Trends over 50 years with liberal abortion laws in the Nordic countries

Abstract

Background: During the 1970s the Nordic countries liberalized their abortion laws.

Objective: We assessed epidemiological trends for induced abortion on all Nordic countries, considered legal similarities and diversities, effects of new medical innovations and changes in practical and legal provisions during the subsequent years.

Methods: New legislation strengthened surveillance of induced abortion in all countries and mandated hospitals that performed abortions to report to national abortion registers. Published data from the Nordic abortion registers were considered and new comparative analyses done. The data cover complete national populations.

Results and conclusions: After an increase in abortion rates during the first years following liberalization, the general abortion rates stabilized and even decreased in all Nordic countries, especially for women under 25 years. From the mid-1980s higher awareness about pregnancy termination led women to present at an earlier gestational age, which was accelerated by the introduction of medical abortion some years later. Most terminations (80-86%) are now done before the 9th gestational week in all countries, primarily by medical rather than surgical means. Introduction of routine ultrasound screening in pregnancy during the late 1980s, increased the number of 2nd trimester abortions on fetal anomaly indications without an overall increase in the proportion of 2nd relative to 1st trimester abortions. Further refinement of ultrasound screening and non-invasive prenatal diagnostic methods led to a slight increase in the proportion of early 2nd trimester abortions after the year 2000. Country-specific differences in abortion rates have remained stable over the 50 years of liberalized abortion laws.

Fig 1. Induced abortions per 1000 women 15–49 years, Nordic countries, 1970–2022.

Fig 2. Selected age-specific induced abortion rates per 1000 women/year, Sweden (bold lines) and Finland (dotted lines), 1970–2022.

Fig 3. Induced abortion rates per 1000 women ≤ 19 years by Nordic country, 1974–2022.

Fig 4. Gestational age ≤ 8 weeks (upper panel) and ≥ 13 weeks (lower panel) at the time of termination, Nordic countries, 1974–2022.

Fig 5. Gestational age ≥ 12 and ≥ 13 weeks at the time for termination, Sweden, Norway, Finland, and Denmark, 1974–2022.

Fig 6. Proportion of 2^nd trimester induced abortions on fetal indications by gestational ages 13–15 weeks/16-22 weeks, Finland, and Norway.

Fig 7

a. Fetal indication for gestational age > 12 weeks to all 2^nd trimester induced abortions by maternal age, Finland, 1983–2022 (dotted lines = linear trend). b: Fetal indication for gestational age > 12 weeks to all 2^nd trimester induced abortions by maternal age, Norway, 1983–2022 (dotted lines = linear trend).