Mapping the strategies to address the gender gap in youth clinic utilization in Sweden; explorative survey and follow up interviews

Background: Despite Sweden’s universalist health model and a long-standing network of youth clinics offering free sexual and reproductive health (SRH) services, boys and young men (BYM) remain significantly underrepresented among clinic users. This gender gap is driven by structural and cultural barriers, including masculine norms, female-oriented service environments, and limited institutional guidance for engaging male adolescents. While some clinics have piloted strategies to improve BYM’s access, these efforts have not been systematically documented or evaluated. The aim of this study was to systematically map and analyze the strategies used by Swedish youth clinics to improve access and participation among BYM. Methods: This study employed an exploratory mixed-methods design, combining an online survey with follow-up unstructured interviews. The survey was distributed to all 240 youth clinics in Sweden between September and November 2024, with 75 responses representing 110 clinics (45% clinic-level response rate). Quantitative data were analyzed descriptively, while qualitative data from open-ended responses and interviews (24 interviews) were analyzed using inductive content analysis. Results: BYM accounted for 9.5% of clinic visits, with 87% of clinics expressing dissatisfaction with this level. While 58% of clinics reported using strategies to attract BYM, only 34% evaluated their effectiveness, and institutionalization was limited. Four main strategy categories emerged: (1) staff capacity-building for male-inclusive care, (2) environmental adaptations to create inclusive spaces, (3) digital outreach and marketing to enhance visibility, and (4) collaboration with schools and community settings to reach BYM. Clinics using strategies were more likely to report increased male attendance, though implementation remained inconsistent and often project-based. Conclusions: This study provides the first national-level mapping of strategies to engage BYM in Sweden and contributes to global discussions on inclusive, adolescent-centered SRH care.