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The apparently contradictory co-existence of high levels of gender equality and intimate partner violence against women (IPVAW) found in Nordic countries has been termed the Nordic Paradox. The aim of this study was to examine how the Nordic Paradox is discussed and explained by Spanish professionals working in the IPVAW field. Five focus groups (n = 19) and interviews with key informants (n = 10) were conducted. Four main categories of possible explanations for the Nordic Paradox were identified: Macro-micro disconnect (i.e., discordance between individual beliefs and behaviors and macro-social norms of gender equality), IPVAW as multicausal (i.e., IPVAW defined as a multicausal phenomenon that does not necessarily have to be associated with gender equality), cultural patterns of social relationships (i.e., the role of social relationships and the way people relate to each other in the Nordic countries), and backlash effect (i.e., men’s reaction to greater equality for women). Although this study does not provide a final explanation for the Nordic paradox, its results provide us with a better understanding of the phenomenon and can help to advance research in this field.

BACKGROUND AND AIM: Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. METHODS: A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. RESULTS: 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. CONCLUSION: This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.

Aims: Human papillomavirus (HPV) vaccination plays a key role in the prevention of cervical cancer. Yet, disparities in HPV vaccination in Sweden have persisted. Previous research on such disparities has typically focused on singular sociodemographic variables and measures of average risk. Using a multi-categorical approach and drawing on intersectionality theory, this study aimed to provide a more precise mapping of HPV non-vaccination among girls in different sociodemographic groups and geographical areas in Sweden during 2013–2020. Methods: Using nationwide register data, we conducted a multi-categorical analysis of individual heterogeneity and discriminatory accuracy complemented by a multilevel geographical analysis. We mapped HPV non-vaccination prevalence across 54 strata defined by parental income, education and country of birth, and urban versus rural place of residence. We also disentangled municipal and regional influences on HPV non-vaccination. Results: HPV non-vaccination was more common in groups with a low income, a low education and an immigration background, whereas among those with an immigration background, the association between income, education and HPV non-vaccination was more complex. Geographical differences were found between municipalities. However, the discriminatory accuracy of the sociodemographic and geographical groups was weak, and 50% of the non-vaccination cases were observed in eight strata, of which some are among those with low risk. Conclusions: Our findings underscore the importance of universal yet tailored approaches, including providing adequate information about HPV vaccination in Swedish and other languages, and of health-care professionals displaying sensitivity to patients’ and parents’ questions or needs.

Despite high gender equality ratings, Sweden shows a high prevalence of intimate partner violence against women (IPVAW). Suggested factors underlying this apparent paradox include backlash effects against women's empowerment. This study explores stories of backlash in interviews with 23 IPVAW survivors in Sweden. Thematic analysis identified categories of narrative segments referring to phenomena provoking violence; the victims’ resources, agency, breaking with gender norms and resistance, and the partner's feelings of subordination, while case-centered narrative analysis pointed to divergences between how these categories appear in the stories. The study underscores the complexity of links between gender (in)equality and IPVAW in Sweden.

The article intervenes in discussions on lay knowledge production about health in the Internet era, through the case of a group of women claiming that their use of copper intrauterine devices has led to systemic side effects. Based on online group interviews and written essays, we examine how women embracing these knowledge claims navigate various sources of information, focusing on the role of scientificity in these epistemic negotiations. The women were found to be involved in an active, scientifically oriented process of knowledge formation, which we refer to as a collective labour of scientific patchworking. Meanwhile, due to a perceived lack of scientifically based expertise on their condition, the women reported having little choice but turn to resources with weaker scientific foothold. We argue that the tendency to portray these women’s claims as unscientific simplifies the nature of lay knowledge production, potentially deepening divides between medical authorities and the public.

Background: Lay online communication about health-related issues has in recent years largely been associated with the spread of misinformation and decreased trust in healthcare. Such communication has included claims about systemic side effects of the copper IUD. In Sweden, a social media group centered on this issue now gathers around 8,700 members. This study aimed to use the case of reported yet unestablished side effects of the copper IUD to investigate experiences of and reasoning about healthcare encounters between caregivers and patients contesting established medical knowledge. Methods: We conducted qualitative, semi-structured, digital group interviews with members of the social media group (seven groups, n = 23) and with midwives and gynecologists (six groups, n = 15). We also gathered essays written by social media group members (n = 23). The material was analyzed thematically. Results: The participant accounts pointed towards tensions related to principles of evidence-based medicine, i.e., perceived insufficiency of research on the safety of the copper IUD and lack of clarity in routines for reporting and following up suspected side effects, and of patient-centered care, i.e., listening respectfully to patients. Tension between caregivers’ obligation to adhere to evidence-based medicine while also providing patient-centered care was noted. Conclusion. Healthcare providers’ efforts to assess and address patient claims contesting established medical knowledge should include ensuring and communicating sufficient research, clarifying procedures for reporting suspected side effects, and improving person-centered care. This can increase the quality of care while contributing to the mitigation of distrust in healthcare and the spreading of health-related misinformation.

'Experiential knowledge' has been identified as a key epistemic resource used by lay people to contest medical authorities and build new knowledge related to health. The Internet has created unprecedented opportunities for such experience-based epistemic projects. This article contributes to understandings of the as yet under-theorised concept of experiential knowledge by analysing accounts of a group of Swedish women who claim that their use of contraceptive copper IUDs has led to systemic side effects not recognised by health care providers. Based on digital group interviews and written essays, we distinguish between three components or stages of experiential knowledge at work in the women's use of experience as an epistemic resource: somatic knowing, collective validation and self-experimentation. Drawing on a critical realist framework, we defend a notion of experiential knowledge as crucially, while only partially, based on a bodily and practical access to aspects of reality organised by extra-discursive principles. By providing theoretical complexity to the notion of experiential knowledge, we contribute resources for discriminating between and evaluating various experience-based claims, something that is particularly needed in the current 'post-truth' era where experience-based knowledge claims pointing in divergent directions flourish.

The perhaps puzzling co-existence of highly rated country-level gender equality and survey reported experiences of intimate partner violence against women (IPVAW) in Sweden and neighboring Nordic countries has been referred to as a Nordic paradox. Hypothetical partial explanations for this apparent paradox have pointed to backlash effects, i.e., resistance from individuals in positions of relative privilege to changes resulting in their loss of power, and to the complex or multidimensional nature of gender in/equality. Based on qualitative in-depth interviews with 23 women exposed to IPVAW in Sweden, analyzed thematically, this presentation will discuss the participant’s narrated experiences of gender in/equality and of backlash dynamics in their violent intimate relationships.

Intimate partner violence towards women (IPVAW) is a global problem, also prevalent in the Nordic countries including Sweden. Attitudes regarding IPVAW are important for the addressing and prevention of the issue. At the individual level, a tolerate attitude towards violence against women has shown to be related to IPV perpetration, while a permissive public view of the issue can have a negative impact on the help-seeking behavior of exposed women. More knowledge regarding IPV attitudes can therefore contribute to the development of preventive measures. The current study investigates University students’ attitudes regarding intimate partner violence towards women (IPVAW). Students responded to a survey covering four different aspects of attitudes to IPVAW: perceived severity and acceptability of IPVAW, victim-blaming and willingness to intervene in cases of IPVAW, usinga validated questionnaire. The respondents (n=656, ≥18 years old) represented different scientific fields (e.g. behavioral, technical, and social sciences) at three different universitiesin Sweden. 81% of them were women and most were undergraduate students. While the results point to low victim-blaming and acceptability of IPVAW overall, differences between female and male students and other student groups were identified, with implications forfuture research, policy and practice.

Aims: Swedish public health reports have repeatedly provided information about socio-economic inequalities in sedentary leisure time, despite that, in the interest of health equity, physical activity should be equally distributed in the population. Such public health reports, however, neither consider the intersection of multiple socio-demographic factors nor the individual heterogeneity around group averages. Drawing on intersectionality theory, this study aimed to revisit previous findings on sedentary leisure time from Swedish public health surveys and demonstrate how the analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can be used for analysing complex health inequalities. Methods: Using data from Swedish national public health surveys (2004–2015), we applied the AIHDA to define 72 intersectional groups by categories of age, gender, educational achievement, migration status and household composition. We then calculated (a) the absolute and relative risk of sedentary leisure time and (b) the discriminatory accuracy (DA) of the intersectional grouping. Results: The average risk of sedentary leisure time ranged from 5.8% among native-born, highly educated, young women living alone to 41.0% among immigrated young men, living alone, with low education. The risk was higher in strata comprising immigrated people with low education and lower in strata including native-born, highly educated people. However, the DA of the grouping was poor, indicating a substantial overlap of individual risk between groups. Conclusions: Using the AIHDA and drawing on intersectionality, this study provides an improved mapping of the socio-economic distribution of sedentary leisure time in Sweden, with the poor DA suggesting universal rather than targeted physical activity interventions.

Aims: Antimicrobial resistance presents an increasingly serious threat to global public health, which is directly related to how antibiotic medication is used in society. Actions aimed towards the optimised use of antibiotics should be implemented on equal terms and according to the needs of the population. Previous research results on differences in antibiotic use between socio-economic and demographic groups in Sweden are not entirely coherent, and have typically focused on the effects of singular socio-economic variables. Using an intersectional approach, this study provides a more precise analysis of how the dispensation of antibiotic medication was distributed across socio-economic and demographic groups in Sweden in 2016-2017. Methods: Using register data from a nationwide cohort and adopting an intersectional analysis of individual heterogeneity and discriminatory accuracy, we map the dispensation of antibiotics according to age, sex, country of birth and income. Results: While women and high-income earners had the highest antibiotic dispensation prevalence, no large differences in the dispensation of antibiotics were identified between socio-economic groups. Conclusions: Public-health interventions aiming to support the reduced and optimised use of antibiotics should be directed towards the whole Swedish population rather than towards specific groups. Correspondingly, an increased focus on socio-economic or demographic factors is not warranted in interventions aimed at improving antibiotic prescription patterns among medical practitioners.

Intimate partner violence against women (IPVAW) poses severe threats to women’s health and rights. This study investigates the role of country context and gender equality in shaping individual perceptions of the severity of IPVAW. Multilevel logistic regression analyses of a Eurobarometer survey on attitudes toward IPVAW from 27 EU states showed that male gender, young age, low education, low self-assessed social position and particularly perceiving IPVAW as uncommon were associated with perceiving IPVAW as less severe. The likelihood of perceiving IPVAW as less severe was higher in countries with low gender equality. Between-country variance accounted for 14% of the variability, while country-level gender equality accounted for 22% of the between-country variance. We conclude that efforts toward strengthening perceptions of IPVAW as a severe issue should focus on awareness-raising and on increasing country-level gender equality., Published online: 09 Nov 2020

Intimate partner violence against women (IPVAW) is a global public health issue often assumed to be associated with gender inequality. The so-called Nordic Paradox, the apparently contradictory co-existence of high levels of IPVAW and of gender equality in Nordic countries, has not been adequately explained. This study explores discussions about how this apparent paradox can be understood among 30 IPVAW professionals working in southern Sweden, through a thematic analysis of focus groups and individual and paired interviews. The analysis highlights complexities of gender (in)equality and its links with IPVAW in Sweden, of relevance for the addressing and prevention of IPVAW.

In recent years, a line of serious incidents of violence towards women have been committed by men who self-identify as involuntary celibates, or ‘incels’. Incels are part of what is described as a political sub-culture or online community, marked by misogyny and driven by affects like resentment, shame and revenge. The incel communities consist of men who feel they are unable to form romantic and sexual attachments with women, who blame women and feminism for this failure and – contrary to a feminist world view – describe this as a proof of a contemporary gynocentric order where men are victims and women powerful. This presentation draws the theoretical contours of a research project on involuntary celibacy and singlehood that is in its starting phase. While the emerging body of incel research and commentary is focused on the ideological distortions at play in incel men’s descriptions of themselves as victims on a mating market where women hold the power (Chang 2020; Menzie 2020; Witt 2020), we set out to take incel men’s claims about vulnerability more seriously, analysing them in light of structural transformations of the conditions of intimacy which have made intimacy an increasingly precarious matter. We situate our analysis of incelhood within research highlighting that post-industrial western societies find themselves in a state of what we call ‘precarious love’, in which, due to cultural, economic and technological changes, love and erotic bonding has become both increasingly important for people’s sense of security and well-being and increasingly characterized by insecurity (Bauman 2003; Gunnarsson et al 2018; Illouz 2012, 2019). In our presentation we aim to show why and how the incel phenomenon and broader experiences of involuntary celibacy and singlehood can be fully understood and explained only in light of these transformations of the conditions of intimacy.

The feminist movement has played a key role in challenging dominant modes of knowledge and expertise, revealing the masculine biases of allegedly objective knowledge and linking such biases to gendered power structures. In the field of health, the contestation of established medical knowledge and practices has also been centrally informed by the women’s health movement. In both the feminist movement broadly and in the women’s health movement, women’s ‘lived experiences’ have comprised an epistemic basis for building new knowledge challenging received wisdom. The use of women’s collectively processed personal experiences as an epistemic counter-authority has been most programmatically articulated in the method of feminist consciousness-raising that was central in the 1970s’ second wave of feminism. Meanwhile, feminist theorists, especially of a poststructuralist or social constructionist orientation, have criticized naïve concepts of experience as a basis for knowledge claims, arguing that experiences are always culturally and discursively mediated in a way that rids them of their status as an unproblematic locus of truth. In this presentation we revisit feminist debates on the epistemic status of experience and its place in building counter-knowledges, through an analysis of group interviews (7) with and essays (23) written by women who claim or suspect that their use of copper IUDs has led to a range of systematic side-effects related to a bodily excess of copper. The knowledge claims about systemic side effects from copper IUDs are not supported by conventional medical authorities or healthcare institutions. The women were recruited from a Facebook group centred on the issue. We delineate the different ways that the women collectively draw on their own experiences as a ground for building their counter-discourse, relating to previous theorizations of feminist consciousness raising and feminist discussions of the relationship between experience and knowledge. Howe

The copper IUD is a widely used contraceptive, recommended to many women who want a long-acting contraceptive method and sometimes seen as an alternative for those who want to avoid side effects associated with hormonal alternatives. However, while many report being satisfied with their copper IUD, a growing number of women speak about a range of mental and physical symptoms believed to be caused by copper excess due to copper IUD use. This set of systemic side effects may be framed as a rare disease but is not recognized as such by established medical authorities. In Sweden accounts about copper IUD related side effects circulate on social media, primarily in a Facebook group which presently includes over 9000 members.Based on online group interviews and written essays, we examine how women embracing these alternative knowledge claims navigate various sources of information, focusing the role of scientificity in these epistemic negotiations. We show that participants were strongly invested in scientificity and criticized medical authorities for not being scientific enough. Meanwhile, due to a perceived lack of scientifically based expertise on their condition, many of the women reported having little choice but to turn to alternative or non-scientific modes of health-related knowledge and practices. We argue that medical authorities’ tendencies towards portraying these women’s claims as unscientific simplify the nature of lay knowledge production, potentially deepening divides between medical authorities and parts of the public.

Background: While HPV vaccination uptake in Sweden is quite high, at around 80%, vaccine hesitancy remains an issue in countries throughout Europe. The latter can be related to a contemporary context of increased contestation of expert knowledge and of a large share of information on health-related issues including vaccination today being sought via the internet. Still, there is a paucity of recent research on attitudes toward the HPV vaccine in a larger sample of the population in Sweden. This survey study assesses such attitudes and any correlations between vaccine hesitancy and sociodemographic characteristics, trust in healthcare and other societal institutions, and evaluation of the reliability of different sources of information. Methods: The validated survey questionnaire was distributed to adult women in Sweden (n = 2,000), via a nationally representative web panel. The response rate was 37%. Aside from descriptive statistics, associations between vaccine hesitancy and sociodemographic and other variables were computed using logistic regressions and expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: Our results show a positive attitude toward HPV vaccination overall. Still, some degree of HPV vaccine hesitancy was indicated by 33.8% of the respondents, and more pronounced hesitancy by 7.6%. Regarding vaccination in general, a very positive attitude was indicated by 55%. HPV vaccine hesitancy was associated with low education and low income and strongly associated with a lack of confidence in healthcare and other societal institutions. It was also correlated with a self-assessed lack of access to, and ability to assess the origin, quality and reliability of, information about the HPV vaccine. Conclusion: Efforts to provide transparent information about HPV vaccination should be combined with healthcare providers being open to discuss vaccine concerns with patients and avoiding practices that do not promote trust.

A large share of health-related information is today sought and communicated via the internet, including in social media. Questions have been raised about how this may affect health perceptions and behaviors, not least by enabling the communication of claims that contradict information from established medical authorities. As an example, knowledge claims about systemic side effects of the contraceptive copper intrauterine device (IUD) have in recent years been circulating in social media. This widely used long-acting contraceptive method is here linked to a range of physical and psychological symptoms believed to be caused by an excess of copper. A Swedish Facebook group centered on this issue currently gathers around 8.500 members. Based on seven online focus groups with women recruited from this Facebook group, and six online focus groups with mid-wives and gynecologists, this paper explores how tensions between alternative and established claims about the copper IUD are expressed and negotiated in and between these groups. While gaining medical support in order to get well is a central concern to women with health issues believed to be related to the copper IUD, many report not only being unable to access help from, but not being taken seriously by, healthcare professionals. Healthcare providers, on the other hand, describe balancing between following guidelines or protocols and caring for or listening to the individual patient. We discuss such tensions and processes of negotiating between sources of knowledge and uncertainty described by participants from both groups.

The internet has radically transformed the way that people seek and share information and, as a consequence, their relationship to established epistemic authorities. It has been stated that ‘the contestation of expertise is perhaps nowhere more pronounced’ than in the field of health (Vuolanto et al., 2020: 508). Health-related information on the internet stems from a variety of actors and sometimes contradicts information provided by medical authorities. There is, hence, a widespread concern about misinformation about health and its potential consequences for individual and public health. In this contribution we intervene in scholarly discussions on knowledge claims about health in an era of ‘epistemic democracy’ (Lynch, 2017) enabled by digitalization. We do this through the case of a group of women who claim, contrary to established medical authorities, that using a copper IUD may lead to side effects caused by a systemic excess of copper. The women are organized through a Swedish language Facebook group currently gathering 9.300 members. Drawing on seven online group interviews with a total of 23 women recruited from the Facebook group and 23 written essays collected from members of the same group, we analyse the women’s ‘alternative’ knowledge claims in relation to three tensions that we identify in the discursive and institutional contexts in which these women’s epistemic negotiations are embedded.The first tension concerns the way that this alternative discourse may be related, on the one hand, to current trends of ‘alternative facts’ and conspiracy theories spreading through digital platforms, but, on the other hand, to the internet’s facilitation of subordinated groups’ information sharing and empowerment in the face of conventional epistemic authorities. Women’s organizing around health has indeed been pivotal given a long history of women’s health concerns and embodied experiences being marginalized or deprioritized in modern medicine. The second tension

The feminist movement has played a key role in challenging dominant modes of knowledge and expertise, revealing themasculine biases of allegedly objective knowledge and linking such biases to gendered power structures. In the field of health,the contestation of established medical knowledge and practices has also been centrally informed by the women’s healthmovement. In both the feminist movement more broadly and in the women’s health movement, women’s ‘lived experiences’have comprised an epistemic basis for building new knowledge challenging hegemonic perspectives. The use of women’scollectively processed personal experiences as an epistemic counter-authority has been most programmatically articulated inthe method of feminist consciousness-raising that was central in the 1970s’ second wave of feminism. Meanwhile, feministtheorists, especially of a poststructuralist or social constructionist orientation, have criticized naïve concepts of experience asa basis for knowledge claims, arguing that experiences are always culturally and discursively mediated in a way that rids themof their status as an unproblematic locus of truth.In this presentation we revisit feminist debates on the epistemic status of experience and its place in building counter-knowledges, through an analysis of group interviews (7) with and essays (23) written by women who claim or suspect thattheir use of copper IUDs has led to a range of systematic side-effects related to an excess of copper in their bodies. Thewomen, whose knowledge claims about the copper IUD are not supported by conventional medical authorities or healthcareinstitutions, were recruited from a Facebook group centred on the issue. We delineate the different ways that the womencollectively draw on their own experiences as a ground for building their counter-discourse, relating to previous theorizationsof feminist consciousness raising and feminist discussions of the relationship between experience and knowledge. However,we also sho

Despite highly rated country-level gender equality, survey-reported experiences of intimate partner violence against women (IPVAW) are common in Sweden, as in neighbouring Nordic countries. This apparently contradictory situation has been referred to as a Nordic Paradox. Among potential partial explanations for this supposed paradox, the complex or multidimensional nature of gender in/equality has been pointed out. While attempts to measure and compare country-level gender equality have endeavored to encompass different aspects, such as the European Institute for Gender Equality (EIGE) gender equality index which assembles data pertaining to the six domains of work, money, knowledge, time, power and health, it has been suggested that such indexes do not necessarily give a full picture of all dimensions of gender inequality that are of relevance for IPVAW. Drawing on the six domains considered in the EIGE gender equality index, this study investigates women’s experiences of gender in/equality in violent intimate relationships. Qualitative in-depth interviews were carried out with 23 women exposed to IPVAW in Sweden, and the material was thematically analyzed. Looking at how the women spoke about work, money, knowledge, time, power and health, the study shows that the experienced violence was described as having influenced all of these domains of the women’s lives, sometimes creating pressure towards subordination in ways that may not be congruent with or readily apparent in more quantitative measures of gender equality. In the domain of money, for example, women experienced forms of domination also in cases where they earned as much as, or more than, the violent partner, while in the domain of knowledge, the women’s desired or attained education could provoke violence. In the domain of work, several women were employed but experienced barriers to fulfilling their work tasks due to violence. Violent power dynamics could thus permeate several areas of the women’s lives

Introduction: Antidepressants are among the most commonly prescribed drugs in Sweden. However, we lack detailed knowledge on the socioeconomic and demographic distribution of antidepressant use in the population. To fill this gap, we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. Methods: Analysing all Swedish residents older than 10 years (n=8,190,990), we measured the absolute risk of antidepressant use across 144 intersectional strata defined by combinations of age, gender, income, country of birth and psychiatric diagnosis. We calculated the strata-specific absolute risk of antidepressant use in a series of multilevel logistic regression models. By means of the variance partitioning coefficient and the area under the receiver operating characteristic curve, we quantified the discriminatory accuracy of the intersectional contexts (i.e. strata) for discerning those who use antidepressants from those who do not. Results: The absolute risk of antidepressant use ranged between 0.93% and 24.78% among those without a psychiatric diagnosis, and between 21.41% and 77.56% among those with a psychiatric diagnosis. Both the variance partitioning coefficient of 41.88% and the area under the receiver operating characteristic curve of 0.81 were considerable. Conclusions: Besides overt psychiatric diagnoses, our study shows that antidepressant use is mainly conditioned by age, which might express the embodiment of socioeconomic conditions across the individual life course. Our analysis provides a detailed and highly discriminatory mapping of the heterogeneous distribution of antidepressant use in the Swedish population, which may be useful in public health management.