Legal abortion: a painful necessity
Introduction
Women in Sweden have had the right to abortion on demand for more than two decades. During this time the living conditions of women have changed. Increased access to education and employment has resulted in increasing economic independence for women. Simultaneously, women postpone having children. On average, women in Sweden have their first baby at the age of 27.7 years and the fertility rate is 1.5 children per woman (Official Statistics of Sweden, 1998). Furthermore, sexual debut takes place at an earlier age (Helmius, 2000) and the total number of sexual partners has increased (Lewin, 2000). Thus, great demands are made on women (and men) to control fertility.
Most European countries have abortion laws that permit abortion on request up to the 12th week of pregnancy or permit abortion if social and medical conditions warrant it. The Swedish Abortion Act of 1975 stipulated that a woman desiring an abortion may terminate her pregnancy before the end of the 18th week without needing to offer any grounds for her decision (Swedish Ministry of Health and Social Affairs, 1983). In connection with the law, the government stressed that abortion was to be regarded as a “last resort” when contraception had failed, and that all women should be offered supportive counselling. After the 18th week of pregnancy, abortion may only take place on the so-called “exceptional grounds”. In these cases, a social worker investigates the case and the National Board of Health and Welfare makes the final decision as to whether or not the abortion will be performed. All abortions in Sweden are performed in public hospitals with 93% being performed before the 12th week and almost all before the 18th week (Official Statistics of Sweden, 1999).
The abortion rate in Sweden has remained relatively unchanged for the last 25 years at 17–21 per 1000 women 15–44 years of age. The number of abortions among teenagers is relatively low at 14.6% of all abortions (Official Statistics of Sweden, 1999). The rate of abortion per 1000 women in Scandinavia and the Netherlands peaks at age 20–24 years in contrast to such countries as Canada, England and the USA where the peak occurs at 18–19 years (Henshaw, 1990). Among countries where abortion is legal and unrestricted as to reason, Vietnam has the highest abortion rates (83/1000 women aged 15–44 in 1996), whilst Belgium and the Netherlands have the lowest rate (7/1000 in 1996) (Henshaw, Singh, & Haas, 1999). Most countries in Western Europe have abortion rates of 10–19/1000 while the frequency in Australia and the USA is 22–23/1000. Among developed countries, abortion rates are highest in Romania (78/1000 in 1996) and the Russian Federation (68/1000 in 1996) (Henshaw et al., 1999).
Concern with becoming a single mother and /or problems in the relationship with the partner are among the most common motives for an abortion according to many studies (Holmgren & Uddenberg, 1994; Skjeldestad, 1994; Söderberg, Andersson, Janzon, & Sjöberg, 1997; Torres & Forrest, 1988; Törnbom, Ingelhammar, Lilja, Möller, & Svanberg, 1994). The wish to limit the number of children and postpone childbirth is another frequent motive for abortion (Husfeldt, Hansen, Lyngberg, Noddebo, & Pettersson, 1995; Jacobsson, Lalos, von Schoultz, & Solheim, 1980; Törnbom et al., 1994). Financial matters were among the dominating reasons for abortion, reported in an American study (Glander, Moore, Michielutte, & Parsons, 1998). In contrast, concrete practical problems with finances and housing are seldom mentioned as motives for abortion among Scandinavian women. The abortion rate may also vary substantially between residential areas with different sociodemographic profiles. In a large Swedish city, the rate was higher in areas of low income, low education, and foreign background and in need of social welfare. (Söderberg, Andersson, Janzon, & Sjöberg, 1993). However, other studies have shown that many women and men desiring abortion have a stable and functional relationship and a good socio-economic situation (Jacobsson et al., 1980; Kero, Lalos, Högberg, & Jacobsson, 1999; Törnbom, Ingelhammar, Lilja, Svanberg, & Möller, 1999). Further exploration of their motives for seeking abortion is needed.
In Sweden about one in four known pregnancies among women aged 15–44 is terminated by legal abortion (Official Statistics of Sweden, 1999), and one-third of the abortions are had by women with previous experiences of abortion. In England, one in five pregnancies results in an abortion (Raleigh, 1998), and one in three women is expected to have at least one abortion in her reproductive lifetime (Drife, 1991). Abortion is thus a common phenomenon. Nevertheless, abortion studies have often searched for some unique characteristic of the women who have had either single or repeated abortions. These studies have produced conflicting results. One study showed that women living in the lower socio-economic districts in a large city had more experience of previous abortion (Hamark, Uddenberg, & Forssman, 1995). Another study showed that women in the age group 20–29 years applying for repeat abortion had experienced more psychological problems during their lifetimes, had had more contacts with the social welfare service and had evaluated their relationship with their partner as less harmonious than women undergoing a first abortion (Törnbom, Ingelhammar, Lilja, Möller, & Svanberg, 1996). Other studies with a wider age range found more similarities than differences (Berger, Gold, Andres, Gillett, & Kinch, 1984; Osler, Morgall, Jensen, & Osler, 1992; Osler, David, & Morgall, 1997). Furthermore, some differences have been shown between women applying for abortion and other women. Such differences concern foreign ethnic origin, unstable civil status, several children and a larger number of sexual partners among women applying for abortion (Barrett, Peacock, & Viktor, 1998; Houghton, 1994; Lalos, 2000). In general, however, social class does not seem to be related to the experience of abortion (Barrett et al., 1998; Lalos, 2000). Consequently, one of the aims of this study is to compare sociodemographic characteristics and motives of women seeking abortion for the first time with those who are seeking a repeated abortion.
Another purpose is to examine the emotions experienced by pregnant women who seek abortion. Ambivalence during the early stages of pregnancy is a well-known phenomenon and is also experienced by women applying for abortion (Holmberg & Uddenberg, 1993; Osofsky & Osofsky, 1972; Törnbom et al., 1996; Törnbom et al., 1999; Uddenberg, 1974). One study showed that 44% of the women seeking abortions were in doubt about their decision when the pregnancy was initially confirmed and 30% when the abortion was due (Husfeldt et al., 1995). Another study showed that the most common argument for abortion was that continuing the pregnancy would jeopardise their future, and the most common argument against abortion was that the woman wanted to have a child (or another child) in the future (Allanson & Astbury, 1995). In a previous study we showed that ambivalent feelings are common among men involved in legal abortion, though this did not imply that they were in doubt about their standpoint on abortion (Kero et al., 1999). However, deeper analysis of ambivalent emotions in abortion studies is rare.
While abortion is a legal right and a common phenomenon in Sweden, women and men involved in abortions do not usually talk openly about their abortions. Although the right to abortion is questioned and defended in public debate by some people, the impact of legal abortion on women (and men) remains in a sense both hidden and private. This preserves the image of abortion as something of a taboo and as an issue concerning only women. By examining not only the reasons for seeking an abortion but also the feelings of women towards their pregnancy and abortion, we aim to obtain deeper knowledge of women facing an abortion.
In summary, the aim of the present study is to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking legal abortion along with their motives for abortion, and their feelings towards pregnancy and abortion. A further purpose is to examine similarities and differences between women with previous experience of legal abortion and those without.
Section snippets
The research context
This study of women is part of a larger project on men and women who use abortion services. The study was carried out at the University Hospital of Umeå, Sweden which serves a catchment area of about 135,000 inhabitants. All legal abortions in the area are performed in this hospital. Umeå is the county town of Västerbotten in the north of Sweden and is a modern university town with 20,000–25,000 students and a population of about 100,000. At the time of the study the abortion rate for Umeå was
Psychosocial characteristics
Table 1 shows the median and mean age of the women and their psychosocial characteristics. Most women were in the age group 20–24 years (31%); few were in the teenage years (10%). Those between 25–29 years and 35–47 years each constituted a fifth (21 and 22%, respectively). The remaining 16% were between 30 and 34 years. The majority of the women had grown up in Sweden (94%) and 27% adhered to some religious belief. Half had children and nearly a third of them (31%) had children under two years
Legal abortion — a necessity in family planning
The present study highlights that women resort to legal abortion in all possible contexts: married and single, young and middle-aged, highly educated and those with a minimum of schooling, those with good and those with unstable relationships, those with adequate and those with insufficient finances, those with and those without religious beliefs, and those with and those without children.
The participation rate in the study was high and the sample can be considered representative of women
Acknowledgements
The authors would like to thank social worker Katarina Bergström for professional assistance in conducting the study. The project has been supported by The Swedish Council for Social Research and the Swedish National Institute of Public Health.
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