of men from the Middle East when becoming and being a father in Sweden. DESIGN, SETTING AND PARTICIPANTS: an exploratory, qualitative study using focus-group discussions and individual interviews, with a semi-structured interview guide and content analysis. A total of 16 men participated. Ten Arabic-speaking men from the Middle East living in Sweden participated in three focus-group discussions. Six men from the Middle East living in Sweden, and speaking Swedish, participated in individual interviews. FINDINGS: three main categories were developed: meeting empathic professionals; finding new positions within the family; and experiencing social demands. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: seeing their partners being met individually and with empathy by midwives and child health-care nurses encouraged men to become involved in areas not previously open to them (i.e. pregnancy, childbirth and the care of babies and young children). As the women often lacked knowledge of Swedish, they depended on the help of their partners when meeting maternity and child health-care professionals. The men found the experience of living in an alien country difficult. They were often unemployed, felt they were a burden to their wives after emigrating to Sweden, and that they were no longer a suitable role model for their children.

Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement.

BACKGROUND: Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner. METHODS: Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. RESULTS: The four main categories that developed were:* Access to the professional midwife* Useful counselling* Stable motherhood in transition* Being a family living in a different culture CONCLUSION: According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost. CLINICAL IMPLICATIONS: There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.