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Contraception and abortion in Sweden


Information about womens' use of different contraceptive methods is not always easy to come by, but a longitudinal survey of a cohort of women in Gothenburg [1] provides a useful insight about how choices change with age.

Study


The study began in 1981 with a random sample of a quarter of women aged 19 years living in Gothenburg. The women were invited by letter to return a questionnaire on contraceptive history, reproductive history and related factors. Most (91%) did so. These women were then followed up at various times, most recently in 1991, when 484 (74% of original sample of 656 women) completed the questionnaire, and there was full information from 430 women who completed questionnaires in 1981, 1986 and 1991.

Additional information came from computerised hospital records: all births and abortions are carried out in hospital in Sweden. A population register showed no differences between the women who completed the questionnaire and those who did not, and the rest of the population of the same age.

Results


The oral contraceptive pill was the method of choice of the women when they were 19 and 24 years, but far fewer at age 29 (Figure 1). Use of condoms increased somewhat, but IUD use rose from a negligible percentage to 1 in 5 by age 29 years (sterilisation is rare in Sweden). At 24 and 29 years the majority of women not using contraception were either pregnant, had recently been pregnant, or wished to become pregnant.

Figure 1: Contraceptive choices made by a cohort of Swedish women at ages 19, 24, and 29 years

Fig 1

Reasons for stopping use of the oral contraceptive and IUD are given in the paper, with fear of oral contraceptives a common cause, alongside bleeding disorders, weight gain and mental side effects.

The outcomes of pregnancy at the three ages is shown in Figure 2. At age 19 59% of pregnancies were terminated, a figure which fell to 10% at age 29 with a concomitant increase in the proportion of live births. There were 188 legal abortions performed for these 430 women. Ectopic pregnancy occurred at about 1% in all three ages.

Figure 2: Pregnancy outcomes in women aged 19 or less, 20 to 24, and 25 to 29 years

Fig 2

Comment


This is a detailed examination of womens' attitudes to contraceptive choices. It may reflect cultural Swedish differences (high abortion rates, low sterilisation rates), but the overall picture is informative. Half of the abortions occurred when women were aged 20 to 24 years, perhaps reflecting a peak of sexual activity at a time when contraceptive knowledge is still weak.

Reference:

  1. G Larsson et al. A longitudinal study of birth control and pregnancy outcome among women in a Swedish population. Contraception 1997 56: 9-16.


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