Contraceptive use among women seeking an early induced abortion in Sweden

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 102; no. 11; pp. 1496 - 1504
• Main Authors: Niemeyer Hultstrand, Jenny, Törnroos, Elin, Tydén, Tanja, Larsson, Margareta, Makenzius, Marlene, Gemzell‐Danielsson, Kristina, Sundström‐Poromaa, Inger, Ekstrand Ragnar, Maria
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.11.2023; John Wiley and Sons Inc
• Subjects: Abortion; Birth control; Clinical Medicine; Contraception; counseling; Covid-19; Family planning; Health behavior; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Obstetrics, Gynecology and Reproductive Medicine; Original; Reproduktionsmedicin och gynekologi; Womens health; Sweden; family planning; abortion; Covid-19; counseling; contraception
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14630

Introduction In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion‐seeking women. Material and methods Swedish‐speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross‐tabulations, and the Chi‐square test was used to compare age‐groups. Valid percentages are presented. Results In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short‐acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long‐acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non‐use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. Conclusion The unmet need for contraception appears to be high among abortion‐seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group. This questionnaire study on contraceptive use among abortion‐seeking women in Sweden showed a high unmet need for contraception; many women had discontinued contraception during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness.