Let’s explore the history and protection of abortion rights in Sweden.

As an American, I’ve been paying close attention to the recent restriction of abortion access in the United States. I believe that safe, reliable, affordable, and de-stigmatized access to reproductive care – including abortion – is a basic human right. Luckily, Sweden agrees.

Currently, Sweden has some of the world’s most progressive abortion protection and access. But, of course, it did not start that way. Let’s dive into the history of abortion access in Sweden.

1920s and earlier

At this time, abortions in Sweden were illegal, but pressure was mounting for abortion access.

1938

Swedish women gain legal access to abortion through The Abortion Act, though only if her life was at risk, if she had been raped, or if the fetus was carrying a genetic disorder. According to Lena Lennerhed, professor at Södertörn University, “The legal abortions were not many, they were only a few hundred every year, whereas the illegal abortions were many many more. They were estimated to be up to 24,000 illegal abortions every year, and everybody knew this. So, there was a need to extend the law.”

1946 – 1960s

The Abortion Act was amended, allowing abortion access if the mother was too poor, too young, or if the mother’s physical or mental health was at risk. Interestingly, the legalization of abortions in Sweden due to a physical or mental health risk played a key role in America’s abortion legislation.

In 1962, Sherri Chessen, an American woman, was denied an abortion in the US and turned to Sweden for help. Sweden granted Chessen legal access to her abortion. Based on Chessen’s case, Sweden amended the Abortion Act again, including protection in the case of serious injury to the fetus. As an American living in Sweden, it was so interesting to hear about this unique historical tie between my two homes on this topic.

In 1965, a highly-publicized case became the focus of Swedish society. The Swedish healthcare system still required a formal application to have an abortion. This step prompted many Swedish women to travel to Poland where they could have a “free” or “on-demand” abortion. After a Swedish woman shared her story of traveling to Poland for an on-demand abortion at a conference called “Sex and Society” in Stockholm, the Swedish police became involved. Ultimately, the Prosecutor General
found that a woman who had obtained an abortion outside Sweden was still punishable according to Swedish law. The Prosecutor General also found that Hans Nestius, who provided the woman seeking an abortion with Polish contacts, was punishable for complicity.

After Nestius’ home was searched, the Social Democratic Youth signed a letter to the Swedish government and public opinion against the Swedish government’s investigation reached a breaking point. All charges were dropped and a commission was started to research how to further liberalize the Swedish abortion law. The commission led to the 1974 changes.

1974

This was the year that the Swedish Abortion Act provided women with the legal right for on-demand abortion, within the first 18 weeks of pregnancy. Beyond the first 18 weeks, further authorization is required from the Swedish National Board of Health and Welfare. Abortion access is covered by the local county council and costs no more than a normal doctor’s appointment (~ 200 SEK or $20 USD).

Now

Since 1974, the number of abortions in Sweden has remained stable, with ~20 abortions per 1,000 women of fertile age (15–44 years old). The proportion of early abortions (within the first nine weeks), however, has increased from 45% in the early 1980s to 80% today. This is due, in part, to the development and rise of medical abortions.

A medical abortion is done with a combination of two drugs. The woman is first given tablets with mifepriston, which in accordance with the Abortion Act must be taken at the hospital/clinic. This drug inhibits the effect of the hormone progesterone and increases the uterus’s sensitivity to prostaglandin analogues such as misoprostol. After a few days, the woman is given misoprostol, which causes the uterus to contract and dilates the cervix so that the foetus is expelled. A check-up or an at-home test verifies that the abortion is complete.

Karolinska Institutet

To sum it up, I think Lena Lennerhed, the professor, put it best: “In Sweden, we have an abortion law that trusts the woman to be the best judge when it comes to decisions about her body and her life, and she doesn’t have to explain herself.”

• According to the World Health Organization, “Unsafe abortion methods take the lives of approximately 47,000 women around the world each year. This makes unsafe abortions one of the major causes of death among women, globally speaking. Women’s access to and possibilities of having a safe abortion differ enormously between different countries.“
• Making abortions illegal does not decrease the number of abortions, but instead increases the number of unsafe, illegal abortions. In 2015, the WHO reported that, globally, ~21 million women go through unsafe abortions every year, primarily in countries with fewer resources. Furthermore, unsafe abortions make up nearly half of all the abortions carried out in the world.
• The Swedish healthcare system does not keep a record of individual abortion procedures.
• The majority (99%) of abortions in Sweden take place before week 18. 79% take place before week eight. 14% between weeks 9-11, and 6% in weeks 12-17. Those that take place after week 18, when authorization is required, are most often due to birth defects.
• Typically, the medical method is used before week 12 and the surgical method is used after.
• Misoprostol, the drug used in medical abortions, is on the WHO’s list of essential medicines for basic medical care.

• Watch the video here to quickly learn about Sherri Chessen, her 1962 abortion, and her current thoughts on abortion rights in the US.
• Read You’re the Only One I’ve Told: The Stories Behind Abortion by Dr. Meera Shah. Dr. Shah is the Chief medical officer of Planned Parenthood Hudson Peconic and in 2020 her book came out with the aim to “humanize abortion and to combat myths”. It is on my to-read list!

• Safe abortion saves women’s lives
• Sweden’s road to abortion on demand
• Sherri Chessen on her 1962 abortion, and the fate of Roe: “We can’t go back to willow sticks and knitting needles”
• Law over mind, and body?