Morag Ramsey discusses the development of abortion pills in Sweden and the social attitudes around this technology
The pandemic strained health services worldwide and some countries took the opportunity to further strip back abortion access (Hurtes and Boffey 2021). At the same time, other countries looked to telemedicine to provide abortions during lockdowns. Using abortion pills, a regimen that usually requires several pills at different intervals, makes this possible. Last April, for example, pregnant people in Wales were able to take the first abortion pill at home, instead of at a registered clinic (Jennings 2021). While officially available since the end of the 1980s, abortion pills have not been widely used in many medical systems. But the pandemic complicated abortion access, making abortion pills seem like the next step in securing abortion rights.
In my doctoral research, I examined the development of abortion pills in Sweden. Hoping to revolutionize early abortion methods, Swedish researchers tested abortion pills in clinical trials as early as 1965. While home abortions have taken on a specific type of importance during the pandemic, the method has been used in Sweden since the 1980s, albeit in testing stages. As a case study, Sweden shows how changing abortion technology can change the way the procedure is treated.
Often regarded as a liberal, social democratic haven, today Sweden counts among one of the countries with liberalized abortion laws and mild opposition to the procedure. In 1974, Sweden passed an abortion act that ensured legal abortion up until the eighteenth week of pregnancy. However, prior to this, abortion was legal only under certain circumstances and tightly controlled by the state (Lennerhed 2017a, 91). When I found newspaper articles from 1966 on “The Swedish Abortion Pill” they raised the question of how research was possible during this decade. In mapping out the research networks—following the researchers, government employees, pharmaceutical companies, trial participants, and media—I could see the decades of coordination that made abortion pill development possible. My research also showed how a new abortion technology impacted the way abortion was discussed and valued in Swedish society.
In the 1960s, abortion was considered necessary for medical, social, fetal-damage and humanitarian reasons, but was still largely seen as an unattractive solution to unwanted pregnancies. In her book, Kvinnotrubbel the historian Lena Lennerhed showed how abortion was controlled by the state—women had to be interviewed numerous times to access the procedure, with many facing rejection (Lennerhed 2017b). While images of long legged and blonde women circulated internationally in films, promoting the idea of “Swedish Sin,” women in Sweden were still far from having the right to free abortion (Narvaez 2014). There was not one attitude to abortion with some accusing women of promiscuity and loose lifestyles, while others fought for its liberalization (Jülich 2018).
Abortions, when provided, were often a surgical procedure. They required legal permission, the involvement of professionals such as gynecologists, social workers, and nurses, and hospital space and equipment. The specific abortion methods of the 1960s helped to sustain the idea that abortion was merit based, state surveyed, and done in hospital by highly trained professionals.
At the same time, there was research to develop abortion pills. Starting in 1965, clinical trials of abortion pills were done at Karolinska Hospital in Stockholm. These trials relied on women who had been evaluated by the state and been provided permission for legal abortion. The head researcher aimed to design an abortion method that could be used early in pregnancy. This went against one of the tenets of the existing abortion system—that abortion should be delayed for as long as possible. This premise, upheld in the long queue systems and multiple interviews spread out over several weeks, was rooted in the idea that abortion was never ideal and that women should be persuaded to change their minds.
In developing a new abortion method, researchers began to challenge existing norms. An abortion pill could shift abortion from a hospital procedure to one done at home, and it could also be exported to other countries. During a decade of overpopulation fears, being able to send a technology abroad as a form of family planning aid was appealing to the Swedish state. There was hope that a pill could be offered to communities with limited medical expertise, expanding abortion availability. Even in Sweden, researchers stressed the importance of being able to reduce local abortion queues by using this new technology.
Abortion pill researchers would make media rounds in the 1970s and 1980s, describing their research to newspapers, radio programs, and television stations. In these instances, abortion, through abortion pills, was described in new ways. Instead of focusing on promiscuous youth, researchers emphasized that abortion pills were used by normal, heteronormative married couples—creating a discourse of abortion as a type of responsible family planning. Abortion pills, researchers said, were important as they allowed husbands to be more involved in the procedure. Instead of in a hospital, pregnant women could take pills at home with the help of their husbands, making the procedure less of an isolated task for the woman. Abortion pills were seen as transforming abortion from a procedure that was done alone and in hospital, to one that was done early in pregnancy and in the privacy of the home with one’s family. However, researchers also insisted that pills would not make the procedure less serious or daunting. While some aspects of abortion were being rewritten through this technological development, other aspects, such as maintaining that there was a psychological and emotional strain of having an abortion, stayed the same.
Swedish researchers tested abortion pills ahead of major legal changes and they were a part of a larger liberalization process. By the mid-1970s, abortion was legally available to anyone before the eighteenth week of pregnancy, a result of various political, social, scientific, and cultural movements.
In the decades that followed this major legal change, trial participants began to speak about their experiences of the technology in the press, expanding how abortion pills were perceived. Some participants spoke of the discomfort and pain of using abortion pills, while others were happy with their experiences. Some of those dissatisfied with abortion pills argued that they took longer and were unnecessarily painful compared to a common abortion method of the time—vacuum aspiration. Other trial participants described abortion pills as a much better alternative, emphasizing how at ease they felt in their own homes. Importantly, many of the participants maintained that abortion pills should be a choice and not the only available method.
The Swedish case illustrates different ways home abortions changed discussions around the procedure—abortion went from a heavily regulated last resort to a practice that should be simple, done early in pregnancy, accessible to anyone, exportable to other countries, a responsible choice for married couples, and done in the home. Since their introduction to international markets in the late 1980s, abortion pills have been used both legally and illegally, further complicating our understandings of the technology.
In her work on abortion pills in the Republic of Ireland, Sally Sheldon has shown that moving abortion from hospitals to the privacy of people’s homes can also build on a corrosive attitude to the procedure. While abortion pills promise “empowerment and privacy” Sheldon argued that matters are more complex, highlighting examples where privacy became secrecy, and secrecy became shame (Sheldon 2018). Pushing abortion use into people’s homes may prevent women from feeling able to talk about the procedure and keep them isolated from those in similar situations. As with other types of reproductive technologies, abortion pills can improve reproductive justice or impede it. They can reduce waiting times for abortion, while making other types of abortion options more difficult to access. In Norway, for instance, the number of doctors able to perform surgical abortions has decreased (Oppegaard et al. 2018). Abortion pills are not suitable for late term abortions, and while use of the technology may make early abortions easier to perform, it does not suit every person or every pregnancy. At the same time, abortion pills have also made new types of activism possible, with organizations able to send pills in the mail (Jelinksa and Yanow 2018). While new abortion technologies can change how abortion is treated, they are, in the words of Chikako Takeshita a “versatile technology,” “adaptable to both feminist and nonfeminist reproductive politics” (Takeshita 2011, 3).
Approving abortion pills for use in different national contexts remains controversial, with fears on both ends of the political spectrum over how their use can change abortion access. As abortion pills become routinely used in various contexts, it is important to remember that the method can impact our understandings of abortion. The pandemic has accentuated the contentiousness of the procedure, showing that many people remain vulnerable to top-down regulations. While pills can turn abortion into a private procedure done in the home, we should continue to talk about abortion, normalize the experience, and insist that it be a standard part of medical practices.
Morag Ramsey is a visiting researcher at the Department of History of Science and Ideas at Uppsala University. She defended her PhD dissertation on the history of Swedish abortion pills in the spring of 2021. She can be reached at morag.ramsey@idehist.uu.se.
References
Hurts, Sarah and Daniel Boffey. “Pills in the Post: How Covid Reopened the Abortion Wars,” The Guardian, April 21st, 2021.
Jelinksa, Klinga and Susan Yanow. “Putting Pills into Women’s Hands: Realizing the Full Potential of Medical Abortion,” Contraception 97 (2018): 86-89.
Jennings, Alex. “Call to Make Covid Home Abortions Rule Change Permanent,” The BBC, March 31st, 2021.
Jülich, Solveig. “Picturing Abortion Opposition in Sweden: Lennart Nilsson’s A Child is Born,” Bulletin of the History of Medicine 89/3 (2015): 491-525.
Lennerhed, Lena. “Trouble Women: Abortion and Psychiatry in Sweden in the 1940s and 1950s,” in Stettner, Shannon, Katarina Ackerman, Kristin Burnett and Travis Hay, eds. Transcending Borders. Electronic resource: Palgrave Macmillan, 2017a.
Lennerhed, Lena. Kvinnotrubbel: Abort i Sverige 1938–1974. Möklinta: Gidlunds förlag, 2017b.
Lindholm Narvaez, Elena. “The Valkyrie in a Bikini: The Nordic Woman as Progressive Media Icon in Spain, 1891-1975,” in Hekma, Gert and Alain Giami, eds. Sexual Revolutions, Palgrave Macmillan, 2014.
Oppegaard, Kevin, Margaret Sparrow, Paul Hyland, and Francsisca Garcia, “What if Medical Abortion Becomes the Main or Only Method of First-Trimester Abortion? A Roundtable of Views,” Contraception 97 (2018): 82-85.
Ramsey, Morag. The Swedish Abortion Pill: Co-producing Medical Abortion and Values, ca. 1965-1992 (PhD Dissertation, Uppsala University, 2021).
Sheldon, Sally. “Empowerment and Privacy? Home Use of Abortion Pills in the Republic of Ireland,” Signs. Journal of Women in Culture and Society 43/4 (2018): 823-849.
Takeshita, Chikako. The Global Biopolitics of the IUD: How Science Constructs Contraceptive Users and Women’s Bodies. Cambridge, Mass: MIT Press, 2011.
