Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 41, Number 3, September 2009

An Illusion of Power: Qualitative Perspectives On Abortion Decision-Making Among Teenage Women In Sweden

By Maria Ekstrand, Tanja Tydén, Elisabeth Darj and Margareta Larsson

CONTEXT: Swedish law permits abortion at the request of a pregnant woman until the 18th week of gestation. However, the extent to which the decision is truly the woman’s own is subject to debate; women are often influenced, directly or indirectly, by the attitudes of their partners, family and friends or by social norms.

METHODS: Individual in-depth interviews about the pregnancy and the abortion decision were conducted 3–4 weeks postabortion with 25 women aged 16–20 at different periods in 2003, 2005 and 2007. Interviews were audio- taped, transcribed verbatim and analyzed using latent content analysis.

RESULTS: The main reasons for unplanned pregnancy were underestimation of pregnancy risk and inconsistent contraceptive use. Pregnancy prevention was perceived as the woman’s responsibility. The abortion decision was accompanied by mixed emotions, and was seen as a natural yet difficult choice. Social norms and the negative attitudes of family and friends strongly influenced the decision. Partners and parents were regarded as the most important sources of support. After the abortion, the women felt pressured by contraceptive counselors to use highly effective contraceptives despite their previous negative experiences or worries about side eff ects.

CONCLUSIONS: Swedish teenagers’ basic right to decide whether to have an abortion may be limited by societal norms and disapproval of teenage childbearing. Given the perception that women are responsible for contraception, programs need to emphasize that pregnancy prevention is a shared responsibility; greater efforts to include males in prevention practices are needed.

Perspectives on Sexual and Reproductive Health, 2009, 41(3):173–180




Maria Ekstrand is researcher, and Tanja Tydén is professor, both in the Department of Public Health and Caring Sciences, and Elisabeth Darj and Margareta Larsson are associate professors, Department of Women’s and Children’s Health—all at Uppsala University, Uppsala, Sweden.