Reproductive health - Preventing unwanted pregnancies
Til WHO Generalforsamling mai 2004-04-28
Sexual and reproductive health and healthcare services
Maternal mortality and morbidity in Norway is extremely low. The same applies to infant and child mortality. Healthcare services for mother and child are available and easy accessible at community level all over the country.
Safe abortion
From 1979, women in Norway have had the legal right to induced abortion on demand until the 12 th week of pregnancy. Abortions are performed in public hospitals within the health insurance scheme. The woman has a right to good counselling. After the 12th week of pregnancy, the approval of a local medical committee is necessary.
Preventing unwanted pregnancies and abortion in Norway
A wide field of measures to prevent unwanted pregnancies accompanies the Abortion Act. Since the beginning of the 1990es the Norwegian government has financed and carried out 3 national strategic plans. The basic goals are:
To ensure the sexual and reproductive rights for the whole population.
To reduce the rates of induced abortion; especially among teenagers and young adults.
Strategies of prevention - empowerment
The key concepts in the preventive work in Norway is empowerment and sexual autonomy. To promote young peoples ownership, self-confidence and pride of their bodies and sexuality. To encourage young people to take control over their fertility and sexual health. Key principles: all work and projects are oriented towards the gender, age and the specific cultural setting of the targetgroups.
Strategies - main directions
The main strategies of prevention includes:
an open and ongoing dialogue with young people on issues of sexuality
training boys and girls to choose and act with competence in sexual situations
low barrier offer of good contraception education and easy accessiible contraception services age and gender spesific education on sexuality for children and young people
preventive work is carried out as an ongoing process
Education and counselling
The work is carried out nationally as well as locally in the communities. Sexual education in school is obligatory in Norway and starts in the fifth grade. Norwegian studies show that teenagers prefer contraception education given by healthcare personnel. Contraception education and -counselling is carried out by the local youth healthcare services.
Contraception - accessibility
Easy accessibility to safe contraception:
young people can obtain contraceptives free of charge from the local youth healthcare- and youth social services all over the country
the p-pill is available free of charge for girls between 16 - 20 years of age. To increase accessibility midwifes and local district nurses with a special training course can prescribe the pill.
since 2000 emergency contraception has been available OTC in all local pharmacies
Gender oriented programmes:
Programmes - boys.
As boys use other information channels, and seem to profit from other kinds of information and training, we have tried new ways to reach them. In the past years we have launched different interactive information and training programs - on the internet, SMS and computergames.
Programmes - girls.
A main strategy that seems to be profitable to most young girls is practical oriented, basic training in self-assertiveness. How to draw your own lines, how to decide over your own body, how to learn to assert yourself in close relationship physically as well as psychologically. This kind of training programme is carried out all over the country..
Local peer educational groups - both sexes.
Young people are encouraged to be directly involved in the preventive work, and local peer educational groups has been established many places. Training is given by the national volunteer organisation of young medical students specialised in sexual issues. A few projects are conducted on a national basis. For example a leaflet on safer sex, developed by a local group of 15 - 16 year old boys, is used all over the country. Boys in Russia also use it.
Results
Abortion and pregnancy.
With the exception of 2001 the general abortion rate has declined steadily in the last ten-year period:
Since the beginning the 1990es the overall abortion rate in Norway has declined 19%. In 2002 the abortionrate was 12.6 per 1000 women
The abortion rate for the age group 20 - 24 has declined 24% totally from 1992 to 2000, the degree of reduction varying from 12% to 31% in different parts of the country. In 2002 there has been a slight increase.
In the age group 15 - 19 the decline in the abortion rate is about 16%. In 2002 the abortionrate among teenagers is 16.6, which is the lowest abortionrate ever in this age group.
Overall teenage pregnancies has shown a steady decline since 1990. Teenage births are exceptionally rare and amounts to less than 5% of the total annually births. The mean age of women having their first child is 28 years.
Use of contraception
Contraceptive use seems to have inclined in the last five year period and most studies report a high contraceptive prevalence among teenagers in all the Nordic countries. The indicators are however not fully reliable:
There has been a slight rise in the use of contraceptives - contraceptives being mostly used by the young age groups
There has been a definite rise in the use of hormonal contraception among women in all age groups
