In Sweden, abortion is recognised as essential healthcare. Behind this reality stand decades of research, early innovation in abortion care, and recent reforms that have allowed midwives to become central providers of timely, safe, and accessible services.

Professor Kristina Gemzell Danielsson, Head of the Department of Women’s and Children’s Health at Karolinska Institutet and senior consultant in gynaecology at Karolinska University Hospital, has played a key role in the research that supported Sweden’s shift toward task sharing in abortion care. Her work has helped shape a system in which midwives now lead care for most early abortions.

When Practice Evolves Faster Than Policy

Sweden’s abortion law was originally designed to protect women from unsafe and clandestine abortions by ensuring services are provided within the health system. Legally, abortions must still be carried out in hospitals or approved clinics by a gynaecologist or a resident in gynaecology.

However, clinical practice has evolved. Research conducted in Sweden demonstrated that trained midwives can safely and effectively provide early medical abortion. As a result, midwives now manage care for healthy women up to around ten weeks of gestation. Although the law has not yet been formally updated to reflect this shift, the model functions successfully in practice. Physicians remain part of the team, while midwives serve as the main providers for uncomplicated cases.

Midwives at the Centre of Care

Today, most abortions in Sweden are medical abortions and take place early in pregnancy. In these cases, midwives play the leading role. Evidence has shown that early medical abortion provided by trained midwives is as safe and effective as when provided by doctors, with high levels of satisfaction among women.

Midwives provide counselling, assess eligibility, perform ultrasound examinations, dispense and administer abortion medication, monitor the process either at home or in the clinic, manage pain relief, offer emotional support, and coordinate follow up and contraception. Doctors intervene when complications arise or when surgical procedures are necessary. This division of roles reflects the broader Swedish model of women’s healthcare, where midwives lead routine care and physicians support more complex cases.

What Abortion Care Looks Like for Women

Abortion care in Sweden is structured to be accessible, evidence based, and centred on women’s choices. For most women, the process begins with a phone consultation with a midwife. During this call, medical history is reviewed, information about options is provided, and contraception counselling is offered. An appointment is then scheduled at a clinic.

At the clinic visit, midwives provide counselling, perform ultrasound dating, plan contraception, and initiate abortion care in line with national regulations. Many women, especially early in pregnancy, choose to complete the abortion at home. They receive clear instructions, pain relief, and access to a 24 hour telephone service. Follow up is conducted by a midwife. Women who prefer or require surgical abortion are referred within the same health system.

After twelve weeks of gestation, abortion care takes place in hospital settings. Midwives remain closely involved, providing continuous clinical and emotional support, while doctors manage complications or perform additional interventions when needed.

Quality, Continuity, and Experience

Because early medical abortion often involves one main clinic visit followed by home based care, continuity differs from antenatal care. Even so, studies show high levels of satisfaction. Women value easy access, respectful communication, and the ability to choose how and where the abortion takes place.

Importantly, research confirms that care provided by midwives is as safe and acceptable as care provided by doctors.

Why This Model Matters

Beyond clinical outcomes, the inclusion of midwives has helped normalise abortion as part of routine healthcare. In Sweden, midwives take pride in providing abortion care. This contributes to reducing stigma and reinforces the understanding that abortion is an integral component of comprehensive sexual and reproductive health services.

From a health system perspective, midwife led care improves efficiency and access. Sweden has more midwives than gynaecologists, and enabling them to work to their full scope of practice allows women to receive care earlier without compromising quality. Doctors are able to focus on more complex cases.

Lessons for Other Countries

Sweden’s experience demonstrates that task sharing in abortion care can be safe, effective, and beneficial for both women and health systems. The model builds on the established role of midwives in leading care for healthy women, supported by doctors when complications arise.

Strong training, clear clinical protocols, teamwork, and trust in midwives’ competencies are essential elements. Evidence based policymaking and continuous evaluation have supported this transition.

At a time when access to abortion care faces increasing challenges in many parts of the world, Sweden offers a model grounded in evidence, collaboration, and respect for women’s choices.

Source: International Confederation of Midwives
https://internationalmidwives.org/what-happens-when-midwives-lead-abortion-care-lessons-from-sweden/