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For Immediate Release: October 1, 1999
Explaining Low Teenage Childbearing and Abortion Rates in Sweden
Contraceptive education, easy access to contraceptive services, and the provision of free abortion on demand helped reduce teenage birth rates, pregnancy rates, and abortion rates in Sweden, concludes an article published in the September issue of Studies in Family Planning. The study, by authors Gigi Santow and Michael Bracher, uses microsimulation to examine the possible roles of contraception and induced abortion in reducing teenage fertility from the mid-1960s to the mid-1980s. Santow and Bracher examine the various changes that could have led to the decline, and they compare Sweden's experience with other European countries and contrast it with the United States.
In 1965, Sweden's teenage fertility rate was 49 births per 1,000 women aged 15 to 19; by 1984 the rate had declined to ten births per 1,000 women. In the United States, the teenage fertility rate exceeded 70 births per 1,000 women aged 15 to 19 in 1965. Although the rate declined until 1976, it moved little until the late 1980s, when it began to rise again. As of 1995, the teenage fertility rate in the United States, at 61 births per 1,000 women, was markedly higher than it had been in any of the Western European countries for the previous 30 years.
Santow and Bracher describe three inter-related changes that occurred in the middle of the 1970s:
* First, in 1975, the school sex-education curriculum was revised to no longer explicitly recommended abstinence when young; nor did it emphasize that sexual activity should take place only within marriage.
* Second, after considerable debate, the abortion law was revised in 1975 to allow abortion on demand and without charge.
* Third, the revision of the school sex-education curriculum was accompanied by explicit contraceptive education, and special youth clinics were instituted to provide free contraceptives to young people.
In studying the rate of induced abortions, Santow and Bracher determine that before 1975, the decline in teenage fertility appears to have been caused primarily by an increase in the number of induced abortions. After that date, however, an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that, even though the proportion of teenagers who sought abortion increased, the abortion rate declined.
"Various changes could have led to the decline in teenage birth rates between the mid-1960s and the mid-1980s," the authors note. "First, young Swedes may have become sexually active at progressively older ages, or their frequency of sexual activity may have declined across cohorts. Second, they may have made increasing use of contraceptives or of highly efficient methods, or they may have become more skillful practitioners of contraception. Third, teenagers increasingly may have sought abortion when they became pregnant. Any or all of these changes could have led to a decline in teenage fertility."
After running a large number of simulation models, the authors conclude that Sweden's approach--providing contraceptive information and supplies along with free access to abortion--reduced teenage birth rates, pregnancy rates, and ultimately abortion rates.
According to the authors, the Swedes approached the problem of teenage pregnancy with a certain pragmatism, viewing teenage sexual activity neither as desirable nor undesirable, but as inevitable. Teenagers' use of contraceptives was viewed as highly desirable because it would prevent both childbearing and abortion. Teenage abortion was seen as desirable only insofar as it would prevent teenage parenthood.
In the United States, on the other hand, "such an unequivocal ranking of priorities has been neither common nor popular," resulting in "a proliferation of 'abstinence-only' and 'just say no' educational campaigns," the authors say. "Although the minority that opposes a pragmatic approach to teenage sexuality has been unable to prevent American teenagers from engaging in sexual activity, it has obstructed the implementation of practical interventions to reduce the level of teenage pregnancy and parenthood."
Elsewhere in northern and western Europe, rates of teenage childbearing have also declined, although not as dramatically as in Sweden, Santow and Bracher note. "In explaining these countries' successes, in contrast to the United States' failure, some would point to a more pragmatic European approach to teenage sexual activity; others would credit the provision of excellent contraceptive services that are universal, confidential, and subsidized or free, and education through the schools or mass media. These explanations are inextricably intertwined, however. Practical steps to prevent teenage childbearing may be effective only when they are implemented with the full understanding and acceptance that teenagers will be sexually active whatever the view of the wider--that is, older--community."
Gigi Santow and Michael Bracher are Senior Research Associates, Demography Unit, Stockholm University, Stockholm S-106 91, Sweden.
Other articles, reports, data, Vol. 30 No. 3, September 1999
Articles:
The Effects of Family Planning Workers' Contact on Fertility Preferences in Bangladesh, by Mary Arends-Kuenning, Mian Bazle Hossain, and Barkat-e-Khuda
A Radio Soap Opera's Effects on Family Planning Behavior in Tanzania, by Everett M. Rogers, Peter W. Vaughan, Ramadhan M.A. Swalehe, Nagesh Rao, Peer Svenkerud, and Suruchi Sood
Reports: Do Parents Prefer Sons in North Korea? by Daniel Goodkind
Data: Chad 1996--97 DHS; Indonesia 1997 DHS
Book Reviews: Malcolm Potts on Sharing Responsibility: Women, Society and Abortion Worldwide, by The Alan Guttmacher Institute
Charlotte Ellertson on Breaking the Abortion Deadlock: From Choice to Consent, by Eileen L. McDonagh
For subscription information on Studies in Family Planning, call 212-339-0514 or fax 212-755-6052.
The Population Council is an international, nonprofit, nongovernmental research organization that seeks to improve the reproductive health and wellbeing of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees from 12 countries. Its New York headquarters supports a global network of regional and country offices.
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