Some pregnant women are so conflicted about abortion that they don’t even talk about it with their own mother.
Almost half of all pregnancies are unplanned. In 2017, 12 733 abortions were carried out in Norway. The number of live births the same year was 56 600.
Abortion in Norway
- 12 733 abortions were performed in 2017. This is the lowest number since abortion began to be recorded in 1970.
- The highest recorded number of abortions – 16,139 – occurred in 2008.
- The number of abortions among teenagers (ages 15-19) has never been as low as since registration started. On average, 6.3 per 1000 women in this age group get an abortion. Regional differences are significant, with five times more abortions in this group recorded in Finnmark county than in Sogn og Fjordane county.
- Abortion is most common in the 20-30 age group. But here too, the number of abortions has fallen sharply among the youngest, to nearly half for women aged 20-24 in the course of a 10-year period. The group with the highest abortion figures are 25-29 year olds.
- In 2017, more than 80 per cent of self-determined abortions were performed before the 9th week, and 96 per cent before week 12.
- The limit for self-determined abortion in Norway is 12 weeks (18 in Sweden). If the woman is more than 12 weeks pregnant, a request for abortion must be considered by a panel of doctors. In 2017, 546 abortions (4 per cent of all abortions) were carried out after panel consideration. Most were granted due to risk of birth defects, social conditions or maternal health.
- Medical abortion was introduced in 1998. Since 2008, most abortions were carried out with drugs. This percentage was 89 per cent in 2017.
- A research group at the Women's Clinic at Akershus University Hospital found that 37 per cent of the women who applied for abortion in the period 2007-2011 had had a previous abortion. Almost 12 per cent had previously had two or more abortions.
- The large mother and child study (MoBa) shows that almost half of all pregnancies are unplanned. Although teenage pregnancies have decreased, this group accounts for most unplanned pregnancies. Women in their 30s have the greatest number of planned pregnancies.
- Every year, around 1500 people withdraw their application for abortion.
- Between 10 and 30 per cent of all pregnancies end in miscarriage.
- The number of stillbirths in 2017 was 180.
- The number of births in 2017 was 56 600, or 1.64 children per woman. This is the lowest birth rate to be measured in Norway.
- In 2015, the average age of mothers giving birth in Norway was 30.6 years old. In the 1986-1990 period, the figure was 25.2 years.
- (Sources: FHI Abortion register, MoBa and SSB)
Norwegian legislation on self-determined abortion became law in 1978.
Week 0-12: the woman has full self-determination (96 per cent of all pregnancies occur during this phase).
Week 12-18: a panel of doctors decides, but must pay attention to the woman's wishes.
Week 18-22: the panel decides. Abortion more restrictive; applies mainly to foetal abnormalities. The limit of viability is set to 21 weeks and six days.
After 21 weeks and six days: abortion only allowed if the mother's life is in danger or the foetus has a fatal abnormality.
In her doctoral work at NTNU in Ålesund, Assistant Professor Marianne Kjelsvik interviewed 13 women between 18 and 36 who came to the hospital for an abortion, but who were so unsure about their choice that they went home again to think about it more.
Between 10 and 20 per cent of women are still uncertain about whether they should have an abortion when they come in for the procedure.
“The women said that they’d been very careful about whom they talked to about abortion. Some of them hadn’t brought it up with the man they’d become pregnant by. They searched online to find stories about women who had been in the same situation. When I asked if there was anyone they would have like to talk to but were hesitant to, several said ‘my mother,’” says Kjelsvik, who works in NTNU’s Department of Health Sciences.
Taboo over generations
Among the women who had talked with their mothers, several mothers opened up and admitted that they’d had an abortion themselves.
“Everyone has an opinion about abortion, but for the women who were in this situation, figuring out what was right and wrong proved to be very complex.”
“When this is kept secret, even from the people you’re closest to, it says something about how alone a woman can feel,” says Kjelsvik.
The PhD candidate is a trained nurse and has extensive experience as a supervisor with the counselling service Amathea, an independent health service whose goal is for women to be able to live well with the decision that they’ve had time to think through.
The voice we don’t hear
Kjelsvik finds that the abortion debate lacks the voices of women who have faced the choice between terminating or completing their pregnancy.
“Ideally, a woman who wants to have an abortion should be sure of her choice, but many women aren’t. They find themselves in a situation that isn’t conducive to having a child, and at the same time they find it difficult to go through with an abortion. Then they end up making the final decision at the hospital.”
“Healthcare workers have busy schedules, and several mentioned that they hadn’t received training on how to help women who were in doubt.”
Religion often enters into the abortion debate. However, the women in this study did not bring up religion when they talked about their values.
“Women have their own values, and the women in the study were concerned with the fact that their decision involved a life. They considered the possibility of life with a child. Everyone has an opinion about abortion, but for the women who were in this situation, figuring out right and wrong became a complex question,” says Kjelsvik.
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Difficult for healthcare workers
The 13 women in the study were recruited from six different hospitals around the country. The women felt well received at the hospital when they came for the abortion. They felt respected.
But at the same time, they wished that staff could have dealt better with their doubts. Not necessarily by giving advice, but by listening to them. They really needed someone to talk to. Someone who could tell the women how difficult it had been for them. The healthcare workers, on the other hand, were very careful not to be judgmental or to influence the women in any way.
“Healthcare workers have busy schedules, and several staff mentioned that they hadn’t received training on how to help women who were in doubt. If several conflicted women come in on the same day, it can mess up the schedule completely,” says Kjelsvik. She thinks more time should be allotted for these appointments and that it shouldn’t be solely up to the individual nurse to help.
“Everyone benefits when a woman is confident that she’s made the right choice. For healthcare workers to avoid appearing judgmental or influencing the decision, I’d suggest an open introductory question like, ‘What has it been like for you to make your decision about this abortion?’ That kind of question signals caring rather than judgment,” says Kjelsvik.
Even after the women in the study had made their final decision, they still had lingering doubts. Kjelsvik did follow-up interviews four weeks and twelve weeks after the women had made their decisions. Everyone was relieved to have come through a difficult time, but at the same time some women were still unsure about whether they had done the right thing.
Those who had chosen to carry their pregnancies to term had mixed feelings. Some were troubled because they didn’t enjoy being pregnant and worried whether they would be able to love the child. The reason they had considered abortion had not disappeared. Some of those who chose to get an abortion later thought that they could actually have gone through with the pregnancy.
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Berge Solberg, professor of medical ethics at NTNU, believes the scepticism towards involving the outside world in the question of abortion has many causes.
“We’re seeing a demystifying and ‘de-tabooing’ of abortion. More and more people are coming forward and talking about having had an abortion. But even though we’re having these big social debates, the issue is perceived as very private for the person who finds herself in this situation. Even people who regard abortion as unproblematic and not ethically difficult know that people can have strong opinions in the opposite direction. So, you become cautious about bringing up the topic,” says Solberg.
He is the deputy chair of the Norwegian National Committee for Medicine and Health Research Ethics.
Fully human at birth
Norway’s Abortion Act came after a long historical battle for women’s rights. Norwegian abortion law is based on the idea that a woman has the right to control her own body, which applies without restriction until the end of the twelfth week of pregnancy.
After twelve weeks, a panel makes the final decision and weighs the woman’s interests against the foetus’ right to life. This may result in a conflict of interest. The panels are required to pay close attention to the woman’s point of view, and in most cases her choice is honoured.
The requirements for granting abortion becomes increasingly strict as the women gets closer and closer to term. Norway does not give the foetus legal status before birth, but recognizes an individual’s “full human dignity” at birth.
“But even if the law were to be interpreted that the foetus has full moral status as a person before birth, it doesn’t mean that abortion wouldn’t be allowed. The woman’s rights over her own body can trump the foetus’s right to life,” says Solberg.
The debate on foetal reduction – aborting one foetus when a woman is carrying twins – became a hot topic after Norway’s Ministry of Justice and Public Security interpreted the abortion law to mean that full self-determination also applied in these cases.
The government’s Granavolden platform, consisting of the Conservatives (H), the Progress party (Frp), the Liberals (V) and the Christian Democratic party (KrF), agreed to remove the possibility of self-determined foetal reduction and to temporarily freeze the Abortion Act and the Biotechnology Act. Professor Solberg believes that proposals to liberalize the Acts will be made when this period is over.
“It’s more likely that the Abortion and Biotechnology Acts will be liberalized than tightened. However, the support for today’s Abortion Act is strong, and fights over it can contribute to sharper divisions,” Solberg says.
Abortion rate the same regardless of law
According to the ethics professor, the number of abortions in practice is pretty consistent from country to country, even though legislation differs. Ireland had a ban on abortion until recently, but the consequence of the ban was that Irish women travelled to England get abortions.
“We find that the legislation on the issue doesn’t affect the choice of action. The consequence of a ban or very strict laws against abortion isn’t fewer abortions, but far more dangerous abortions, and a lot of suffering. Unsafe abortions are a major global health problem,” says Solberg.
Kjelsvik, M., Sekse, R. J. T., Moi, A. L., Aasen, E. M., Chesla, C. A., & Gjengedal, E. (2018). Women’s experiences when unsure about whether or not to have an abortion in the first trimester. Health Care for Women International, 39(7), 784-807. doi:10.1080/07399332.2018.1465945
Kjelsvik, M., Sekse, R. J. T., Moi, A. L., Aasen, E. M., & Gjengedal, E. (2018). Walking on a tightrope – Caring for ambivalent women considering abortions in the first trimester. J Clin Nurs, 27( 21-22), 4192-4202. doi:10.1111/jocn.14612
Kjelsvik, M., Sekse, R. J. T., Moi, A. L., Aasen, E. M., Nortvedt, P. & Gjengedal, E. (2019). Beyond autonomy and care: experiences of ambivalent abortion seekers. Nursing Ethics, doi: 10.1177/0969733018819128