Another Planet: Abortion in Norway


This article is cross-posted from ANSIRH (Advancing New Standards in Reproductive Health), a website of the Bixby Center for Global Reproductive Health

It was the “of course” in Dr. Anja Hauge’s (not her real name) e-mail to me that was my first hint that when it comes to abortion, Norway and the United States exist in two different universes.

On a recent visit, I had asked a Norwegian colleague to arrange an interview for me with a physician involved in abortion provision. Dr. Hauge, a prominent gynecologist, agreed to meet with me, and in her introductory e-mail, mentioned that she worked in a large hospital department, where “we, of course, also provide abortions.”

“Of course”?! In the United States, to use “abortion,” “hospital” and “of course” in the same sentence is oxymoronic. Only about 5 percent of all abortions performed in the United States occur in hospitals, and even these relatively few procedures are increasingly under attack. The Republican-led Congress, in one of its first acts after taking control in January, passed the Orwellian-named “Protect Life” Act which stipulates that hospitals receiving federal funds are permitted to refuse abortions to women in life-threatening situations. Just recently, the House passed the so-called Foxx amendment, which would withhold newly available funds for comprehensive medical training from hospitals that provide abortion training.

When I met Dr. Hauge in person, my sense of being on a different planet intensified. To summarize our conversation:

  • Abortion is “completely integrated” into the Norwegian health care system, paid for (like other medical procedures) by the government, and available virtually everywhere in the country;
  • ob/gyn residents are expected to undergo training in abortion provision, and though opt-out provisions exist, very few young physicians make use of them;
  • health care professionals involved in abortion provision are neither sanctioned by medical colleagues nor harassed by anti-abortion activists.

Abortion, in short, is largely a non-politicized issue, both within Norwegian medical circles, and the population at large.

Comparing the two countries

On paper, interestingly, Norway’s abortion regulations appear to be somewhat stricter than those in the United States. Up through 12 weeks of pregnancy, abortion is routinely available. But between 12 and 18 weeks, a woman must go before a committee before obtaining an abortion, and after 18 weeks, abortions are only permitted in instances of threats to the life or health of the woman and serious or lethal fetal anomalies.

But it is only on paper, of course, that the U.S. situation is more liberal. One of three American women do not live in a county with a provider (several states are now down to one clinic); many women can’t pay for abortion and the majority of states do not permit use of public funding for abortion. (The search for money often pushes poorer women into later abortions, which are more expensive and even harder to find).  And, as the recent anniversary of the assassination of George Tiller reminds us, abortion providers are terrorized in this country in a way that leaves Norwegians incredulous—and of course, appalled.

But to my American ears, the most interesting part of our conversation came when we discussed the Norwegian committee system, which deals with requests for abortions after 12 weeks. When these requests are denied by local hospitals, there is an automatic appeal to a central committee. This central committee came into existence a little more than a year ago, because of the authorities’ concern about differing rates of turndowns across the country. Moreover, Dr. Hauge told me, every two years the Ministry of Health convenes a conference to which hospital representatives from all over the country come, to discuss abortion issues.

To be sure, the overwhelming majority of requests for abortions between 12 and 18 weeks are initially approved. Several gynecologists are frustrated with the need for committee approval starting at 12 weeks, and would prefer to see the limit raised to 16 or 18 weeks.  As Dr. Hauge put it, “It is humiliating for the woman and a waste of everyone’s time.” But hearing from her that there is a government body that “watches carefully” to assure that abortion policy is being carried out fairly made my head spin.

Norway ranks 1st in State of the World’s Mothers report; United States 31st

So how do Norway and the United States, two countries that legalized abortion at approximately the same time (the former in 1978, the latter in 1973), compare—not only with respect to abortion, but along the whole spectrum of reproductive health outcomes?

Norway, where abortion is freely available, subsidized by the government, and apparently not stigmatized, was recently named by a leading children’s advocacy group as “the world’s best place to be a mother” because of its family-friendly policies and excellent record of both maternal and infant mortality.

The United States, in contrast, notwithstanding the sanctimonious bows to motherhood by anti-abortion politicians, came in 31st—the worst of any developed nation, due mainly to its shameful record of both maternal mortality and under-five mortality.

Norway not only has a better record than the United States with respect to teenage pregnancies and births, but also has a lower abortion rate—a reflection, among other things, of Norwegians’ better access to contraception, its comprehensive sex education policies, and its generally more mature attitude toward human sexuality.

As I ended my interview with Dr. Hauge, I asked her, as I always do with U.S. physicians, if she wanted her name changed when I wrote about our encounter. She laughed apologetically and said, “It’s better if you change it. I’m not worried about Norwegians, but I don’t want some American (anti-abortionist) reading about me.”

When I returned to my hotel room after our meeting, I opened my computer to find that an arrest had been made in Wisconsin of yet another disturbed individual with plans to murder local abortion providers. Two different planets indeed.

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

To schedule an interview with Carole Joffe please contact Communications Director Rachel Perrone at rachel@rhrealitycheck.org.

  • elburto

    Abortion is mostly carried out in hospitals here too. A woman entering the hospital could be an employee, a visitor, any possible kind of patient. She’s in a safe, secure environment. Where she should be. If anything goes wrong there’s access to emergency equipment and specialist staff.

    Medical procedures belong in hospital. They don’t belong in a strip mall or on an industrial estate.

  • prochoiceferret

    It’s like an episode of Sliders!

  • arekushieru

    My dream would be to have a country like Canada where abortion is completely regulated by the medical profession come together with a country like Norway, where abortion seems to be completely destigmatized.

  • broodstock

    There’s absolutely no reason abortion can’t be performed in a strip mall.  Dentists operate in similar capacity all the time.  

     

    First trimester abortions are extremely safe and there is absolutely no reason they can’t or shouldn’t be performed in small, accessible clinical settings.  Very, very few people are ill enough to require a hospital setting for their first trimester abortion and “things going wrong” rarely, rarely, rarely, rarely happens (and probably has less to do with “mistakes” of the Dr than the patient jumping around).

     

    Would a hospital offer an increased sense of privacy/security?  Maybe.  But I personally don’t think we should be allowing these zealots to hover around clinics and needlessly harass people anyway.  If they want to have an “abortion vigil” in a grotto somewhere – fine- but they get off on their voyeurism and a real look at a true, living bad person.  If abortion only ever took place in hospitals, the protestors would flock there, and everyone would get harassed.  But maybe that would finally open some eyes to the absolute injustice of letting crazies obsess outside the doors of medical facilities.

  • arekushieru

    Dentistry usually doesn’t involve as invasive a procedure as a late first trimester-early second trimester abortion does, nor does one need to be monitored by a health care professional as one does even after a very early-term abortion.  A mall is a place where so many people congregate that it would be difficult to monitor people as effectively.  At least, that’s what I think.

  • prochoiceferret

    A mall is a place where so many people congregate that it would be difficult to monitor people as effectively.

     

    There’s no need. A mall is private property. The minute anti-choicers begin to raise a fuss, one of these guys will show up and put an end to the party:

     

  • arekushieru

    Or the guy who was the creative mind behind the Segways and drove it off a cliff…?  That doesn’t inspire much confidence, PCF….

  • prochoiceferret
  • broodstock

    I get what you mean, yes, it is more invasive than general dentistry.

     

    But I don’t understand what you mean when you say the patient needs to be monitored by a healthcare professional.

     

    A patient is monitored about 30 minutes post-procedure and then they are out into the world on their own again.  Immediately after the procedure, the patient is seated, given OTC medication, and vitals are monitored for a short period.  Then they go home … or shopping, or out to eat… whatever they choose to do.  

  • arekushieru

    If they are given Mifepristone, a woman needs to make a second follow-up appointment and see a health care professional once the procedure is finished.  As I was discussing, that comment was in reference to hormonally induced abortions.  I made my point on surgical abortions fairly clear, though, I presume…?