The Association Between Education and Induced Abortion for Three Cohorts of Adults in Finland Heini Väisänen

The association between education and induced abortion for three cohorts of adults in Finland Heini Väisänen To cite this version: Heini Väisänen. The association between education and induced abortion for three cohorts of adults in Finland. Population Studies, Taylor & Francis (Routledge), 2015, 69 (3), pp.373-388. 10.1080/00324728.2015.1083608. hal-03085068 HAL Id: hal-03085068 https://hal.archives-ouvertes.fr/hal-03085068 Submitted on 21 Dec 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Population Studies A Journal of Demography ISSN: 0032-4728 (Print) 1477-4747 (Online) Journal homepage: http://www.tandfonline.com/loi/rpst20 The association between education and induced abortion for three cohorts of adults in Finland Heini Väisänen To cite this article: Heini Väisänen (2015) The association between education and induced abortion for three cohorts of adults in Finland, Population Studies, 69:3, 373-388, DOI: 10.1080/00324728.2015.1083608 To link to this article: http://dx.doi.org/10.1080/00324728.2015.1083608 © 2015 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Published online: 08 Oct 2015. Submit your article to this journal Article views: 305 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=rpst20 Download by: [LSE Library Services] Date: 27 July 2016, At: 07:56 Population Studies, 2015 Vol. 69, No. 3, 373–388, http://dx.doi.org/10.1080/00324728.2015.1083608 The association between education and induced abortion for three cohorts of adults in Finland Heini Väisänen London School of Economics and Political Science This paper explores whether the likelihood of abortion by education changed over time in Finland, where comprehensive family planning services and sexuality education have been available since the early 1970s. This subject has not previously been studied longitudinally with comprehensive and reliable data. A unique longitudinal set of register data of more than 250,000 women aged 20–49 born in 1955–59, 1965–69, and 1975–79 was analysed, using descriptive statistics, concentration curves, and discrete-time event-history models. Women with basic education had a higher likelihood of abortion than others and the association grew stronger for later cohorts. Selection into education may explain this phenomenon: although it was fairly common to have only basic education in the 1955–59 cohort, it became increasingly unusual over time. Thus, even though family planning services were easily available, socio-economic differences in the likelihood of abortion remained. Keywords: induced abortion; register data; Finland; reproductive health; event-history analysis [Submitted July 2014; Final version accepted February 2015] Introduction administrative registers that made it possible to investigate both the association between education In many countries women in less advantaged socio- and the likelihood of abortion and—something economic positions have more abortions than other that to the best of my knowledge other studies in women (Jones et al. 2002; Rasch et al. 2007;Hansen Finland or elsewhere have been unable to investi- et al. 2009; Regushevskaya et al. 2009). High preva- gate—whether the association changed over time. lence of contraceptive use has been shown to reduce The nature of the data set meant that the study the number of abortions in a population (Bongaarts did not suffer from attrition and non-response Downloaded by [LSE Library Services] at 07:56 27 July 2016 and Westoff 2000) and healthcare costs (Frost et al. common in panel studies or the common problem 2008, 2014; Cleland et al. 2011), but studies have not of underreporting of abortions in surveys (Jones examined whether universal access to family plan- and Kost 2007). ning services reduces socio-economic differences Previous studies on the topic in Finland differed in the likelihood of abortion. from the one reported here in one or more of the The aim of the study reported in this paper was to following respects: they were based on cross-sec- investigate differences by education in the likeli- tional surveys (Regushevskaya et al. 2009); they hood of abortion in Finland, a country where com- studied women who had had at least one abortion, prehensive family planning services and sexuality thus ignoring those who had never experienced education have been available since the early one (Heikinheimo et al. 2008, 2009; Niinimäki 1970s (Kosunen 2000;Kontula2010), and where et al. 2009; Väisänen and Jokela 2010); they did parents are offered generous financial and other not investigate the women’s level of education help to enable them to ensure that at least the essen- (Vikat et al. 2002; Hemminki et al. 2008;Sydsjö tial needs of their children are met (Vikat 2004; et al. 2009). Because most other countries in Haataja 2006). The study used a unique and nation- which studies have been undertaken do not have ally representative longitudinal data set based on register data on abortions (Gissler 2010), their © 2015 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 374 Heini Väisänen studies have been based on surveys, which often The Finnish context suffer from underreporting of abortions (Jones and Kost 2007). Before 1970, legislation in Finland allowed abortion in the following circumstances only: the woman’s Socio-economic status and pathways to life or health was at risk, or one of the parents was abortion believed to have a severe physical or mental illness, or the foetus had a medical problem, or pregnancy Previous studies in the US and Europe (including was due to rape or incest, or the woman was Finland) have shown that the likelihood of having an younger than 16 (Keski-Petäjä 2012). A change of abortion is positively associated with the following legislation in June 1970 established more liberal pro- characteristics: low socio-economic status (SES) visions. In particular, the change allowed abortion for (Rasch et al. 2007; Väisänen and Jokela 2010; Klemetti ‘social reasons’, defined as being under considerable et al. 2012); low education and income (Jones et al. strain owing to any of the following: living conditions 2002; Regushevskaya et al. 2009); young age (Jones or other circumstances; being younger than 17 or et al. 2002; Knudsen et al. 2003; Rasch et al. 2007;Niini- older than 40; and already having at least four chil- mäki et al. 2009; Klemetti et al. 2012); being single, dren (Knudsen et al. 2003). At first, abortions for having relationship problems, or previous births most social reasons were allowed until the end of (Jones et al. 2002; Rasch et al. 2007;Hansenetal. 16 weeks’ gestation, but in 1978 that was changed 2009; Regushevskaya et al. 2009; Klemetti et al. 2012); to 12 weeks. If the woman is younger than 17, or and previous abortions (Hansen et al. 2009; Niinimäki there is another special social reason for abortion, et al. 2009). an abortion can be allowed until the end of 20 A higher likelihood of experiencing an unintended weeks’ gestation. It is allowed until the end of 24 pregnancy is associated with a higher likelihood of an weeks’ gestation if the foetus has a medical abortion. Unintended pregnancies may be unwanted problem, and there is no limit on the period of ges- (not wanted at all) or mistimed (preferred later) tation if the woman’s life or health is at risk. If the (Trussell et al. 1999; Santelli et al. 2009). Pregnancies abortion is sought because of ‘considerable strain may be unintended for one or more of the following caused by living conditions or other circumstances’, reasons: because a woman does not want to have any the approval of two doctors is required. If it is (more) children, because she wants to postpone sought on the grounds of a woman’s age or number childbearing, because she does not want to have chil- of children, the approval of one doctor is enough dren with her current partner, or because she per- (Knudsen et al. 2003). In practice, approval is ceives her socio-economic situation as unfavourable granted if a woman applies for an abortion before for childbearing. the end of 12 weeks’ gestation (Gissler 2010). Low education and income have been associ- Attitudes towards abortion are liberal in Finland: ated with a higher likelihood of unintended preg- 65 per cent of Finns believe that abortions should nancies in the US (Finer and Zolna 2011), the be available on request (Kontula 2008). In the early Downloaded by [LSE Library Services] at 07:56 27 July 2016 UK (Wellings et al. 2013), and Spain (Font- 1990s, only 5 per cent of Finnish women were Ribera et al. 2007). That association was not against abortion in all situations (Notkola 1993). found in a study in the Netherlands. Although Abortions are currently provided at low cost in the highly educated women there were overall found public healthcare sector—for example, one of the less likely to become pregnant, there was no hospital districts charges between €30 and €100 association between education and the proportion depending on the duration of the pregnancy and of unintended pregnancies among all pregnancies whether it is a medical or surgical termination (Levels et al.

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