Cerisa Obern

Despite the wide variety of contraceptive methods available and high access to counselling, unmet contraceptive needs remain in Sweden. Around 22% of women have experienced at least one unintended ...

Globally, women are postponing childbearing and total fertility rates are decreasing. In Sweden, a 2018 law requires consent before sexual activity and LARC is now recommended as a first-hand choice. This study compares sexual behaviour (including consent), contraceptive use and family planning intentions with past surveys. This is a cross-sectional survey that has been repeated every fifth-tenth year since 1989 in Sweden. It explores sexual behaviour, contraceptive use and family planning intentions among women attending a gynaecology clinic for contraceptive counselling and compares these results with previous surveys. Of the 596 women surveyed, 558 were sexually experienced, the majority (98%) of which perceived consent during their most recent sexual activity. Over 30 years, there was a significant trend towards having more sexual partners (p = 0.02). The use of SARC (p = p = 0.04) has increased since 2014, while condom use and emergency contraceptive use have decreased (p = n = 449) wanted children, significantly fewer than 2014. Sexual behaviour and contraceptive use have changed over the last ten years in Sweden. More women use effective forms of contraception and informed consent laws may have positive implications. Yet fewer women have decided to have children in the future.

Background: The spread of sexually transmitted infections (STIs) is an ongoing public health challenge, and awareness of risk factors is essential for designing effective preventive interventions. This study aimed to assess self-reported STI occurrences and identify risk factors and sexual behaviors associated with STIs among female university students. Methods: This is a cross-sectional, online questionnaire study, including 384 female university students seeking contraceptive counseling at a gynecology clinic in Uppsala, Sweden, and reporting having had sex. Associated risk factors and behaviors were assessed by comparing those who reported STIs and those who did not. Results: The mean age of participants was 22.8 years. Seventy-eight (20%) had contracted at least one STI, with seven (9%) experiencing multiple infections. Seventy-three (94%) reported first-date sexual activity without a condom among STI experienced. Chlamydia trachomatis was the most common STI pathogen (68% of all infections), followed by Herpes simplex virus (18%) and Mycoplasma genitalium (13%). Behavioral factors associated with self-reported STIs were first-date sexual activity without a condom, not using condom at first intercourse, younger age at first intercourse, a higher number of sexual partners overall and in the last 12 months, experience of anal sex, dating app usage, and regretting sexual activity after substance use (P < 0.003 for all). Conclusions: Condom use was low among the respondents, and STIs were common regardless of the high level of education in this group. Contraceptive counseling needs to highlight the importance of condom use in addition to contraceptive efficacy. It is also essential to consider the specific risk factors and behaviors prevalent among young adults to reduce the spread of STIs.

Since 2020, World Health Organization guidelines state that universal access to abortion care is critical for individual and community health, and for the realization of human rights. Yet the right to access safe abortion care is severely restricted in many countries. This article outlines institutional and educational systems in the USA, Sweden, and Ghana, which all require obstetrics and gynecology (ob‐gyn) training to include abortion care but vary in implementation. It argues that regardless of the political environment, the specialty should protect abortion training worldwide. In Sweden and Ghana, ob‐gyn residents are required to participate in abortion training, while in the USA they are permitted to opt out. In Sweden, practicing ob‐gyn specialists are required to provide abortion care, whereas in Ghana and the USA, this care is optional, leading to geographic disparities in abortion care access in these two countries. In the USA, the Supreme Court's Dobbs ruling jeopardizes programs' abilities to meet the training mandate, a requirement that was insufficiently implemented even before the ruling. It is critical that all clinicians are well‐equipped to provide accurate information to their patients and provide pre‐ and post‐abortion care. For this reason, we recommend that abortion is included in all undergraduate medical education programs in accordance with the recommendations of FIGO (the International Federation of Gynecology & Obstetrics). To meet WHO guidelines that require ob‐gyn specialists to provide abortion care in an emergency, we urge FIGO to create a guideline about expectations for abortion training integration in obstetrics and gynecology.

Objective: To investigate whether an early need of hormonal contraceptive (HC), or a failure to find a suitable method, are warning signs for endometriosis.Design: A retrospective cohort study.Setting: Sweden.Population: The cohort consisted of 720 805 women aged 12–27 years during the period 2005–2017. All women, regardless of whether they received a diagnosis of endometriosis or not (reference group), were included.Methods: We used data from Swedish national registers. Risks are expressed as crude and adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (95% CIs), adjusted for age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea or depression.Main outcome measures: A diagnosis of endometriosis between 12 and 27 years of age.Results: During this period, 3268 women were diagnosed with endometriosis (0.45%). Women who started HC at the ages of 12–14 years had a higher risk of receiving the diagnosis (aHR 2.53, 95% CI 2.21–2.90) than those who began at age 17 years or older. Having tried more types of HCs was associated with a twofold increased risk of endometriosis (more that three types of HC, aHR 2.31, 95% CI 1.71–3.12). Using HC for more than 1 year was associated with a decreased risk of endometriosis (>1 year, aHR 0.53, 95% CI 0.48–0.59). Women with endometriosis more commonly had dysmenorrhea, depression or infertility.Conclusions: The use of HCs at an early age and a failure to find a suitable HC were identified as warning signs of later receiving an endometriosis diagnosis. A longer duration of HC usage reduced the risk of receiving the diagnosis.

Seeking multiple abortions is common in Sweden, and is associated with parity, low education, tobacco use, and exposure to violence. Although Sweden provides high quality and accessible comprehensive abortion care, counselling must be adaptable and address specific needs in vulnerable groups.

To investigate women’s decision-making on induced abortion.A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion wa...