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

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.

Medical abortions performed by specialists in private practice. / Medikamentell abort hos avtalespesialist.

BAKGRUNN: I Norge utføres abort kun i offentlige sykehus. I 2010 besluttet Helse- og omsorgsdepartementet å iverksette et toårig prøveprosjekt som ga avtalespesialister i fødselshjelp og kvinnesykdommer adgang til å tilby medikamentell abort før utgangen av 9. svangerskapsuke. Prøveprosjektet ble igangsatt 1.3.2015 og varte til 31.3.2017. I denne artikkelen presenterer vi de første erfaringene, herunder hvordan behandlingstilbudet ble mottatt av kvinnene. MATERIALE OG METODE: Gravide med en svangerskapsvarighet < 63 dager ultrasonografisk vurdert, som oppsøkte avtalespesialist for medikamentell abort, ble fortløpende inkludert i prosjektet (n = 476). Kvinnene inntok 200 mg mifepriston peroralt på legekontoret, 36-48 timer senere satte de selv 800 µg misoprostol vaginalt hjemme. Informasjon ble innhentet ved spørreskjema på den første konsultasjonen, under aborten og ved etterkontrollen 2-4 uker etter aborten. RESULTATER: Under aborten rapporterte 66 % (296/450) moderat eller sterk smerte og 79 % (358/451) moderat eller sterk blødning. De fleste opplevde det som trygt å være hjemme. 96 % (390/406) ville valgt medikamentell abort hos avtalespesialist ved en eventuell senere abort, og 97 % (392/405) ville anbefalt behandlingstilbudet til andre i samme situasjon. FORTOLKNING: Kvinnene i studien opplevde abortbehandling hos avtalespesialist som trygt. Tilbudet gir større valgfrihet til gravide som ønsker abort, og pasientene er tilfredse.

Implementing medical abortion with mifepristone and misoprostol in Norway 1998-2013.

Background: Medical abortion with mifepristone and misoprostol was introduced in Norway in 1998, and since then there has been an almost complete change from predominantly surgical to medical abortions. We aimed to describe the medical abortion implementation process, and to compare characteristics of women obtaining medical and surgical abortion. Methods: Information from all departments of obstetrics and gynaecology in Norway on the time of implementation of medical abortion and abortion procedures in use up to 12 weeks of gestation was assessed by surveys in 2008 and 2012. We also analysed data from the National Abortion Registry comprising 223 692 women requesting abortion up to 12 weeks of gestation during 1998-2013. Results: In 2012, all hospitals offered medical abortion, 84.4% offered medical abortion at 9-12 weeks of gestation and 92.1% offered home administration of misoprostol. The use of medical abortion increased from 5.9% of all abortions in 1998 to 82.1% in 2013. Compared with women having a surgical abortion, women obtaining medical abortion had higher odds for undergoing an abortion at 4-6 weeks (adjusted OR 2.33; 95% confidence interval 2.28-2.38). Waiting time between registered request for an abortion until termination was reduced from 11.3 days in 1998 to 7.3 days in 2013. Conclusions: Norwegian women have gained access to more treatment modalities and simplified protocols for medical abortion. At the same time they obtained abortions at an earlier gestational age and the waiting time has been reduced.

Medical abortion with mifepristone and home administration of misoprostol up to 63 days' gestation.

OBJECTIVE: To evaluate the acceptability and efficacy of medical abortion at home up to 63 days' gestation without limits on travel distance to a registered institution. DESIGN: Observational prospective study. SETTING: Haukeland University Hospital between May 2006 and May 2009. POPULATION: A total of 1018 women requesting abortion before 63 days' gestation who chose medical termination with mifepristone and home administration of misoprostol. METHODS: The women took 200 mg mifepristone under nurse supervision and self-administered 800 µg misoprostol vaginally 36-48 h later at home. All were contacted by phone for follow-up and assessment of bleeding, pain and acceptability. MAIN OUTCOME MEASURES: Evacuation rate, pain, bleeding, acceptability, influence of distance on treatment. RESULTS: Median gestational age was 50 (range 35-63) days and 70 (7.1%) of the women lived more than 60 min travel from the clinic. The rate of completed abortion was 93.6% and surgical evacuation was performed in 50 (4.9%) cases. Two women requested treatment on the day of misoprostol use. Moderate to strong pain was experienced by 68.4%, and 74.7% reported moderate to heavy bleeding. Parous women experienced less pain than nulliparous women (odds ratio 0.27; 95% confidence interval 0.19-0.34). In all, 95.1% of the women were satisfied with staying at home. Travel distance did not influence treatment outcome variables. CONCLUSIONS: In our experience, home administration of misoprostol is an effective and acceptable method for abortion up to 63 days of gestation and women should be eligible for this treatment option regardless of their travel distance from hospital.

[Is it possible to obtain reliable information about the long-term effects of induced abortion?]. / Er det mulig å få pålitelig kunnskap om psykiske senvirkninger etter provosert abort?

BACKGROUND: The psychological long-term effects of an induced abortion are the subject of constant debate, but the scientific basis of experience is limited and by no means unambiguous. We wanted to study how a random selection of women felt about pre-agreed follow-up studies after an induced abortion. MATERIAL AND METHOD: All abortion patients who attended the Department of Obstetrics and Gynaecology at Haukeland University Hospital during a three-month period received a questionnaire. They were asked if they would be willing to be contacted in writing with questions about long-term effects 1-2 years and 5-10 years after the intervention, and to give reasons for their decisions by setting crosses in the multiple choice responses that were listed. RESULTS: During the period of the study, 300 abortions were carried out at the department. Questionnaires were distributed to 227 of these patients, and 181 (80 %) of them were included. 43 % of the women in the study agreed to take part in a questionnaire survey concerning the long-term effects, if any, of induced abortion 1-2 years after the intervention, and 35 % 5-10 years afterwards. INTERPRETATION: It appears that it may be difficult to study the psychological long-term effects of induced abortion by means of questionnaire surveys. Our results indicate that the percentage of participants in long-term studies would be too low, and hence not representative of the group as a whole.

Abortion: the legal right has been won, but not the moral right.

In 1978 the abortion law was liberalised in Norway. It permits abortion on request up to 12 weeks of pregnancy, and after that with the agreement of a medical commission, taking the woman's own views into consideration. In 2003, 96% of abortions took place before 12 weeks of pregnancy. There is considerable support among the population for the current law, and the right to abortion does not seem to be under threat, yet opponents of abortion attack the law frequently. Debates on recent biotechnology laws and difficulties introducing the abortion pill, on the spurious grounds that it would make abortion too easy, imply continuing moral qualms about abortion. While abortion among young, unmarried women is more accepted, many married women feel they have to justify their decision. Women are expected to feel sorrow, shame and guilt because of their sexual conduct for many reasons, but especially if the result is an unwanted pregnancy. It is easier to protect the law when there is recognition of the moral right to choose abortion. The legal battle has been won, but winning the moral battle is important in Norway now. I believe that until having an abortion is considered as acceptable morally as using contraception, women will not have gained their full reproductive rights.