When It Comes to Abortion, Norway and the United States Are on Different Planets

When It Comes to Abortion, Norway and the United States Are on Different Planets

Carole Joffe: Reproductive Health in Norway

On a recent visit to Norway, I had asked a Norwegian colleague to arrange an interview for me with a physician involved in abortion provision. Dr. Anja Hauge (not her real name), a prominent gynecologist, agreed to meet with me. In her introductory email, she mentioned that she worked in a large hospital department where ?we, of course, also provide abortions.?

?Of course??! In the United States, it?d be shocking to see ?abortion,? ?hospital,? and ?of course? in the same sentence. 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 House of Representatives, in one of its first acts after taking control in January, passed the Orwellian-named ?Protect Life? Act, which would permit hospitals receiving federal funds to refuse abortions to women in life-threatening situations. Just last month, the House passed the Foxx amendment, which would withhold newly available funds for comprehensive medical training from hospitals that provide abortion training.

When speaking with Dr. Hauge, I got the sense that Norway and the United States are on two different planets when it comes to abortion. 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 non-politicized, both in Norwegian medical circles and the population at large.

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

But it is only on paper, of course, that the situation in the United States 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 the 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 appalled.

The most interesting part of my conversation with Dr. Hauge came when we discussed the Norwegian committee system, which deals with requests for abortions after twelve 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 abortion denials across the country. Even without the central committee, the overwhelming majority of requests for abortions between twelve and eighteen weeks are initially approved.

Some gynecologists are frustrated with the need for committee approval starting at twelve weeks and would prefer to see the limit raised to sixteen or eighteen 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. Every two years, Dr. Hauge told me, the Ministry of Health convenes a conference to which hospital representatives from all over the country come to discuss abortion issues.

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 on both maternal and infant mortality. The United States, in contrast, notwithstanding the sanctimonious bows to motherhood by anti-abortion politicians, came in thirty-first?the worst of any developed nation, due mainly to its shameful record on both maternal 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, their comprehensive sex education policies, and their 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.

An earlier version of this post appeared at RH Reality Check.