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Purpose: The article aims to elaborate on two recent European Court of Human Rights (ECtHR) decisions which have rejected, on grounds of non-admissibility, the appeals by two Swedish midwives who refused to carry out abortion-related services, basing their refusal on conscientious objection, and to expound upon the legal and ethical underpinnings and core standards applied to the framing process of such a ECtHR decision., Materials and Methods: By drawing upon relevant recommendations from international institutions, the authors have aimed to assess how the ECtHR rationale could affect the balance between CO and patient rights; searches have been conducted up until December 2020., Results: In both decisions the European Court has asserted that the right to exercise conscientious objection must give way to the protection of the right to health of women seeking to have an abortion., Conclusions: ECtHR judges concluded that the failure to provide for a right to conscientious objection does not constitute, in fact, a violation of the more general right to freedom of thought, conscience and religion, if provided for by a state law to protect the right to health. The legal ethical and social ramifications of such a decision are of enormous magnitude.

Pregnancies occurred in 57 (12%) of 482 Swedish women with Turner syndrome with a liveborn rate of 54% in 124 pregnancies. Spontaneous pregnancies occurred in 40%, mainly in women with 45,X/46,XX mosaicism, and oocyte donation in 53% where miscarriages were less frequent, odds ratio = 0.43 (95% confidence interval 0.17-1.04)., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The aim of the study was to investigate the impact of abortion on contraceptive use, partner relationship and sexual satisfaction., Methods: In a longitudinal study, 58 women answered a pre-abortion questionnaire and participated in two interviews, one in connection with the abortion and a second 1 year later., Results: Most women (40/58) had retained the same partner 1 year after the abortion. More than half of these (22/40) experienced no change in the quality of the partner relationship, while the rest (18/40) had deepened their relationship. Furthermore, the majority of the women (45/58) had not experienced any negative influence on their sexual satisfaction. Most women who were sexually active 1 year post-abortion (42/47) used some contraceptive method; the number who used hormonal methods or intrauterine devices had, for example, increased from four to 35, although one-third of them had been doubtful about these methods before abortion. Conversely, 15 women had tried these methods during the follow-up year but had not continued because of negative effects. Overall, contraceptive use 1 year post-abortion had increased., Conclusions: To achieve well-founded decisions about contraceptives, counsellors should be aware of women's ambivalence about the use of modern, effective contraceptive methods. In order to prevent abortion it is important to discuss gender differences in sexual behaviour and encourage communication with both sexes about the pros and cons of coitus-dependent and coitus-independent methods.

Background: Little is known about staffs' attitudes and experiences of legal abortion. The aim of this study was to gain knowledge about the views of Swedish midwives and gynecologists on legal abortion. Another aim was to investigate differences between professions and possible impacting factors on these views., Methods: A questionnaire was sent to a random sample of 258 midwives and 269 gynecologists. The response rate was 84%., Results: The vast majority of all respondents supported the legislation on induced abortion. A great majority also believed that the woman alone should make the decision, and that abortion was not used as a form of contraception. Generally, there were smaller differences among views of female and male gynecologists than among views of female gynecologists and female midwives. For example, female midwives disagreed more than female gynecologists with the statement: 'Legal abortion should be permitted even if the woman has felt fetal movements'. The most impacting factors on views were the extent to which the staffs had been working with legal abortion, especially during the last year, and type of profession. Views were, however, not influenced by private experiences of legal abortion., Conclusions: The present study highlights that midwives and gynecologists overwhelmingly agree that legal abortion should be allowed. The more experience of working with legal abortion, especially current experience, the less restrictive gynecologists and midwives are in their views. Compared with previous studies, staffs have become more liberal in their attitudes toward abortion and the relevant legislation.

This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion.

The prevalence of contraception and pregnancy outcome in two representative samples of 19-year-old women resident in the city of Göteborg, born in 1962 (n = 596) and 1972 (n = 641), respectively, was assessed and compared using a postal questionnaire technique. The prevalence of different contraceptive techniques was as follows (62/72): Oral contraception (OC) alone 44%/35%, (p < 0.001); OC + condom 1%/12%, p < 0.001; intrauterine device 4%/1%, p < 0.001; condom only 11%/14%; depot gestagen 0%/0.3%; no contraception 40%/38%. The median duration of OC use was 15 and 14 months, respectively. Fear of OCs was the commonest reason given for cessation of OC in the 62 cohort and that contraception was no longer required in the 72 cohort. The proportion of women who gave the latter explanation for cessation of OC had increased (p < 0.001) from 10% in 1981 to 57% in 1991, indicating that young women in Sweden now tend not to continue with OCs when a relationship ends. Although the prevalence of cigarette smoking was reduced (p < 0.05 in the 72 cohort compared to the 62 cohort), there was still an over-representation of smokers in both cohorts among contraceptive users (p < 0.001) and in women who had been pregnant (p < 0.001) or undergone an abortion (p < 0.001). Pregnancies were reported by 11% of the women from the 62 cohort and by 13% from the 72 cohort. A greater proportion (p < 0.001) of pregnancies terminated in legal abortion in the 72 cohort (61%) compared to the 62 cohort (50%). The medical complication rate following legal abortion was lower (p < 0.05) in the 72 cohort compared to the 62 cohort.

Aim: To compare life-style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut., Methods: Girls resident in the municipality of Karlstad, Sweden, starting their upper secondary school education were invited to attend the teenage clinic during two years (five visits). Gynecological examinations were performed and questions were asked about possible symptoms, sexual activity, contraception and sexually transmitted diseases., Results: Ninety-eight girls accepted the invitation to participate and 88 girls completed all visits (mean age on admission 16 years). Median age for coitarche was 16 years. A sexual debut < 15 years was reported by 17 girls (19.3%), 54 (61.4%) had their debut > or = 15 years and 17 girls (19.3%) had not had their sexual debut on completion of this study. Girls with an early sexual debut had a greater number of sexually transmitted diseases (p < 0.05) and more cervical atypias (p < 0.05), and more often had a menarcheal age < 13 years (p < 0.05), > two brothers and/or sisters (p < 0.01), were more often not living with their parents (p < 0.01) and reported a greater number of life-time partners (p < 0.06) than the remainder, Girls with a sexual debut < 15 years started drinking alcohol earlier than others (p < 0.01). There was a greater proportion of smokers among girls with an early sex debut compared to the remainder (p < 0.05)., Conclusions: Early sexual debut is associated with an earlier menarche and a more premature adult life-style and is an important indicator for continued risk behavior regarding reproductive health.

In Sweden, contraceptive methods for birth control are readily available, but one in four pregnancies was legally terminated during the period from 1975 to 1990. Our purpose in conducting the present study was to describe young women's choices and use of contraceptive methods and their attitudes to abortion. The participants were 305 Swedish women ages 23-29 years. Eighty-eight percent of the women were using some contraceptive method. The most common method was hormonal (43%), followed by a barrier method (22%). The women considered that abortion should not be used as a method of birth control and that the fact that a pregnancy is unintended is not a sufficient reason for terminating it. An acceptable reason, they thought, for a woman to have an abortion is the woman's present situation, in particular her social situation. The women were aware that the use of contraceptive methods gives them the chance to choose if and when they wish to have children.

The Swedish abortion legislation of 1975 gave women the right to make a decision about abortion before the end of the 18th week of pregnancy. The number of abortions is rising in Sweden as a chosen method of birth control. The attitudes of students toward abortion were studied in 1986-1987. A questionnaire containing items on how sex education is taught, the anatomy and physiology of reproduction, contraceptives, sexually transmitted diseases, and legal abortion was answered by 421 high school students. Results pertaining to the students' attitudes toward abortion are reported. Two thirds of the students believed that the decision about an abortion should be made by the man and woman together. Nearly all respondents believed that abortion should not be considered a method of birth control. These results may be considered a guide for interventions to prevent the need for abortion. One fourth of all pregnancies in Sweden terminate in abortion. The students in the present study thought of abortion as a solution. Authors studying samples with different cultural backgrounds have reported similar attitudes.

During the 70s and 80s ethical debate concerning the fetus became intensive. The great advances made in medical technology and research and improvements in prenatal diagnosis as well as in embryological research have led us to believe that the fetus is an individual with recognised claims to protection. In Sweden the aborted fetus has previously been considered merely as a risk-disposal problem, equivalent to dangerous and infected material and there have been no specific guidelines for the treatment of the fetus after abortion. In July 1990 treatment of aborted fetuses was changed with the general guidelines from the National Board of Health and Welfare. The present paper sets out the main contents of the guidelines and discusses the gradually changing views concerning the status of the human fetus in Sweden, as well as the public debate which has been a contributing factor to these changes.

Both Italy and Sweden have legislated abortion without grounds since the 1970s but background conditions in the two countries are bipolar. The overall purpose of the present study was to investigate a sample of adolescents from Italy and Sweden regarding their attitudes towards abortion and their knowledge of family planning and to compare the results from the two countries. A questionnaire was distributed among 400 adolescents, 177 from Stockholm, Sweden and 223 from Rome and Locri, Italy. Whereas Sweden is a relatively homogeneous country. Italy has large regional differences regarding social and other aspects. For this reason two regions of Italy were studied separately. The participants were all secondary school students. The results indicated that nearly all adolescents in both countries were concerned about abortion and its consequences, although their concern was expressed differently, in accordance with their religious and cultural norms and also with their background in sexual education. The present study raises questions concerning the knowledge level as an outcome of sex education programs. In fact comparing the answers between the Italian and the Swedish samples no particular difference, in favour of the Swedish adolescents was noticed.

The present study was undertaken to investigate the opinions of health professionals working in family planning clinics in Italy and Sweden. The comparison of two such different countries seemed of interest both to describe differences and/or similarities between the samples as well as to analyze factors that could influence professionals' opinions regarding abortion. A questionnaire was distributed to doctors, nurses and social workers in family planning clinics in Rome, Italy and in Gothenburg, Sweden. The opinions of the health professionals in the two countries investigated were similar in many respects, both regarding their attitudes to abortion as well as their considerations concerning the care offered to the woman/couple undergoing an abortion. Fifty-nine percent of the Italian sample and 68% of the Swedish sample considered abortion justifiable on the same indications as those laid down in the laws, while 36% of the Italian and 32% of the Swedish professionals considered it justifiable only on medical grounds and 5% in the Italian sample did not justify abortion at all. In both Italy and Sweden, doctors as well as nurses suggest that the preventive work should be increased and that the psychological care for women undergoing abortion has to be improved.

A study was made of live birth rates, infant, neonatal, and postneonatal death rates, late fetal death ratios, and perinatal death ratios for Sweden and the United States for selected years, 1950-1973. Sweden has lower live birth rates, infant, neonatal, and postneonatal death rates, as well as lower perinatal death ratios. Data available on low-birth-weight live births for selected years, 1959-1970, for both countries indicated that rates in the United States were almost twice those in Sweden. Implications of these findings for the United States are discussed in light of the quantity, quality, and delivery of health care services, as well as of other factors in Sweden.

Antenatal care consumption, obstetric conditions, and neonatal health, were studied retrospectively in all women in the county of Stockholm who had a baby during 1976-77 and also had been admitted to a psychiatric department after the 20th week of pregnancy or within the first postpartum year, and the findings were compared in matched obstetric controls. Fewer index women had had uncomplicated pregnancies than the controls. A positive relationship was found between acute mental illness and pregnancy complications. Delivery complications tended to to be more common in the index group than in controls, but, only in patients with prepartum onset of mental illness. More index women had a history of several previous abortions than the controls. The index women, and especially the addicts, attended the antenatal care clinics significantly less frequently than the controls. The neonatal health of the index children seemed to be more closely correlated with alcohol or drug dependency per se in the mothers than with mental illness.

Health care for mothers and children has been a cornerstone of the Swedish system of health care for many years, starting in the 1930s, when a national network of maternal health centers offered a variety of free prenatal services. This paper describes modern maternal health services whose primary goal is preventive care. Instruments for attaining this goal are regular check-ups for early detection of problems and for maintenance of good health; social and psychological support to expectant parents; information and training to prepare parents for delivery and parenting; information and education about risk factors in the parents' local environment and in society in general. Details of how these programs were developed, delivered and evaluated are provided by the author, a former Senior Medical Officer at the National Board of Health and Welfare, responsible for maternal health care and family planning on a national level.

The reproductive history and use of contraception in a representative sample of 19-year-old women from the city of Göteborg is reported. Oral contraceptives (OC) were taken by 47%, 4% had an intrauterine device and 12% used a barrier method while 37% practiced no form of contraception. The type of OC used and reasons for discontinuation are presented. The duration of OC use was one year or less for 46% of the women and exceeded 3 years in only 10%. Major causes of discontinued OC were the result of side effects attributed by the woman to OC, or a fear of OC. There were 93 pregnancies reported in the population sample, resulting in the birth of 34 infants. Pregnancy was terminated by legal abortion in 51% of the reported pregnancies. The ready availability of a return visit to discuss possible side effects and fears resulting from the chosen method of contraception may improve continuity, thus reducing the number of legal abortions.