Birth and abortion rates among young women over the past 50 years examined in relation to providers and reimbursement for hormonal contraception across the Nordic countries, an ecological study.

introductionWith liberalization of abortion laws in the Nordic countries during the 1970s, there were efforts to prevent unplanned pregnancies among young women by improved contraceptive provision. In an ecological design, we describe country-specific actions for meeting young women's contraceptive needs and their impact on induced abortion and births. MATERIAL AND

methodsWe used national data from 1974 to 2023 on populations and numbers of induced abortions and births for 15-19- and 20-24-year-old women. Available public documents included information on preventive measures, availability of hormonal contraceptives (providers/dispensation), and reimbursement schemes. Joinpoint regression analysis was used to assess breakpoints in country-specific age trends for annual abortion and birth rates.

resultsSweden authorized midwives to prescribe contraceptives in 1976, Norway in 2002 (and public health nurses), Finland in 2020 (and public health nurses) and Iceland in 2021, while physicians have remained the only provider in Denmark. Sweden set up youth clinics from the late 1970s and clinics opened in Norway from the early 1990s. Partial or full reimbursement for combined oral contraceptives to 16-23-year-old women began gradually in Sweden in the early 1990s and expanded to a national program on contraceptives in 2014/2016. A Norwegian free-of-charge scheme to 16-19-year-old women for combined oral contraceptives from 2002 changed in 2006 to include partial coverage for short-acting reversible contraceptives and was expanded to long-acting reversible contraceptives in 2015/2016. In Finland two large cities offered long-acting reversible contraceptive free-of-charge from 2007/2013. Denmark and Iceland have not had reimbursement schemes for hormonal contraceptives. We found no breakpoints in trends for induced abortions and births that could relate to any preventive actions. Trends were relatively similar in countries with or without expanded prescription rights to midwives/public health nurses and unrelated to reimbursement schemes. Birth rates among women <25 years are now <10% of those seen 50 years ago, while most of the decline in abortion rates took place after 2010.

conclusionTrends for induced abortion and births among women <25 years have developed similarly across the Nordic countries. They are global and appear less likely to be associated with national health services and targeted contraceptive policies.