No Backlash for Swedish Women? The Right to Abortion on Demand, 1975-2000

In 1932, the Social Democratic Party took over power. Sweden gained an international reputation of being a progressive nation and a model for other countries to follow. In his bestseller Sweden: The Middle Way (1936), the American journalist Marquis Childs described Sweden as a country that had achieved a compromise between capitalism and socialism, a balance between individualism and collectivism. The result was, according to Childs, a pragmatic and modern country that was in peace and which saw economic growth, and with an ambitious social reform programme on the agenda. These social reforms included issues of sexuality and reproductive health and, over time, the image of Swedes as being gender-equal, open-minded, and sexually liberated became fixed. American and European scholars and journalists frequently repeated this narrative of a progressive Sweden, and it became a political trademark and self-image for Swedes themselves. The self-image of Sweden, combined with Swedish people’s comparatively strong trust in the state, forms a background for the consensus and the backing for the country’s liberal attitude towards abortion.

In 1938, abortion became legal on medical, eugenic, and humanitarian grounds, that is, if a woman was seriously ill, carried a hereditary disease or had become pregnant after rape or incest. The state established a centralized system, including centres with counsellors, gynaecologists, and psychiatrists where women could apply for abortion. A committee at the National Board of Health and Welfare, or in some cases two doctors, decided on the requests for abortion. The 1938 abortion law was accompanied by a repeal of a law that banned information on contraceptives. During the Social Democratic governance, traditional and Christian ethics regarding sexuality were largely replaced by modern, secular, and scientific views.

But, the 1938 abortion law did not give women the right to abortion. Legal abortions were seen as exceptions, and initially, a woman’s chances of getting a legal abortion were extremely limited. While physicians performed a few hundred legal abortions per year, illegal abortions numbered in the thousands. The Swedish Association for Sexuality Education (Riksförbundet för sexuell upplysning, or RFSU), among others, criticized the restrictive nature of the law, and in 1946, legislators added a socio-medical indication to the law. This meant that a woman could be granted an abortion if her mental or physical health would likely be harmed by giving birth and taking care of a child. The number of legal abortions rose. In 1963, legislators further expanded the abortion law to include abortions in cases where the foetus had become seriously ill or damaged. This reform followed a wave of birth defects caused by the tranquilizer thalidomide and occurred a year after the American journalist, TV host, and mother of four, Sherri Finkbine, had a legal abortion in Sweden. Sherri had taken thalidomide and, fearing that her foetus would suffer from birth defects, had applied for a therapeutic abortion in the United States. After being denied, she and her husband flew to Sweden. Their case was followed across the world and, in articles and interviews, Sherri and her husband Robert described Sweden as humane and down to earth, confirming the image of ‘progressive Sweden’.

Swedish liberal and social-democratic youth organizations, however, did not find Swedish abortion policy progressive at all. In the early 1960s, they were the first to demand free access to abortion. The social-democratic student activist Jacob Palme, author of the book Fri abort (‘Free Abortion’, 1964) and Hans Nestius, editor of the journal Liberal ungdom (‘Liberal Youth’), argued for women’s right to freedom and held that every child had the right to be wanted. At a 1964 conference ‘Sex and Society’ organized by Stockholm’s Liberal Student Club and the RFSU, a young woman sitting on a darkened stage told the story of travelling to Poland for an abortion after her abortion application had been turned down in Sweden. Her story garnered significant media attention, and police questioned Nestius and searched his house in an attempt to find names and addresses of women who had travelled to Poland for abortion.

Initially, the struggle for abortion on demand was controversial and was met with strong reactions. Those objecting to abortion on demand referred to the foetus’ right to life but also to the welfare of the woman. Nancy Eriksson, a social democratic MP and member of the Social Democratic Women’s Association, stated for example that ‘a real woman’ would always find abortion ‘a terrible ordeal’. Others argued that pregnant women were in a state of psychological imbalance and did not always know what was best for them. A woman might wish for an abortion, for example, because of ‘pregnancy depression’ or hormonal imbalances of early pregnancy. Even personnel within the abortion care sector often voiced this opinion.

The Swedish women’s movement was initially ambivalent about abortion on demand. They viewed motherhood as being of central importance to women, and many shared the belief that a pregnant woman would usually wish to give birth to the child that she is carrying. If she applied for abortion, many Swedish feminists felt, it was because of social and economic circumstances or an unwilling male partner. Improved support for mothers and children, feminists argued, was more important than access to abortion. Younger women in the organizations, however, frequently supported liberalization, and with time, the women’s movements came to support elective abortion. The Swedish Women’s Left Party Association (Svenska kvinnors vänsterförbund) did so in 1965, while the Social Democratic Women’s Association (Socialdemokratiska kvinnoförbundet) waited until 1970 to voice its support. For the socialist-feminist organization Group 8 (Grupp 8), founded in 1970, abortion on demand was a crucial feminist issue.

Abortion on demand was also on the agenda in the other Nordic countries. In 1966, the Nordic Council (Nordiska rådet), an organization for collaboration between the parliaments in the Nordic countries, discussed the possibilities of a liberalized as well as uniform abortion law for the countries. This idea of a uniform law was never realized, but abortion reform was to follow. In Denmark, abortion on demand until the twelfth week of pregnancy as well as free counselling on contraceptives was introduced in 1973. Norway introduced abortion on demand in 1979.

In Sweden, the increased debate on abortion went hand in hand with the liberalization of abortion practices. In 1960, 3000 legal abortions were performed in Sweden. Ten years later, the number exceeded 16,000. During the first half of the 1970s, applicants were routinely granted access to abortion. In 1974, the number of legal abortions had climbed to over 30,000. In the following year, legislators introduced abortion on demand. The introduction of the 1975 abortion law entailed a repositioning of the actors in the abortion debate. Those opposing the right to abortion became marginalized and had to find new strategies, while those who had fought for the right to abortion found themselves on the side of the establishment and government.

The committed civil servant

When the Swedish parliament decided to introduce abortion on demand, its members also stressed the importance of eliminating the need for abortion. They emphasized that abortion should not be viewed as a substitute for contraception. As a result, Sweden expanded free counselling on contraceptives. The state financially supported access to contraceptives, opened youth clinics, and improved school sex education. Furthermore, Sweden’s National Board of Health and Welfare founded a committee for health counselling, the so-called H-Bureau, which produced informational leaflets, periodicals and books on abortion, contraceptives, pregnancy, parenthood, gender roles, and sexually transmitted diseases. In her thesis Den välplanerade sexualiteten (‘Well-Planned Sexuality’, 2001), pedagogue Birgitta Sandström describes the civil servants working within the H-Bureau as spirited and engaged. Their self-image was that of front-line fighters for openness about sexuality and for equality between women and men.

The H-Bureau also tried to reduce prejudices against abortion. Its publication Varför är det så svårt med abort? (‘Why is Abortion so Difficult?’, 1982) was based on interviews with women who had had an abortion and with abortion counsellors. The booklet presented claims such as ‘too many abortions are performed’, ‘women have abortions instead of using contraceptives’, and ‘women have abortions because they have been careless’, in order to subsequently discuss and dismiss these claims. The booklet represented a clear stance in favour of the right to abortion. Still, the authors noted that choosing to have an abortion and undergoing the procedure itself was ‘difficult’. A woman’s choice, the publication argued, was to some degree determined by the wishes of her male partner. Abortion, H-Bureau emphasized, should be freely accessible while the need for the procedure should be reduced at the same time.

Despite the liberalization of abortion regulations, there was no dramatic change in the number of abortions after 1975. Between 1975 and 1985, total abortions fluctuated between 30,000 and 35,000 per year (or between 18 and 21 per 1000 women aged 15-44 years). However, the number of teenage abortions fell dramatically, while the number of abortions grew for women over 35 years. In 1980, the government established an Abortion Commission to evaluate developments since the introduction of abortion on demand. In its report Familjeplanering och abort. Erfarenheter av ny lagstiftning (‘Family Planning and Abortion. Experiences of New Legislation’, SOU 1983: 31), the commission stated that preventive measures such as the promotion of contraceptives had been successful.

The years following the passing of the 1974 abortion bill were marked by relative calm in the abortion debate. The National Board of Health and Welfare produced and distributed information materials. Feminist organizations and the Swedish Association for Sexuality Education defended the abortion law when it was attacked, but were otherwise relatively passive. The fact that they did not dwell more on the abortion issue might indicate that they were satisfied with the status quo. Alternatively, they might have feared losing what had already been gained. The organized opposition to abortion, being consisted of disparate action groups with a Christian background, was negligent at this point.

Despite the lull in the abortion debate, the law had not fully responded to the abortion question. Journalist Inga-Lill Valfridsson noted that far too many women were left alone to face the anxiety, disquiet, and feelings of shame. For her 1979 book, Aborten—det svåra ingreppet (‘Abortion—The Difficult Procedure’), Valfridsson had interviewed women who had undergone abortions. While most women handled having an abortion very well and emphasized the importance of the right to abortion, Valfridsson stressed that abortion stirred up emotions that were necessary to discuss.

The theme of ‘the difficult abortion’ appeared in other texts, such as Bilder och röster. Intervjuer bland kvinnor och sjukvårdspersonal kring abort (‘Pictures and Voices. Interviews among Women and Healthcare Providers about Abortion’), published by the Ministry of Health and Social Affairs in 1981, and in Abort: erfarenheter och teorier (‘Abortion: Experiences and Theories’, 1986) by counsellor Margareta Callersten Brunell and psychologist Merike Lidholm. Part of the difficulty lay in women’s feelings of shame; however, several writers argued that women’s shame was in fact not connected to the abortion as such, but rather to the unwanted pregnancy. Women felt that they had ‘failed’ or ‘been sloppy’ with their contraceptives. One woman who had an abortion in the 1990s, noted the following:

Women who had regularly used birth control at times felt less shame because they felt that they had acted responsibly. As another one noted, ‘In a way I thought I had a right to get an abortion, because I had used an IUD and had not been careless’.

In a more political work published some years later by journalists Maria Hede, Nina Lekander, and Mian Lodalen as well as physician Nina Yderberg, ‘difficult’ appeared in the title: Det svåra valet. En bok om abort (‘The Difficult Choice. A Book about Abortion’, 1994). The book, written as a defence of abortion on demand at a time when elective abortion had been legal for almost 20 years, offered feminist, historical, and ethical perspectives on the right to abortion. At the same time, it provided the opportunity for reflection on a choice that could result in a ‘difficult and lonely’ experience for women.

When advocates of abortion rights emphasized the abortion decision as ‘difficult’, they sought to consider the emotional and existential aspects of abortion. They stressed that discussing that which is ‘difficult’—be it the difficulty of choosing an abortion, or the process of the operation itself—did not entail opposition to the right to abortion. Valfridsson and other pro-choice writers probably also had strategic reasons for emphasizing that abortion could be ‘difficult’: they sought to encourage women and men to talk more about the abortion choice, and hoped to counter claims from abortion opponents that women had abortions carelessly and dispassionately.

In 1980, Sweden’s prime minister Thorbjörn Fälldin was asked how he felt about the fact that women had, 5 years previously, been granted the right to abortion. He answered that he would have preferred a restrictive law that allowed abortion only if the woman was seriously ill or had become pregnant as a result of rape. Fälldin was the leader of the Centre Party and the prime minister in the conservative coalition government that had come into power in 1976, replacing the social democrats after the latter’s 40-odd years in power. Fälldin expressed his personal opinion, and neither he nor his government proposed a restriction of the abortion law. However, his statement led to protests and fears that the law was in jeopardy. It was not until the early 1990s, however, that things began to heat up. The first march on ‘Yes to Life Day’ (Ja till livet-dagen) was held in 1990. In 1991, anti-abortion activists founded the organization ‘Yes to Life’ (Ja till livet) and appointed Mikael Oscarsson as the spokesperson. ‘Yes to Life’ had its roots in free churches such as the evangelical ‘Word of Life’ (‘Livets Ord’).

Ethical and medical arguments overshadowed religious arguments. ‘Yes to Life’ drew parallels between abortion and the Nazi Holocaust, but given this comparison, their political demands were initially rather modest: that the limit for abortion be lowered from 18 to 12 weeks. They also demanded the introduction of a conscience clause for personnel working in abortion care, mandatory counselling for women who sought abortion, and a more restrictive use of prenatal diagnosis. The American anti-abortion movement was very influential in ‘Yes to Life’. Speakers such as Wanda Franz and John C. Willke, the presidents of the anti-abortion organization American National Right to Life Committee, gave lectures at seminars arranged by ‘Yes to Life’. At the same time, ‘Yes to Life’ emphasized that it was not going to adopt any ‘vulgar American methods’ such as blocking access to abortion clinics.

The emergence of a Swedish anti-abortion movement rekindled the political debate about abortion. ‘Yes to Life’ was met with protests and its marches with counter-demonstrations. Many abortion advocates realized that legal abortion could not be taken for granted but had to be defended. Still, ‘Yes to Life’ did not make any political gains.

The introduction of the abortion pill led to significant anti-abortion opposition. Prior to the introduction of the abortion pill Mifegyne or RU 486 in 1992, abortion was a surgical procedure. Medical abortion allowed women to take the pills and miscarry at home rather than to have to visit a clinic for surgical procedures. ‘Yes to Life’ collected signatures and protested against what they called the ‘death pill’. After the state Medical Products Agency (Läkemedelsverket) had approved the use of Mifegyne, an MP representing Sweden’s Christian Democratic Party proposed that the approval be withdrawn. As he argued, ‘[t]he abortion pill Mifegyne is per definition not a medicine—indeed, seen from the foetus’s point of view, quite the opposite’. Anti-abortion activists’ fight against Mifegyne was, however, also unsuccessful.

Even the entry of the Christian Democratic Party into parliament in the 1990s did not lead to political gains for anti-abortion activists. The Christian Democratic Party entered parliament for the first time in 1991, and—in coalition with other conservative parties—even the government. In the abortion question, however, the Christian Democrats went from a very restrictive approach to actual support for abortion on demand, albeit with some reservations. In the 1970s, the party platform only supported legal abortion in the case of rape or in order to save a pregnant woman’s life. During the 1980s, the party demanded that abortion should be allowed ‘in special circumstances’. The party’s 1996 manifesto stated that the right to life applies from the moment of conception and should be protected by law. The Christian Democratic Party sought to incorporate the foetus’ right to life into the Swedish constitution. The party also proposed that every woman seeking an abortion should be counselled that abortion entailed an ethical dilemma, and it asked for a formal enquiry into lowering the gestational age for legal abortion. Finally, the party sought to prevent abortion by extending support to pregnant women. However, at no point did Christian Democrats advocate the criminalization of abortion. In 1997, the party’s medical-ethic action programme På livets sida (‘On the Side of Life’) dedicated 10 of 40 pages to the discussion of abortion, concluding with the following: ‘[T]he Christian Democrats cannot find it reasonable that anyone but the woman, in the first trimester, makes the important decision about a possible abortion’. With this conclusion, every party in the Swedish parliament stood behind the abortion law.

‘Yes to Life’ reacted sharply, criticizing the Christian Democrats’ programme as ‘amazingly abortion-liberal’, and started to organize for the next election. In 1998, Mikael Oscarsson entered the parliament for the Christian Democrats.

Following the legalization of abortion in 1975, it became less common to discuss and question women’s reasons for choosing abortions. However, psychiatrists and, later, anti-abortion activists inquired about possible negative mental health outcomes as a result of abortion. Between 1975 and 1976, psychiatrist Anne-Christine Trost interviewed women who had had a legal abortion. Trost found that most women did not experience any mental problems after abortion. One in five women experienced short periods of problems, while one in ten underwent slight depression so temporary in nature that it did not necessitate psychiatric treatment. A woman’s ambivalence about abortion, she concluded, increased the risk of post-abortion problems. Post-abortion mental disorders were not always related to the abortion itself; however, they could often be dated back to an earlier time in the woman’s life. Serious psychiatric problems after abortion were rare. Trost’s findings supported the results of international research: mental health problems after abortion were, most often, moderate, and short-lived.

The government-sponsored evaluation of the abortion law mentioned above, Familjeplanering och abort. Erfarenheter av ny lagstiftning, SOU 1983: 31, commented very briefly on the psychological effect of abortion. While the report referred primarily to Trost, its authors also cited studies that showed that women were more likely to suffer from negative mental health outcomes following abortion in societies where abortion was highly stigmatized. In liberal societies, however, women showed few, if any, negative mental health effects.

In 1981, American psychologist and trauma specialist Vincent Rue coined the term Post-Abortion Syndrome (PAS; sometimes called Post-Abortion Stress Syndrome, PASS). In cooperation with psychiatrist Ann Speckland, Rue developed the theory of PAS in an article published in the Journal of Social Issues in 1992. According to Rue and Speckland, abortion led to a continuum of ill effects, from the milder symptoms of Post-Abortion Distress (PAD), through PAS, to the traumatic Post-Abortion Psychosis (PAP). They defined PAS as a form of post-traumatic stress disorder as a result of which a woman might feel that she had consciously destroyed her ‘unborn child’, experience negative memories of the ‘moment of death’ during the abortion, and conclude that she had violated her parenting instinct and responsibility. Nightmares, flashbacks, repressions, memory loss, sorrow, and guilt over having ‘survived’ were part of the syndrome.

Although PAS was never officially recognized as a diagnosis or condition, for the American and Swedish pro-life movements, PAS became an important argument against abortion. The journal Yes to Life-News (Ja till livet-nytt) repeated Wanda Franz’s claims about the existence of PAS and the complications from which women might suffer even long after the abortion. As PAS became a new argument for Sweden’s anti-abortion activists, their arguments shifted in focus from the foetus to the woman: abortion was detrimental to women’s health.

The intensity of the debate surrounding abortion and mental health was, in 1997, picked up in the Swedish parliament when two Conservatives and one Christian Democrat introduced a motion to re-evaluate the 1975 abortion law. Although the motion had no chance of passing, it at least brought the issue of abortion before parliament. The three members of parliament proposed that the Swedish parliament reassess how far into a pregnancy abortion should be legal and to assess if a foetus was in need of painkillers during abortion. Moreover, the motion proposed for abortion counselling to be mandatory. The proposal contained a detailed account of ‘research on PAS’, citing a number of American studies that the three Swedish parliamentarians believed were also applicable to the situation in Sweden. Studies showed, they argued, that the suicide risk for women who had had an abortion was nine times higher, that 90% of all women who had had an abortion would ‘experience moderate to severe emotional and psychological stress’ after the abortion and that up to 10% had needed ‘treatment in a psychiatric clinic or other medical care’. The motion did not get any support and was turned down.

Those who supported the right to abortion cited scientists’ findings that the majority of women had only moderate and temporary emotional problems after an abortion and that women were mostly relieved. While anti-abortion activists in ‘Yes to Life’ contended that abortion led to trauma and PAS, their claims rested on the assumption that the traumatic mental effects of abortion were caused by women’s feelings of guilt at having killed their babies. The ethical discussion about the legitimacy of abortion had been replaced by a discussion of the psychology of abortion. A closer look, though, shows that abortion opponents presented an ethical line of argument in a new guise. The argument rested on the assumption that women who had abortion were traumatized because they agreed that abortion entails the act of killing. In the end, attempts to establish PAS as a diagnosis in Sweden were unsuccessful. Legislators turned down proposals referring to PAS, and the theory found no support among researchers.

Ethical discussions of abortion have traditionally focused on the question of whether or not, and when, abortion should be allowed. In this discussion, the status of the foetus has been the focus, when life begins (at conception, implantation, or birth), and whether the foetus should be granted human dignity. In her thesis Legal Abortion during Very Early Pregnancy. Women’s Experiences and Ethical Conflicts (1994), physician Kristina Holmgren shifted attention to the woman. Women who chose to have an abortion, Holmgren claimed, do so after a series of moral deliberations. The most important ethical dilemma in this decision is not the conflict between a woman’s right to integrity and a foetus’ right to life, but rather how women can, in a responsible manner, create and protect close and lasting relations that were at the centre of their deliberations. Pregnant women develop an ethics of care, Holmgren argued. They consider the conditions for a good life for all those concerned, including the expected child, and might then choose abortion. In her thesis, Holmgren drew on the theories of feminist ethicist and psychologist Carol Gilligan on the ethics of care. By describing women as moral actors, Holmgren broadened the discussion on the ethics of abortion.

Others argued that women also had a right to selective abortion. Philosopher Torbjörn Tännsjö argued that women should have access to advanced prenatal diagnosis, including access to information about the foetus’ gender and potential foetal defects, and should be able to make decisions regarding abortion based on this information. In cases of great suffering or early death of an infant, Tännsjö propounds, women’s access to elective abortion should not only be an option but might be morally desirable.

Finally, how to dispose of the foetal remains after an abortion emerged as an issue of concern. Usually, foetal remains would be burnt as clinical waste together with other human tissues. In the 1980s, some hospitals began to cremate foetal remains and spreading the ashes in cemetery memorial glades. In 1990, Sweden’s National Board of Health and Welfare issued a general advisory that the foetal remains before the end of the twelfth week of pregnancy should be treated as clinical waste. Foetal remains for older foetuses should be cremated under the supervision of cemetery authorities and the ashes buried or spread anonymously. This directive was met with strong reactions. A routine of cremation and burial of older foetuses, critics argued, was funeral-like and might contribute to women’s guilt feelings and, indeed, be perceived as questioning abortion. The National Board’s advisory, however, remained in force in spite of the critique.

The right to abortion received strong support in Sweden in the 1980s and the 1990s, whereas the anti-abortion movement that was mobilized during the 1990s had no political success. The opponents’ use of ‘scientific’ and ‘women-centred’ arguments against abortion, as the theory of PAS, had no impact. Demands for conscience clauses, mandatory abortion counselling, or a lowering of the time-limit for abortion were raised, but with no effect. Neither did the fight against RU 486 find a receptive audience. At the same time, the foetus’ status was in some respects strengthened as indicated by the state advisory to cremate and bury foetuses aborted after the twelfth week of pregnancy. Another example is the 1989 Swedish government report on prenatal diagnosis that was given the title Den gravida kvinnan och fostret—två individer (‘The pregnant woman and the foetus—two individuals’), which argued that the foetus is an individual worthy of protection. Swedish abortion opponents interpreted the report as a vindication of their cause and repeatedly referred to the fact that in the report the foetus had been granted the status of an individual. However, the report did not propose legal rights for the foetus and had no effect on legislation of regulations.

The proactive role of the state—through the National Board of Health and Welfare and in particular its H-Bureau—in promoting abortion on demand was probably important for the widespread support for women’s right to abortion. In addition, history and self-image played a role. Legal abortion had been part of the Swedish welfare policy since the 1930s. The introduction of abortion on demand in 1975 fits well into the narrative of progressive Sweden.