Copyright C Acta Obstet Gynecol Scand 2003

Acta Obstet Gynecol Scand 2003: 82: 3847

Printed in Denmark . All rights reserved

Acta Obstetricia et
Gynecologica Scandinavica
ISSN 0001-6349

ORIGINAL ARTICLE

Trends in teenage fertility, abortion, and

pregnancy rates in Iceland compared with
other Nordic countries, 197699
SOLEY S. BENDER1, REYNIR T. GEIRSSON2

AND

ELISE KOSUNEN3

From the Faculties of 1Nursing and 2Medicine, University of Iceland, Reykjavik, Iceland, and the 3University of Tampere
Medical School, Tampere, Finland

Acta Obstet Gynecol Scand 2003; 82: 3847. C Acta Obstet Gynecol Scand 2003
Background. Iceland is often considered very similar to the other Nordic countries. The
purpose of this study was to explore trends in teenage fertility, abortion, and pregnancy rates
in Iceland, compare these trends with corresponding rates in Denmark, Finland, Norway,
and Sweden during the period 197699, and to evaluate similarities and dissimilarities.
Methods. The study is based on data about fertility, abortion, and pregnancy rates obtained
from the Icelandic and Nordic national population and abortion registers for the age group
1519 years years.
Results. Teenage fertility and pregnancy rates in the five Nordic countries declined over the
study period by 5767% and 3150%, respectively, and in Iceland they remained significantly
higher than in the Nordic countries. In 1999 almost every other teenage pregnancy in Iceland
(45.9/1000) resulted in a childbirth (24.4/1000). Regional fertility rates were highest in the
countryside. While the abortion rate has been declining in the four Nordic countries by 20
41%, they have concurrently been rising in Iceland by 133% (9.4/1000 in 197680, 21.9/1000
in 199699) and are presently higher than in the other Nordic countries. Regionally, abortion
rates in Iceland were highest in the Capital area.
Conclusions. The teenage pregnancy rate is higher in Iceland than in the other Nordic
countries. This may be explained by cultural norms in Icelands society regarding
childbearing, early initiation of sexual intercourse, more limited sex education, and less
effective delivery and use of contraceptive methods. There is a need to promote sexual and
reproductive health to young people in Iceland by combining diverse preventive approaches.
Key words: abortion rate, fertility rate, pregnancy rate, teenagers, trends
Submitted 21 August, 2001
Accepted 10 January, 2002

Trends in teenage fertility, abortion, and pregnancy

rates in Iceland have often been assumed to be
similar to those in other Nordic countries on account of the similar historical and cultural background but not because of actual research. Differences based on local customs and belief do exist,
one of these being attitudes to teenage pregnancy.
The pregnancy rate of young women in Iceland is
similar to that seen in countries such as Canada,
Abbreviations:
AR: age-specific abortion rate; AbR: abortion ratio; FR: agespecific fertility rate; PR: age-specific pregnancy rate.
C Acta Obstet Gynecol Scand 82 (2003)

and the fertility rate is similar to that seen in Hungary and Latvia (1, 2). Iceland is situated between
the lowest pregnancy rate among teenagers in the
Western world, in the Netherlands, and the highest
rate, in the United States (24).
A study of 37 developed countries including
Denmark, Finland, Norway, and Sweden showed a
relation between low fertility rates and openness
about sexual matters, government policy for providing contraceptives to young unmarried women,
well-organized teaching about contraception in
schools, and a high percentage of the population
living in large cities (5). Henshaw and coworkers

Nordic teenage fertility and abortion rates

(6) have shown that the main reason for a drop in
abortion rates worldwide is increased use of contraceptive methods. Ketting and Visser (7) have
pointed out that a national emphasis on the importance of contraceptive methods, ongoing positive sex education in schools, and easily accessible,
low-cost and friendly contraceptive services are the
main reasons for low fertility and abortion rates in
the Netherlands.
A revised abortion law took effect in Iceland in
1975, at approximately the same time as in the
other four Nordic countries. According to Icelandic legislation, considerable emphasis should
have been placed on prevention, i.e. sex education
in schools and elsewhere and family planning
counselling in community health centres and hospitals. Few measures were, however, taken to comply with this legal provision. In contrast, the abortion law in Sweden stimulated the development of
contraceptive services for young people, and Swedish midwives were, for example, made responsible
for these services (8, 9). The more accessible availability of contraceptive methods in Sweden was
made possible through the immediate development
of teenage clinics, which now comprise over 200
nationwide (9). The link between fertility and use
of contraception was considered important, and its
preventive effect regarding abortion was recognized. Sweden also developed an effective link between sex education in schools and contraceptive
services for young people (5). Likewise, after the
renewed abortion law in Finland in 1970 each local
municipality in the country was required to provide preventive health services, including contraceptive counselling. The new legislation was to
guarantee equal access to family planning services.
A major goal of the Finnish family planning policy
was minimizing the number of unintended pregnancies and abortions by provision of contraceptive and abortion services nationwide (10). In
Denmark and Norway several preventative measures were also taken.
In this study, the trends in teenage fertility, abortion, and pregnancy rates in Iceland are explored
and these rates are compared with corresponding
data from Denmark, Finland, Norway, and
Sweden in order to show similarities and differences.
Materials and methods

Data about live births in Iceland for the period

197699 were obtained from the statistical reports
of Statistics Iceland, where national vital statistics
are centralized (12, 13). Age-specific fertility rates
(FR) for women aged 1519 years years were calculated by dividing the number of live births in a year

39

for this group by the annual mean population of

women aged 1519 years years 1000 (11). Live
births by maternal age were based on age at the
time of childbirth. Live births among teenagers
younger than 15 years were included in the data.
The number of live births by region and the number of women aged 1519 years years living in each
region of the country for the period 199097 were
also obtained from Statistics Iceland in order to
calculate annual age-specific fertility rates regionally. The regional FR calculations were based
on the 1st of July population. Icelandic data on
abortions for the whole country (197699) and the
eight regions (199097) were obtained from the Directorate of Health, which is in charge of the centralized national registration of abortions (12, 14,
15). Age-specific abortion rates (AR) of women
aged 1519 years were calculated by dividing the
number of abortions in a year for this age group
by the annual mean population of women aged 15
19 years 1000 (11). Abortions among teenage
girls younger than 15 years were included in the
data. The regional AR calculations were based on
the 1st of July population. Abortion calculations
before 1996 were based on age at the end of the
year, but after 1996 on age at the time of the abortion. Both methods are shown in Tables I and II.
The present method shows a 617% increase in the
abortion rate during 199699 compared with the
previous method. The abortion ratio (AbR) was
calculated by dividing the number of abortions in
a year by the number of live births in a year
100 (16). Pregnancy rates (PR) were calculated by
adding the teenage fertility rates to the legal abortion rates (17). The pregnancy rate used in this
study does not include the number of spontaneous
or missed abortions, as it is considered to be totally constant across the populations and apparently does not influence trends (10).
The Nordic statistics for the period 197699
were obtained from statistical reports of the Nordic countries (1828). The average rates for each 5year period (196780, 198185, 198690, and
199195) were used in this study except for the
period 199699, where calculations are based on 4
and not 5 years.
Results

Table I shows a fall in FR and PR, and the rising

AR for women aged 1519 years in Iceland between 1976 and 1999. Of the 721 teenagers who
became pregnant in 1976, 91% decided to carry
the pregnancy to term and 9% chose to have an
abortion. In 1999 this decision pattern had
changed to 53% having a child and 47% having an
abortion.
C Acta Obstet Gynecol Scand 82 (2003)

40

S. Soley et al.

Table I. Fertility, abortion and pregnancy numbers and rates per 1000 women aged 1519 year*, and the abortion ratio in Iceland, 197699

1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999

Mean no. of
women

No. of
births

FR

No. of
abortions

AR

No. of
pregnancies

PR

AbR

10966
10920
10950
11043
11048
11075
11094
10891
10595
10297
10030
10012
10250
10336
10352
10481
10388
10166
10181
10324
10414
10541
10682
10673

657
614
627
598
628
542
540
447
404
358
316
296
326
301
315
298
282
237
237
238
224
254
264
260

59.9
56.2
57.3
54.2
56.8
48.9
48.7
41.0
38.1
34.8
31.5
29.6
31.8
29.1
30.4
28.4
27.1
23.3
23.3
23.1
21.5
24.1
24.7
24.4

64
93
98
148
116
132
153
164
175
160
144
156
143
129
163
134
146
162
158
158
215
228
259
229

5.8
8.5
8.9
13.4
10.5
11.9
13.8
15.1
16.5
15.5
14.4
15.6
14.0
12.5
15.7
12.8
14.1
15.9
15.5
15.3
20.6
21.6
24.2
21.5

721
707
725
746
744
674
693
611
579
518
460
452
469
430
478
432
428
399
395
396
439
482
523
489

65.7
64.7
66.2
67.6
67.3
60.8
62.5
56.1
54.6
50.3
45.9
45.2
45.8
41.6
46.1
41.2
41.2
39.2
38.8
38.4
42.1
45.7
48.9
45.9

9.7
15.1
15.6
24.7
18.5
24.4
28.3
36.7
43.3
44.7
45.6
52.7
43.9
42.9
51.7
45.0
51.8
68.4
66.7
66.4
96.0
89.8
98.1
88.1

(186)
(213)
(232)
(192)

(17.8)
(20.2)
(21.7)
(17.9)

(39.3)
(44.3)
(46.4)
(42.3)

(83.0)
(83.8)
(87.8)
(73.8)

FR age-specific fertility rate; AR age-specific abortion rate; PR age-specific pregnancy rate; AbR abortion ratio.
*Those aged younger than 15 years are included in the data. Figures in brackets are based on the method of using the age of the women at the end of the year
(used until 1996).
All abortion figures for 1998 and 1999 are preliminary.

Fertility trends
During the study period, FR among Icelandic
teenagers dropped from 56.9/1000 in 197680 to
23.7/1000 in 199699; by 58%. The proportion of
live births by women aged 1519 years of total live
births was declining by 59% in 197699, from
15.3% to 6.3%. Less than 2% of these women were
aged 16 years or younger (Table II). The number of
live births by women aged 16 years or younger out
of total live births declined over the study period

from 1.7% to 0.4%. The majority (8795%) of

teenage (age 1519 years) live births during 1976
99 was among women aged 1719 years old (Table
II).
Fertility rates declined during 197699 in all the
Nordic countries by approximately 5767%, but
Iceland has continued to have the highest rate
(Fig. 1). Higher FR among young women in Iceland compared with the other Nordic countries are
demonstrated in the higher proportion of live
births among Icelandic teenagers aged 1519 years
out of total live births by all age groups (Fig. 2).
In 1999, 6.3% of total live births in Iceland were
to women aged younger than 20 years, compared
with 2.5% in Norway, 2.7% in Finland, 1.7% in
Denmark, and 1.4% in Sweden (Fig. 2, Table II).
Abortion trends

Fig. 1. Live births per 1000 women aged 1519 years in five
Nordic countries, 197699.
C Acta Obstet Gynecol Scand 82 (2003)

The AR of Icelandic teenagers rose by 133%, from

9.4/1000 in 197680 to 21.9/1000 in 199699. The
proportion of abortions by the age group 1519
years out of all abortions has fluctuated, but
reached a high of 28.7% in 1998; 8.3% by women
aged 16 years or younger (Table III). This 1998 rate
was higher than that found among young women
aged 2024 years, who usually have a higher pro-

Nordic teenage fertility and abortion rates

41

Table II. Number of live births among Icelandic women aged 19 years or younger during 197699, and the proportion of those aged 16 years or younger of
teenage live births and total live births
Age (years)

1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999

14*

15

16

17

18

19

Total

% of those
aged 16 years
or younger of all
tenage mothers

0
1
5
1
3
2
1
1
1
1
1
1
1
1
0
0
2
1
0
0
0
1
0
0

17
11
10
12
6
12
15
6
4
9
10
4
8
4
5
4
2
4
3
3
4
2
4
1

56
58
60
49
70
55
33
39
30
24
20
24
28
17
25
20
20
16
16
14
14
10
18
18

123
136
142
103
118
97
91
67
72
65
54
49
50
58
54
59
47
37
38
50
38
58
49
42

215
178
176
181
174
167
172
145
134
113
93
89
106
95
103
85
86
69
76
67
64
76
104
88

246
230
234
252
257
209
228
189
163
146
138
129
133
126
128
130
125
110
104
104
104
107
89
111

657
614
627
598
628
542
540
447
404
358
316
296
326
301
315
298
282
237
237
238
224
254
264
260

11.1
11.4
11.9
10.4
12.6
12.7
9.1
10.3
8.6
9.5
9.8
9.8
11.3
7.3
9.5
8.0
8.5
8.8
8.0
7.1
8.0
5.1
8.3
7.3

Total no
of births by
women in all
age groups

% of live
births by
1519-years-olds
of total live births

% of those
aged 16 years
or younger of
total live births

4291
3996
4162
4475
4528
4345
4337
4371
4113
3856
3881
4193
4673
4560
4768
4533
4609
4623
4442
4280
4329
4151
4178
4100

15.3
15.3
15.0
13.3
13.8
12.5
12.4
10.2
9.8
9.3
8.1
7.0
7.0
6.6
6.6
6.6
6.1
5.1
5.3
5.5
5.2
6.1
6.3
6.3

1.7
1.7
1.8
1.4
1.7
1.6
1.1
1.0
0.8
0.9
0.8
0.7
0.8
0.5
0.6
0.5
0.5
0.4
0.4
0.4
0.4
0.3
0.5
0.4

*Aged 14 years or younger.

portion of abortions as demonstrated in Fig. 3. Between 19 and 36% of all teenage abortions in 1985
99 were by women aged 16 years or younger (Table
III).
The trends in teenage ARs in Iceland compared
with the other Nordic countries during 197699
are shown in Fig. 4: in Iceland it rose (133%), but

the reverse occurred in Norway (20%), Sweden

(25%), Denmark (39%), and Finland (41%).
The rising proportion of abortions from 9.7/100
in 1976 to a peak in 1998 of 98.1/100 occurred at
the same time as the proportion of women deciding to have a child was equal to those having an
abortion (Table I).

Fig. 2. Live births by Nordic mothers aged under 20 years as percentages of all live births, 199099.
C Acta Obstet Gynecol Scand 82 (2003)

42

S. Soley et al.

Table III. Age-specific numbers of teenage abortions and the proportion of abortions for girls aged 16 years or younger and those aged 1519 years during 1976
99 in Iceland
Age (years)

1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999

14*

15

16

17

18

19

Total

% aged 16
years or
younger of all
teenage abortions

u
u
u
u
u
u
u
u
u
4
2
4
5
0
2
2
0
3
3
0
8
11
11
7

u
u
u
u
u
u
u
u
u
9
6
14
9
9
11
12
10
10
14
15
16
21
21
12

u
u
u
u
u
u
u
u
u
37
20
20
21
25
30
24
31
20
23
19
54
30
43
41

u
u
u
u
u
u
u
u
u
28
40
40
31
35
40
23
29
41
37
37
38
53
60
54

u
u
u
u
u
u
u
u
u
34
41
40
38
32
48
38
30
48
34
46
50
68
63
58

u
u
u
u
u
u
u
u
u
48
35
38
39
28
32
35
46
40
47
41
49
45
61
57

64
93
98
148
116
132
153
164
175
160
144
156
143
129
163
134
146
162
158
158
215
228
259
229

u
u
u
u
u
u
u
u
u
31.2
19.4
24.3
24.5
26.3
26.4
28.3
28.1
20.4
25.3
21.5
36.3
27.2
28.9
26.2

(3)
(5)
(5)
(3)

(13)
(14)
(17)
(5)

(28)
(27)
(32)
(31)

(50)
(41)
(53)
(53)

(45)
(64)
(56)
(56)

(47)
(62)
(69)
(44)

(186)
(213)
(232)
(192)

(23.6)
(21.6)
(23.3)
(20.3)

Total no.
of abortions by
women in all
age groups

% of abortions by
1519 year-olds
of total
abortions

% of
16-year-olds
or younger
of total
abortions

368
456
455
556
523
597
613
689
745
705
685
695
673
670
714
658
743
827
775
807
854
921
901
947

17.4
20.4
21.5
26.6
22.2
22.1
24.9
23.8
23.5
22.7
21.0
22.4
21.2
19.2
22.8
20.3
19.6
19.6
20.4
19.6
25.2
24.7
28.7
24.2

u
u
u
u
u
u
u
u
u
7.1
4.1
5.4
5.2
5.1
6.0
5.8
5.5
4.0
5.1
4.2
9.1
6.7
8.3
6.3

(21.8)
(23.1)
(25.7)
(20.3)

*Aged 14 years of age or younger. Figures in brackets are based on the method using the age of the women at the end of the year (used until 1996). All data of
abortions for 1998 and 1999 are preliminary. After 1989, registration is only based on women who are legal residents in Iceland. u unavailable.

Pregnancy trends
The teenage PR dropped by 31% in Iceland from
66.3/1000 in 197680 to a low of 45.6/1000 in
199699 (Fig. 5). In 1996 the rate started to rise
again and reached 48.9 in 1998 (Table I). The
greatest reduction of 21% occurred between the
two 5-year periods from 198185 and 198690.
The PRs among young women in the Nordic
countries declined by 3150% during 197699 (Fig.
5). In Iceland the PR remained higher than in the
other countries during the whole study period.
While the PR in Iceland declined by 31%, in the
other countries the decline was greater. In Finland
and Denmark the decline was by approximately
50%, in Norway 41%, and in Sweden 44%. The PR
in Iceland in 1999 (45.9/1000) was identical to
those in Finland, Denmark, and Sweden during
197680.

Icelandic regional differences

By the end of 1999 the distribution of the population (279 049) was 61.5% in the Capital area of
C Acta Obstet Gynecol Scand 82 (2003)

Reykjavik, 6% in the south-west, 5% in the west,

3% in the westfjords, 3.5% in the north-west, 9.5%
in the north-east, 4% in the east, and 7.5% in the
southern regions (12).
There was a general reduction in FRs and PRs
in all regions during the study period, except in
Reykjavik where pregnancies increased by an overall 4.5/1000 (Table IV). The reduction in the FR
( 18./1000) and the PR ( 22.3/1000) between
1990 and 1997 was greatest in the north-western
region. Teenage mean FRs and PRs were highest
in the south-west, 39.9/1000 and 54.0/1000, and the
Westfjords, 35.5/1000 and 50.8/1000, respectively
(Fig. 6). Fertility rates were, on average, lowest in
the north-east (20.1/1000) and in the Reykjavik
area (22.9/1000) (Fig. 6). The mean PR was lowest
in the north-eastern region (29.8/1000).
A general pattern of a rising AR in the whole
country was most evident in the Reykjavk area
(mean 18.8/1000). In some other regions there was
a rise in the AR between 1990 and 1997, but not
as great as in the Reykjavik area ( 9.0). The lowest mean AR, 8.5, occurred in the north-western
region. In the east there were fluctuations in the
AR, from 3.6 in 1993 to 21.4 in 1995.

Nordic teenage fertility and abortion rates

43

Fig. 3. Abortion rates among Icelandic women, 197699, by age group.

Fig. 4. Abortion rates per 1000 women aged 1519 years in five Nordic countries, 197699.

Discussion

Although teenage FRs and PRs generally declined

in Iceland during 197699, they remained significantly higher than in Denmark, Finland, Norway,
and Sweden. Also, a higher proportion of Icelandic
young women decided to have the child in comparison with the women in the Nordic countries.
However, the proportion of teenage pregnancies
ending in childbirth has been declining. One contributing factor to these higher PRs in Iceland is
early initiation of sexual intercourse. The age of
sexual debut has been reduced from a median age
of first intercourse of 17 years for men and 18 years
for women born in 194252 to 15 years for men

and 15.5 years for women born in 197379 (29).

This is younger than in Norway, Sweden, and
Denmark where the median age was approximately
18 years for men and 17 years for women in Norway and Sweden, and 16.9 and 16.8, respectively,
in Denmark (3032). In Finland, less than onethird of 9th-grade students (mean age 15.8 years)
had experienced sexual intercourse (33). These
studies of first sexual intercourse are, however, not
fully comparable because they are based on different methods, age groups, and the times in which
they were conducted. In spite of these limitations,
our data probably imply that Icelandic young
people are starting sexual relationships earlier and
seem to have greater problems controlling their
C Acta Obstet Gynecol Scand 82 (2003)

44

S. Soley et al.

Fig. 5. Pregnancy rates per 1000 women aged 1519 years in five Nordic countries, 197699.

Fig. 6. Regional mean abortion and pregnancy rates in Iceland, 199097. This map is printed with permission from the National
Land Survey of Iceland.

fertility than their age-matched counterparts in

other Nordic countries.
Childbearing has been highly valued within Icelandic culture and this is as likely to apply to
young people as to older age groups (34). This is
demonstrated by the higher total fertility rate in
Iceland compared with the other Nordic countries.
In Iceland the abortion ratio was low at the beginning of the study period but rose to almost 100 by
the end of the period (1998). In Finland the abortion ratio was more than 100 in most of the provinces during 198688 and in several of the provinces during 198183 (10). Thus, a much greater
number of young women in Finland compared
C Acta Obstet Gynecol Scand 82 (2003)

with Iceland chose abortion instead of having the

child. This suggests considerably different attitudes
to teenage childbearing in these two countries.
However, early parenthood is not greatly desired in
Iceland either, as the majority (8085%) of young
people do not want to have a child at a young age
(S. Bender, unpublished data). When a pregnancy
occurs at a young age incidentally, however, it is
more acceptable in Iceland to have the child. The
inconsistencies between attitudes and the high PRs
indicate some shortcomings in the preventive steps
taken on a personal level as well as at the health
authority level.
Only a few studies have been conducted in Ice-

45

Nordic teenage fertility and abortion rates

Table IV. Regional fertility, abortion, and pregnancy rates per 1000 females aged 1519 years in Iceland, 199099

Reykjavik
(Capital region)
South-west

West

Westfjords

North-west

North-east

East

South

Rates

1990

1991

1992

1993

1994

1995

1996

1997

Difference
199097

Mean
199097

FR
AR
PR
FR
AR
PR
FR
AR
PR
FR
AB
PR
FR
AR
PR
FR
AR
PR
FR
AR
PR
FR
AR
PR

25.7
16.2
41.9
50.4
13.0
63.4
32.2
16.9
48.1
49.6
16.9
66.5
46.2
8.8
55.0
29.4
14.7
44.1
31.2
18.3
49.5
29.0
16.1
45.1

27.6
14.4
42.0
39.0
11.4
50.4
31.3
12.5
43.8
38.5
9.6
48.1
34.1
6.8
40.9
22.6
7.5
30.1
21.4
8.9
30.3
28.6
16.9
45.5

27.1
16.0
43.1
40.3
9.7
50.0
29.6
13.1
42.7
37.6
23.4
61.0
15.9
13.7
29.6
21.1
10.1
31.2
23.4
7.2
30.6
27.6
11.0
38.6

20.8
20.1
40.9
39.5
17.4
56.9
32.6
15.4
48.0
29.2
13.5
42.7
19.7
4.4
24.1
16.5
10.4
26.9
21.9
3.6
25.5
30.3
10.5
40.8

21.7
19.6
41.3
34.5
15.7
50.2
26.6
13.3
39.9
35.0
13.4
48.4
19.9
4.4
24.3
17.4
6.9
24.3
22.6
7.5
30.1
27.6
13.2
40.8

21.7
18.6
40.3
33.5
13.8
47.3
23.6
9.4
33.0
24.0
13.1
37.1
38.7
11.4
50.1
14.2
7.9
22.1
21.4
21.4
42.8
27.5
7.2
34.7

17.4
20.8
38.2
39.4
17.5
56.9
26.1
18.4
44.5
24.3
13.8
38.1
38.6
13.6
52.2
17.1
9.0
26.1
27.8
11.9
39.7
23.3
16.0
39.3

21.2
25.2
46.4
42.6
14.7
57.3
30.5
7.6
38.1
45.8
18.5
64.3
28.0
4.7
32.7
22.3
11.6
33.9
20.4
18.4
38.8
17.6
20.2
37.8

4.5
9.0
4.5
7.8
1.7
6.1
1.7
9.3
10.0
3.8
1.6
2.2
18.2
4.1
22.3
7.1
3.1
10.2
10.8
0.1
10.7
11.4
4.1
7.3

22.9
18.8
41.7
39.9
14.1
54.0
29.0
13.3
42.2
35.5
15.3
50.8
30.1
8.5
38.6
20.1
9.7
29.8
23.7
12.1
35.9
26.4
13.9
40.3

FR age-specific fertility rate; AR age-specific abortion rate; PR age-specific pregnancy rate.

Data based on 1st July population.

land about the contraceptive use of young people.

One study, 1996, showed that 60% used contraception at the time of first intercourse (35). In
Denmark, 89% of adolescents used contraception
at first intercourse in 1989 (32). In Finland, 73%
of girls and 80% of boys used an effective contraceptive method in 1992 (33). Another Icelandic
contraceptive study among women in all age
groups who had an abortion showed that during
197784, 6273% did not use contraception at the
time of conception, a higher proportion than in
Norway and Denmark (3638). A possible personal hindrance to effective use of contraception
in Iceland is cost. Contraceptives are also not subsidized like in Sweden and Finland. Additionally
the availability of emergency contraception was restricted in Iceland until a few years ago; there has
been less emphasis on sex education and contraceptive services for young people in Iceland in
comparison with the other Nordic countries such
as Sweden and Finland; presently, there are only
two community health centers in Iceland providing
youth services, including contraceptive services;
but most young people in Iceland would, however,
be interested in attending such services (35). This
relationship between high fertility, limited sex education, and lack of contraceptive services for
young people is well established (5).
High fertility rates have further been linked to

limited openness about sexual matters (5).

Coupled with this is the tendency for Icelandic media, as with western media in general, to present
sexual matters in a way that may be considered as
unhealthy and too early. Considerable emphasis
is placed on the desirability of having sex and entering the adult world while sexual health issues
focusing on safe sex and responsible sexual behavior receive limited space. Sexual information on
the radio, television, and in newspapers is frequently provided by people who have no educational background in sexology or contraceptive
counselling.
Several studies have demonstrated lower fertility
rates and higher abortion rates in urban vs. rural
areas (10,39,40). Our findings are consistent with
these results. Regional analysis of FRs showed
higher rates in the westfjords and the south-west.
In these communities there has been a demand for
young people in the fishing industry, where wellpaid jobs are easily obtained. Concurrently, there
may be more limited motivation for higher education. The reverse situation may prevail in the Reykjavik area, where fewer births were observed
compared with the rest of the country but where
the highest rate of abortion occurs. In the Capital
area it is likely that educational motivation follows
better educational opportunities, and having fewer
children may be better accepted. Additionally, the
C Acta Obstet Gynecol Scand 82 (2003)

46

S. Soley et al.

higher rate of abortion in the Reykjavik area may

partially be explained by the number of women
who live in the countryside and choose to go to
Reykjavik to have an abortion instead of their
place of residence.
In comparison with the four other Nordic countries the AR rose by 133% among young women
in Iceland during the study period. The rise is
likely to be related to cultural changes taking place
over time, such as womens liberation, freedom of
choice, and an increasing number of women seeking higher education. The steady increase in the
AR in Iceland, however, does raise concern about
sex education and the use of contraceptive
methods by young Icelandic people. In the other
Nordic countries, such as Finland and Sweden,
government policy has emphasized preventive
measures since the 1970s and contraceptive
methods became available at low or no cost (10,
41). In Finland, the Advisory Committee for
Health Education set out numerous goals in 1984
for decreasing the teenage AR by 7% per year (33).
All of these efforts have been considered to contribute to the low AR for young women in Finland; a country where restrictions on providing the
pill to women younger than 17 years were already
abolished in 1982 (33). No similar change took
place in Iceland. In 1975, one family planning
clinic was opened in Reykjavik, mostly serving
young people, but was closed by the health authorities around 1993. No attempt has yet been made
by the health authorities to lower the cost of contraceptives for young people, although the Icelandic abortion law has suggested such action. A
recent report about the AR and availability of contraceptive methods in Iceland with suggestions to
promote prevention, such as sex education and
contraceptive services for young people, was, however, recently adopted by the government (42). It
is now hoped that this will be followed by positive
steps to promote prevention, e.g. making contraceptive methods better available and lower their
costs.
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Address for correspondence:
Soley S. Bender
Faculty of Nursing
University of Iceland
Eirberg
Eiriksgtu 34
101 Reykjavik
Iceland
e-mail: ssb/hi.is

C Acta Obstet Gynecol Scand 82 (2003)