Signe Svallfors

All Publications

• Obstetric violence in the context of community violence: The case of Mexico. Social science & medicine (1982) Torrisi, O., Svallfors, S., Gargiulo, M. 2024; 360: 117348

  Abstract

  This study examines the relationship between community violence and obstetric violence in Mexico, where the so-called "War on Drugs" has led to sustained high levels of homicides and one-third of pregnant people report experiencing abusive treatment from healthcare providers during childbirth. We combine unique nationally representative survey data on experiences of obstetric violence for births that occurred between 2016 and 2021 with administrative homicide data at the month-municipality level. Using fixed effects models, we investigate how different manifestations of obstetric violence relate to community violence in the short-, medium-, and long-term. Results suggest that the intensity of community violence matters for obstetric violence. Specifically, we find that sustained high-intensity homicidal violence is associated with an increased risk of mistreatment at childbirth, particularly in the form of physical abuse and non-consensual care. Associations are stronger among adolescent, low-educated, and urban respondents. Addressing obstetric violence requires recognising the structural role of sustained high-intensity community violence and the normalisation of violent behaviour that exposure to such environmental stressors may create.

  View details for DOI 10.1016/j.socscimed.2024.117348

  View details for PubMedID 39321723

• Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data. Reproductive health Svallfors, S., Båge, K., Ekström, A. M., Dessie, Y., Wado, Y. D., Fagbemi, M., Larsson, E. C., Litorp, H., Puranen, B., Sundewall, J., Uthman, O. A., Kågesten, A. E. 2024; 21 (1): 90

  Abstract

  Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions.We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020-2021 (n = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive "SRHR Support Index", standardized on a 1-100 scale (mean = 39.19, SD = 15.27, Cronbach's alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only.The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective - addressing the need for a common measure to track progress over time.

  View details for DOI 10.1186/s12978-024-01820-2

  View details for PubMedID 38918832

  View details for PubMedCentralID 8009211

• Milestone Moments: Community Violence and Women's Life-Course Transitions in Colombia, the Dominican Republic, and Guatemala POPULATION AND DEVELOPMENT REVIEW Svallfors, S. 2024

  View details for DOI 10.1111/padr.12628

  View details for Web of Science ID 001206452200001

• Giving Birth While Facing Death: Cesarean Sections and Community Violence in Latin America POPULATION RESEARCH AND POLICY REVIEW Svallfors, S. 2024; 43 (2)

  View details for DOI 10.1007/s11113-023-09854-3

  View details for Web of Science ID 001171718400001

• Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. Social science & medicine (1982) Svallfors, S., Båge, K., Ekström, A. M., Elimian, K., Gayawan, E., Litorp, H., Kågesten, A. 2024; 348: 116777

  Abstract

  Armed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria.We conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017-2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED.Exposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls' childbearing.Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

  View details for DOI 10.1016/j.socscimed.2024.116777

  View details for PubMedID 38569280

• Reproductive Justice in the Colombian Armed Conflict. Disasters Svallfors, S. 2023

  Abstract

  This study explores the impacts of armed conflict on women's sexual and reproductive health in Colombia, building on a reproductive justice perspective on original interviews with stakeholders in healthcare, women's rights, and peacebuilding. The analysis reveals a threefold impact of war on women's sexual and reproductive health, through violent politicization, collateral damage, and intersectional dimensions. Multiple armed actors have used women's health as an instrument in politically motivated strategies to increase their power, assigning political meaning to sexuality and reproduction within the context of war. Women's health has also suffered from secondary damages of conflict resulting from a range of factors. Marginalized women have been particularly affected by a discriminatory nexus of poverty, ethnicity, and geographic inequality. The article concludes with a reflection on opportunities for reproductive justice in Colombia.

  View details for DOI 10.1111/disa.12618

  View details for PubMedID 38102735

• Gender Dynamics During the Colombian Armed Conflict SOCIAL POLITICS Svallfors, S. 2023

  View details for DOI 10.1093/sp/jxad016

  View details for Web of Science ID 001011912200001

• COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden. European journal of public health Svallfors, S., Larsson, E. C., Puranen, B., Ekström, A. M. 2023

  Abstract

  In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity.Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years.One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy.The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.

  View details for DOI 10.1093/eurpub/ckad073

  View details for PubMedID 37229599

• Hidden Casualties: The Links between Armed Conflict and Intimate Partner Violence in Colombia POLITICS & GENDER Svallfors, S. 2023; 19 (1): 133-165

  View details for DOI 10.1017/S1743923X2100043X

  View details for Web of Science ID 000778888500001