Why are Finns so much less likely to have abortions than Swedes? 65DN looks at an operation that remains taboo in Finland and meets a former Oulu resident who’s been through it.

36 year-old former Oulu University student Susanna Urpi was happy to talk about her experiences but wanted to be given ‘a nice’ pseudonym. ‘It’s still a very taboo and sensitive issue,’ added ‘Susanna.’ Now a PhD researcher, the single mother of a nine year-old girl has had two abortions, the first when she was 25.

Over 10,000 women like Susanna have abortions in Finland each year and there have been recent cases of women having to wait up to three weeks to have an unwanted pregnancy terminated on the municipal health service.

But, for Susanna, studying at Helsinki University back in 2001, the process went relatively smoothly. ‘I wasn’t on the pill, I just wasn’t paying attention to anything. I had a boyfriend who was seven years younger than me, he was a junkie . . . it was a wild time in my life . . . I kind of thought, I wouldn’t get pregnant! I was kind of in denial.’

Susanna, of course, got pregnant. Crying on the phone to her mother, she ruminated on how it would interfere with her studies and mean she’d have to keep in touch, for a very long time, with a heroin-abusing father.

‘It was such a big shock! I thought to myself, “What should I do? Is it right to have an abortion?” I thought, “What does God want me to do?” even though I’m just an ordinary Lutheran who only goes to church at Christmas!’

Though Finnish women may believe they have abortion on demand, ‘the law in, in theory, is a little more complicated,’ explains Dr Dan Apter, of the Vaestoliitto health clinic. ‘Some kind of reason must be provided to the doctor. In practice, it works that the woman goes to the doctor and says she wants an abortion and she is given a referral to the hospital.’

As long as the doctor at the hospital agrees, the abortion is then carried out. The legal requirement that two doctors agree to the procedure is thus ‘no more complicated than with any other operation.’

As a student, Susanna got an appointment through the Helsinki University health service. She had to discuss her situation with a nurse and a doctor and justify why she should have a termination. Then she had a week, required by law, to mull over her decision.

Illegal until 1950, for the following twenty years abortion was only permitted in Finland in cases of rape, to preserve the health of the mother or if the child was severely disabled. From 1970, when the law was liberalised, abortion could be carried-out for ‘social reasons,’ or if the woman was under 17 or over 40, or if the mother already had four children. The termination deadline is only twelve weeks unless the woman is under 17 (20 weeks) or a serious defect is found in the foetus (24 weeks).

‘In Germany, there is a law that a woman wanting an abortion must be seen by a doctor within a week. In Finland, we don’t have any law but in practice it’s a few days,’ explains Dr Apter. ‘When a woman goes to the health clinic saying she wants an abortion, it will be treated as an emergency appointment.’

Eventually, Susanna went for her hospital appointment. According to Prof. Mika Gissler, of the Finnish National Health Institute, early pregnancies have, since 2000, been terminated solely by inducing miscarriage but later ones still require an operation. The night before the operation occurred, Susanna took a pill to help dilate her vagina.

‘Once you take the pill, that’s it!’ states Susanna. ‘There’s no going back or if you do the baby may be harmed.’ She recalled that she could not put out of her head the thought that, ‘I’m killing my baby.’ Susanna was placed under general anaesthetic and the foetus was removed. When she came round, Susanna continued to be haunted by the feeling that she’d ‘done an awful, terrible, terrible thing.’ One summer morning, she burst out crying to her family that, ‘My baby will never see this sunrise!’

Of the 10783 abortions in Finland in 2007, the vast majority, 9324, were for social reasons. Nine of them were because of rape or incestuous rape.

According to Dr Apter, the 1970 law defines ‘social reasons’ as the pregnancy being a ‘significant burden to the mother.’ Dr Apter explains that, as any pregnancy might be interpreted as a significant burden to the mother, this is effectively abortion on demand. But it does give anti-abortion doctors a certain degree of space. In theory, a doctor can insist that the pregnancy would not be a ‘significant burden’ and refuse to perform the termination.

Doctors who oppose abortion, often for religious reasons, can refuse to have anything to do with the process, though they must refer the patient to a doctor who will. For Dr Apter, the early stage foetus is not a ‘person’ and so aborting it, in order to help the mother, is not, for him, a problem. ‘It’s helping the woman to have a child when she is ready,’ he adds.

There is no clear profile for those who have abortions. In many cases, they are less educated women who, according to Dr Apter, have a poorer understanding of how to use contraception. But there are also university students, just like Susanna was, who wish to delay motherhood until they have a career. Prof. Gissler has found that, though abortion is generally associated with low education, a large minority of the women who seek the operation are students or young career women.

A year or so after her abortion, while taking the pill ‘not so regularly,’ Susanna got pregnant again. This was actually pleasing, in a way, because ‘one of my fears after having an abortion was that I wouldn’t be able to get pregnant again.’ Susanna was adamant that she would keep this baby, especially as she was in ‘a stable relationship’ at the time. Her daughter is now nine. She moved to Oulu to be with the father.

But four years later ‘the relationship went to Hell. I had an affair with an ex-boyfriend and became pregnant again.’ She took the morning-after pill ‘well within the time it says’ but, for some reason, it didn’t work.

‘This time, I knew how much a baby gives but also how much it takes,’ she tells me. ‘I felt I had done the right thing (by taking the morning-after pill) . . . I was being responsible.’ So she felt less guilty about having this pregnancy, who would have aborted anyway if the morning-after pill had worked, terminated.

Prof. Gissler explains that 36 percent of women who have abortions in Finland have already had one before. ‘It’s difficult to say why they have more than one,’ he tells me. ‘Sometimes they are alcoholics with very poor education . . . or it’s something to do with their lifestyle.’

However, Susanna’s decision to have an abortion at all seems to be relatively rare in Finland.  Abortion statistics in Finland are by far the lowest in Scandinavia. Dr Apter suggests that there are a variety of factors behind this trend, true in every age group: ‘Education on how to use contraceptives is better,’ and, he suggests, Finland is more culturally conservative than the rest of Scandinavia and abortion is a bigger taboo. ‘Often Finnish women will feel very ashamed to asked for an abortion,’ he states.

According to Statistics Finland, in 2009 (the most recent year for which statistics are collated) there were 37,500 abortions in Sweden, 16200 in Denmark, 15800 in Norway and only 10400 in Finland – that is 8.9 per 1000 people compared to 17.8 in Sweden, 14.1 in Norway, 12.1 in Denmark.

Prof. Gissler, however, disagrees with Dr Apter. He argues that contraceptive education in Finland and Sweden is the same and Finland has actually had de facto abortion on demand for longer. ‘The difference is that in Finland, unlike in the other countries, there is a compulsory waiting time of a week to think about it, before the abortion is organised.’ But he agreed that, in Finland, abortion is more of a taboo than in Sweden, ‘where it is universally considered a woman’s right. Here we debate over women who have more than one abortion and whether this is right.’

Susanna asked the university health service for her second abortion but was told she had to wait until week 8. ‘I thought it was like torturing me! I wanted it straight away!’

This time, the abortion was conducted entirely be inducing a miscarriage. As she lived in the countryside, she wasn’t allowed to do it at home because she was too far from medical help.

‘You take this pill. Then you start to bleed. You feel like shit. But this time it wasn’t as much of a shock and it wasn’t a big ethical question.’

Susanna is happy to be interviewed almost as a kind of therapy, ‘I don’t often get to talk about it,’ she tells me. ‘But this is me. And sometimes I think, “I could have three kids now. Oh my God! I have killed two babies! Is it for me to decide?!” I guess I’ve decided that it is for me to decide.’