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Abortion has been available in Sweden, since 1975, on request and without regards to reason, for up to 18 weeks’ gestation and in specific circumstances through 21 +6 weeks’ gestation. Abortion care is viewed as core component of obstetric and gynecological and midwifery care. Medical students in Sweden all receive theoretical training and are offered clinical rotation to abortion care. Similarly, all students in midwifery receive theoretical training in abortion and some clinical training. Core competencies for the registered nurse-midwives include the ability to care for women in abortion care including post abortion contraceptive counselling and provision. For residents in obstetrics and gynecology, training in abortion care is mandatory. Not permitting conscientious objection for any professional cadre guarantees prompt access to services for women seeking abortion care in Sweden, consistent with the principle that abortion is a right and a core service to which access should not be delayed.
This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.