The road to equity: A scoping review of the evidence and practices on abortion policies and services in Sweden

Objective

The aims of this study are to i) map and synthesize scientific evidence on abortion policies and service provision and delivery developments in Sweden and ii) identify potential facilitators and barriers to equitable abortion services nationally.

Methods

A scoping review of peer-reviewed papers (n = 51) and grey literature (n = 23) published 1975–2024 was conducted. The PRISMA-ScR protocol for scoping reviews was followed. Seventy-four (n = 74) documents were included, and a qualitative synthesis was used to summarize, analyze, and assess the body of evidence identified.

Results

Divergence in clinical guidelines was found and indicates inconsistencies in service delivery. Although there is strong evidence supporting midwife’s role in delivering medication abortion, it has not been fully implemented and differs between and within regions. The Swedish abortion legislation prevents the implementation of midwives being key providers of medication abortion and self-managed home abortions in whole, thereby hampering access. The gap analysis show that although abortion services have been well researched, the experiences of migrants are scarcely addressed, and those of LGBTQI + people and persons with disabilities are absent.

Conclusion

Significant progress has been made in advancing access to equitable abortion services through legislative developments, medical innovations and the expansion of midwifery-led medication abortion services. However, some barriers remain including variability in service delivery and there is a research gap from an intersectional perspective. To better inform policy and practice, future research could apply a reproductive justice lens to explore how ethnicity, gender, disability and sexuality intersect and shape access to and experience of abortion services.