Sweden Abortion

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An Illusion of Power: Qualitative Perspectives
On Abortion Decision-Making Among Teenage Women
In Sweden
CONTEXT: Swedish law permits abortion at the request of a pregnant woman until the 18th week of gestation. However, the extent to which the decision is truly the woman’s own is subject to debate; women are often influenced, directly or indirectly, by the attitudes of their partners, family and friends or by social norms. METHODS: Individual in-depth interviews about the pregnancy and the abortion decision were conducted 3–4 weeks postabortion with 25 women aged 16–20 at different periods in 2003, 2005 and 2007. Interviews were audiotaped, transcribed verbatim and analyzed using latent content analysis. RESULTS: The main reasons for unplanned pregnancy were underestimation of pregnancy risk and inconsistent contraceptive use. Pregnancy prevention was perceived as the woman’s responsibility. The abortion decision was accompanied by mixed emotions, and was seen as a natural yet difficult choice. Social norms and the negative attitudes of family and friends strongly influenced the decision. Partners and parents were regarded as the most important sources of support. After the abortion, the women felt pressured by contraceptive counselors to use highly effective contraceptives despite their previous negative experiences or worries about side effects. CONCLUSIONS: Swedish teenagers’ basic right to decide whether to have an abortion may be limited by societal norms and disapproval of teenage childbearing. Given the perception that women are responsible for contraception, programs need to emphasize that pregnancy prevention is a shared responsibility; greater efforts to include males in prevention practices are needed.

Perspectives on Sexual and Reproductive Health, 2009, 41(3):173–180, doi: 10.1363/4117309

Despite a high level of adolescent sexual experience, the
large majority of female teenagers in Sweden avoid pregnancy. From an international perspective, the pregnancy rate among Swedish adolescents is low1—about 30 pregnancies per 1,000 women aged 15–19 in 2006.2 However, when pregnancy does occur, termination is the primary

choice; about 75–90% of known teenage pregnancies
in Sweden end in abortion, indicating an intense desire
among young women to avoid pregnancy during the teenage years.2 Over the years, the abortion rate among teenagers in
Sweden has fluctuated; the highest level, 29.7 abortions
per 1,000 women aged 15–19, was reached in 1975, and
the lowest level, 16.9 abortions per 1,000 women, in
1995. Since this lowest point, the rate has increased by almost 50%, to 24.4 per 1,000 in 2008.3 Currently, a higher proportion of teenage pregnancies in Sweden than in any
other Nordic country end in abortion; in 2006, the abortion rate per 1,000 women aged 15–19 was 14.0, 16.3 and 16.7 in Finland, Norway and Denmark, respectively,
compared with 24.6 in Sweden.4
The current Swedish abortion law, passed in 1975, permits abortion at the request of a pregnant woman until the 18th week of gestation.3 The extent to which the decision is truly the woman’s own is subject to debate;

women are often influenced, directly or indirectly, by the
Volume 41, Number 3, September 2009

By Maria Ekstrand,
Tanja Tydén,
Elisabeth Darj
and Margareta
Larsson
Maria Ekstrand is
researcher, and Tanja
Tydén is professor,
both in the Department of Public Health
and Caring Sciences,
and Elisabeth Darj
and Margareta
Larsson are associate
professors, Department of Women’s and
Children’s Health—all
at Uppsala University,
Uppsala, Sweden.

attitudes of their partners, family and friends or by social norms.5–7
Teenage pregnancy is often considered a public health
problem because of its association with socioeconomic
difficulties and health-related problems for both mother
and child.8–10 The current trend in industrialized countries is to postpone childbearing, in part so that young people can finish their education,...
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