Personal Health

Why Is Norway the Best Place to Be a Mother and the U.S. the Worst? Abortion Access

Norway, where abortion is freely available, subsidized by the government, and apparently not stigmatized, was recently named "the world's best place to be a mother."

This article iscross-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.

Carole Joffe is professor of sociology at the University of California-Davis, and a senior fellow at the Longview Institute.