title: Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden.
abstract: BACKGROUND
  Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.
  
  
  METHODS
  Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.
  
  
  RESULTS
  Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.
  
  
  CONCLUSIONS
  Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, S-791 88 Falun, Sweden. uby@du.se.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Byrskog
authors.forename: Pia
authors.initials: P
authors.lastname: Olsson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essén
authors.forename: Marie Klingberg
authors.initials: MK
authors.lastname: Allvin
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D005260:Female; D006262:Health; D006297:Health Services Accessibility; D006806:Human Rights; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011902:Rape; D012036:Refugees / Q000523:psychology; D060728:Reproductive Health; D034121:Reproductive Health Services; D012111:Residence Characteristics; D012650:Self Disclosure; D012998:Somalia / Q000208:ethnology; D013179:Spouse Abuse / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology; D013548:Sweden; D014171:Transients and Migrants / Q000523:psychology; D014754:Violence / Q000523:psychology; D014857:Warfare; D055815:Young Adult