What Happens When Midwives Lead Abortion Care: Lessons from Sweden
Sweden has long viewed abortion as essential healthcare, a position built on decades of research and innovation. A key development has been the increasing role of midwives in providing timely, safe, and accessible abortion care.
When practise Moves Faster Than Policy
Sweden’s abortion law aims to protect women by ensuring care is delivered within the established healthcare system, through hospitals and approved clinics. While the law currently requires abortion procedures to be performed by a gynecologist or resident in gynecology, clinical practise has evolved. Research conducted in Sweden has demonstrated the safety and efficacy of midwives providing early medical abortion, leading to a shift in practise where midwives now handle healthy women up to around 10 weeks of gestation.
Although the law hasn’t been updated to reflect this change, the model is functioning effectively. Physicians remain part of the care team, but midwives are the primary providers for uncomplicated cases, demonstrating a clear instance of practise informing policy, supported by robust evidence.
Midwives at the Centre of Abortion Care
Today, the majority of abortions in Sweden are medical and occur early in pregnancy, with midwives taking on a leading role in these cases. Research has confirmed that trained midwives can provide early medical abortion as safely and effectively as doctors, with high levels of patient satisfaction. This evidence has fostered confidence among policymakers, healthcare professionals, and the public.
Midwives now provide the majority of care for healthy women seeking early medical abortion, encompassing counseling, eligibility assessments, ultrasounds, administering medication, monitoring the process—whether at home via phone or in-clinic—managing pain relief, providing emotional support, and coordinating follow-up care and contraception. Doctors are involved when complications arise or surgical intervention is necessary, mirroring the broader Swedish model of teamwork in women’s health.
What Abortion Care Looks Like for Women
Abortion care in Sweden is designed to be straightforward, evidence-based, and centered on women’s choices, shaped by decades of research. For most women, care begins with a phone call to a midwife who gathers medical history, provides information, and offers contraceptive counseling, then helps schedule an appointment. During the clinic visit, midwives provide counseling, ultrasound dating, contraceptive planning, and initiate abortion care according to national regulations.
Many women prefer to complete the abortion at home, supported by clear guidance, pain relief, and a 24/7 telephone service with midwife-led follow-up. Surgical abortion is offered as an option within the same healthcare system. Care after 12 weeks takes place in a hospital setting, with midwives closely involved, often utilizing medical management similar to pregnancy loss or birth care, depending on gestational age and clinical needs. Doctors are involved when complications arise or further intervention is needed.
Continuity, Quality, and Women’s Experiences
While abortion care often involves a single clinic visit plus home-based care, continuity differs from antenatal or postnatal care. Women may not always see the same midwife throughout, and many require only one visit. Despite this, studies indicate high levels of satisfaction with the care received, with women valuing easy access, clear information, and choices regarding the process.
Strong evidence supports the safety and acceptability of care provided by midwives, with satisfaction levels comparable to those receiving care from doctors.
Why Midwives Make a Difference
Clinical outcomes are comparable whether abortion care is provided by a midwife or a doctor. However, Kristina Gemzell-Danielsson highlighted an important difference: stigma. Including midwives as abortion providers has helped normalize abortion as part of routine healthcare. This acceptance creates a respectful environment for women and reinforces that abortion is a component of comprehensive sexual and reproductive health care.
From a health system perspective, midwife-led care improves efficiency. With more midwives than gynecologists available in Sweden, enabling midwives to practise to their full scope increases access. Doctors can focus on complex cases, and women can access care earlier without lengthy waits for specialist appointments, without compromising quality.
What Other Countries Can Learn
Sweden’s experience offers valuable lessons for other countries. The success of the model stems from building on the existing role of midwives in providing care for healthy women during pregnancy and childbirth, with doctors providing support when complications arise. Key elements include strong training, clear protocols, teamwork, and a healthcare system that trusts midwives to practise to their full potential. Evidence-based practices and ongoing evaluation are also critical.
Sweden demonstrates that progress is possible even when laws lag behind practise, provided care remains safe, regulated, and integrated into the healthcare system.
Frequently Asked Questions
What role do gynecologists play in abortion care in Sweden today?
While midwives now provide most care for uncomplicated cases, physicians remain part of the team and step in when complications arise or surgical intervention is needed.
How does Sweden ensure the safety of medical abortions performed by midwives?
Safety is ensured through strong training, clear protocols, and research demonstrating that trained midwives can provide early medical abortion as safely and effectively as doctors.
Is abortion care in Sweden accessible to all women?
Abortion care in Sweden is designed to be accessible, with care beginning with a phone call to a midwife and options for both medical and surgical abortion.
As healthcare systems worldwide grapple with access and quality of care, what aspects of the Swedish model – prioritizing evidence, empowering midwives, and centering patient choice – could be most readily adapted to improve reproductive healthcare in other nations?