The three Scandinavian countries--Denmark, Norway and Sweden--all legalized voluntary sterilization in the 1970s. Previous legislation had been very restrictive, limiting access to certain defined minority groups. During the two decades with this new possibility, sterilization has been accepted as a good contraceptive alternative, equally accessible for men and women above age 25 years. The sterilization frequency varies considerably between the three countries, being most popular in Norway and Denmark. The proportion of sterilization in males versus females is 40% in Denmark, 25% in Norway and 20% in Sweden. Published follow-up studies point out risk groups for regret of the intervention, and underline the need for good preoperative counseling. The overall results are very positive.
PIP: 2 obstetrician-gynecologists from Central Hospital in Karlskrona, Sweden, analyzed official sterilization data and reviewed the literature to determine the development of sterilization in Denmark, Norway, and Sweden. National registration of sterilizations were available from Norway as far back as 1984 and from Sweden as far back as the early 1940s. It is not required in Denmark, so the researchers had to use hospital registrations. New sterilization laws in the 1970s allowed contraceptive sterilization for everyone at least 25 years old; prior to the 1970s, sterilizations were allowed mainly for hereditary or eugenic indications, mentally ill, severely retarded persons, ill women needing to avoid a life-threatening pregnancy, and sometimes people determined to not be able to care for children. Vasectomies are more common in Denmark than Norway and Sweden (in the 1980s: about 40% vs. about 20-25%, respectively), but vasectomy was already somewhat popular in Norway before enactment of its new law. The sharpest increase in female sterilizations after enactment of the new law occurred in Denmark. Either the husband or wife is sterilized by the end of the reproductive years among 10-15% of all couples in Sweden. There were marked differences in sterilization rates between regions in Sweden. 90-95% of sterilized men and women from all 3 Scandinavian countries were satisfied with the operation. Postoperative hematoma or infection were the most frequent short-term complications for sterilized men and women. Men also reported postoperative pain. Some women noted trauma to intra-abdominal organs. Longterm effects were regret/desire for reversal, pregnancy, and negative effects on sexuality. Women also reported bleeding disturbances and pain. Pregnancy rates are .54-1.6% for women and 0.5% for men. These findings suggested that surgeons should pay more attention to preoperative counseling to reduce the likelihood of later regret, especially among young applicants. High quality counseling and accessible services should minimize complications and continue to provide contraceptive sterilization.