Original StudiesAbortion Rate and Contraceptive Practices in Immigrant and Swedish Adolescents
Introduction
Since 1975 induced abortion has been free on request in Sweden until the 18th gestational week. At the same time efforts have been made to reduce the number of unwanted pregnancies in adolescents. Small units of adolescent centers were opened in near proximity to secondary schools. Young people should be able to easily find their way to a youth clinic for family planning counselling. Until now more than 200 such youth clinics exist in Sweden, staffed by nurse-midwives and social workers, with medical doctors as consultants. In Stockholm, there are 39 such youth clinics. The abortion rate among teenagers decreased during the decade following the new legislation in 1975, and has since fluctuated between 17 and 21 per 1000 teenagers. Also the abortion ratio, i.e. the proportion of induced abortion per known pregnancy, increased among teenagers from 60% in 1975 to 80% in 1999, resulting in a dramatic reduction of the number of very young mothers.
The majority (95%) of induced abortions in Sweden are performed before the 12th week of gestation.1 Nearly all induced abortions are done within the public health care system, and all are subsequently reported to the National Board of Health and Welfare. The registered information on each woman contains year and month of birth, gestational week of current pregnancy, number of previous pregnancies, and county, commune, and parish of residency.1
In the capital of Stockholm, the abortion rate is generally higher than in the country at large, around 23/1000 women aged 15–44 years, and, among adolescents, even higher, around 26/1000 compared to 19/1000 in the rest of the country. This city of 1.8 million inhabitants has, like many large cities in Europe, experienced a multinational immigration in recent years with the immigrants now constituting 19% of the population.
In a previous Swedish study, we showed that the abortion rate was higher than expected among immigrant women in Stockholm. From those results, it was concluded that cultural difference is an unlikely explanation, because the women in the study originated from 77 different countries, but that the high abortion rate could be explained by the socio-economical and other difficulties that are associated with the immigrant status per se.2
Available data from sociological studies on women who request abortion have shown that socio-economical factors such as educational level, language, employment, marital status, cultural background, sex education, and access to health care and contraceptive counselling availability influence the number of unwanted pregnancies and abortions in a society.3, 4, 5, 6
In a survey, low income was stated as a reason for abortion by 68% of women in the United States and by 13% of women in the Netherlands, whereas being too young was stated by 30% and 11% of the women in the US and the Netherlands, respectively. Relational problems with the partner were stated as a reason by 23% of US women and by 16% of women in the Netherlands.7 In a recent Swedish study, low income was the most common reason for pregnancy termination and quoted by 32% of the women, whereas relational problems was quoted by 19% of the women.8 Contraceptive practices of women requesting induced abortion have been reported in several studies.9 In a recent study from Sweden, 36% of 509 women requesting pregnancy termination had used no contraceptive method, 22% used condoms, 11% oral contraceptives, and 1% intrauterine devices at the time of conception.8
In our previous study, where we reported a higher than expected abortion rate among immigrant women in Stockholm, all age groups were represented.2 The aim of the present study was to further investigate the characteristics of the group of adolescents among those requesting a pregnancy termination in 1999.
Section snippets
Materials and Methods
During one year, from April 1, 1999, to March 30, 2000, all women who attended the outpatient clinic at Karolinska Hospital for pregnancy termination were asked to participate in the study. In total, the study contained 1,286 women. Of those 126 (9.8%) women were <19 years of age which constitute the study group in the present study. The information was gathered as personal interviews, using a standardized questionnaire. All interviews were performed by one of three experienced nurse-midwives.
Results
Using the official statistics from the Swedish National Board of Health, the proportion of women <19 years among women in the study population, 9.8%, was lower than expected compared to the total proportion of teenagers among women seeking abortion, 12.6%, as reported for the whole city of Stockholm. The proportion of adolescents born abroad in the study sample was 29% compared to 18% in the general population in corresponding areas of Stockholm. Out of the women in the study sample, 37 (29%)
Discussion
Our results suggest that induced abortion is utilized more frequently among immigrant girls than by ethnical Swedes, which could, at least in part, be explained by the fact that the immigrant girls had received less contraceptive counselling and had less experience of previous use of contraceptive methods. The experience of contraception was, however, high in both groups. The lesser experience of contraceptive use was underlined by the fact that the immigrant girls had been pregnant in the past
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Culture and religious beliefs in relation to reproductive health
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