Sweden is about to get an updated abortion law following an investigation commissioned by the Tidö government. The bill is now on the Riksdag's table. The directives to the inquiry underpinning the proposal included modernizing the language, enabling midwives to provide abortions and for patients to perform the entire abortion at home.
Although the proposal contains marginal improvements compared to today's legislation, it is insufficient to be able to provide abortions in line with the current state of knowledge and to strengthen women's reproductive rights.
Already today, many medical abortions are provided in practice by midwives. A majority of abortions also take place at home, as the medicine that de facto leads to the expulsion of the pregnancy can be taken at home. The planned update of the legislation is thus not a progressive proposal, but in many ways an adaptation to the way we already work, which was also the purpose of the legislative change.
Under current legislation, the first drug that increases the ability of the uterus to contract must be swallowed in a hospital or other healthcare facility. In the new legal text, the requirement for hospital treatment is removed. There is good evidence that a large percentage of pregnant women do not need to undergo any physical examinations before a medical abortion and that counseling can take place via various forms of telemedicine. When the Swedish Medicines Agency now proposes new directives, due to the new law, there remains, however, a requirement that medicines can only be dispensed at an abortion clinic.
Access to abortion is today unequal across the country. Many women in sparsely populated areas may have to travel several hours to an abortion clinic. There are also waiting times of more than a week, especially during holiday periods, despite the fact that the law states that abortion must be provided expeditiously – a term that has never been defined.
Every day delay in treatment means increased bleeding, pain and risk of complications. A change in legislation that allows women to complete the abortion at home should also allow for simplified provision of the treatment. In order to increase availability and shorten waiting times, abortion drugs, including the pain relief needed, need to be able to be provided via pick-up at a pharmacy, other health care facility (for example, a health center, maternity care center or youth clinic) or by mail.
In Sweden, abortion is permitted at the woman's request up to and including week 18+0. Between week 18+0 and until the fetus is considered viable (in practice until pregnancy week 21+6), special reasons are required to obtain permission for an abortion, which is then granted by the National Board of Health and Welfare's Legal Council for abortion and sterilization cases.
The legal council consists of six members for abortion matters: a lawyer, a counselor, a representative from the National Board of Health and Welfare, a gynecologist, a psychiatrist and a member of the Swedish Parliament. Although the role of the Judicial Council was not included in the inquiry's directive, it was nevertheless addressed in the final report.
The majority of the clinics that the investigation had contact with had raised the role of the Judicial Council and the application procedure as problematic. In addition to the fact that the current organization is legal (lack of transparency, you cannot appeal decisions, you do not get a justification for the decision), it also stands for a paternalistic and archaic view of women's self-determination that does not belong in today's Sweden. In principle, everyone who applies for an abortion due to medical reasons (usually birth defects) is approved, but a significant and increasing proportion of those who apply for an abortion for social reasons are rejected (from 13 percent to 26 percent between the years 2013 and 2022).
Globally, there is a lot of research that shows negative economic, social and emotional consequences for women who are denied an abortion, but there is a lack of current research on how Swedish women experience the process. We who meet these patients can testify to crisis reactions, despair and that some women seek abortion care abroad. Even for the women who receive permission, the application process means worry and stress as well as delayed treatment, which in turn causes increased bleeding, pain and a greater risk of complications.
Updating today's legislation is urgent, but the bill is insufficient on two points in particular.
1. When full home abortion is made possible, other authorities' directives also need to enable care in accordance with the current state of knowledge. This means that medicines must be able to be sent to or picked up as close to the woman as possible without delay: at a pharmacy, health centre, maternity care or youth clinic.
2. Abolish the requirement for permission from the Judicial Council for women who wish to have an abortion between the ages of 18+0 and 21+6. The person who knows best whether an abortion is the right decision will always be the pregnant woman herself.
Women in Sweden deserve abortion legislation that neither limits the quality of care, accessibility nor women's self-determination.
