Sweden blazes trail in women's hockey by allowing body checking and finds health, quality benefits

ÖRNSKÖLDSVIK, Sweden (AP) — Lauren Bellefontaine came off the ice after a game in Sweden’s top women’s hockey league and detailed the toll her body had just taken.

“I got a stick to the collarbone tonight and also a hit to the head. Definitely some bumps and bruises,” she said with a smile. “But I’m feeling fine.”

Growing up in Canada, Bellefontaine kept hearing people ask why there was no hitting in women’s hockey. It has taken a move to northern Sweden for her to discover the more physical side of the sport.

In 2022, Sweden became the first country to introduce body checking to its premier women’s league, bringing its rule book closer to men’s hockey even though hockey’s world governing body does not formally allow the practice because of safety concerns. It has opened up a new world for women's players, who say they feel more empowered playing the game the way it was intended.

Swedish hockey officials say the results have been overwhelmingly positive: The women’s game has become faster and more entertaining while concussions, which have been a scourge for the sport, have decreased.

Other countries are now looking to follow suit, with the PWHL — the professional women’s league in North America with some of the world's top players — putting checking in the rules for its inaugural season last year.

“It has given us the opportunity to prove we’re physical, we’re strong and we can play just like the men’s players,” Bellefontaine said. “It allows us to show we can — and we will.”

Bellefontaine joined MoDo for the start of the 2023-24 season. It’s a title-contending team from Örnsköldsvik, a sleepy coastal town some 530 kilometers (330 miles) north of Stockholm — and not far from the Arctic Circle — whose population of 30,000 lives and breathes hockey and whose most famous alumni include NHL greats Peter Forsberg, Henrik and Daniel Sedin, and Markus Naslund.

Initially it was something of a culture shock to her.

“I had no prior experience of hitting at all,” the 25-year-old Bellefontaine said, “and we went right into the season so it took me a while to get into it … it was tough but now it’s just fun.”

Safer, too.

Statistics supplied by the Swedish women’s league show the number of concussions sustained by players has dropped since 2018, when its “Project Zero Vision” was launched. There were 35 reported concussions in the 2018-19 regular season, 10 in 2022-23 and 15 in 2023-24. By Jan. 8 this year, which was approaching the end of the regular season, there had been six.

Preventing concussions was the main driver behind the introduction of checking, as counterintuitive as that may seem. It has forced players to skate with their heads up, increasing their ice awareness.

There have been other benefits of bringing back checking, which was part of the game in women’s hockey in Europe and North America until the mid-1980s but isn’t in the International Ice Hockey Federation’s current rule book. Coaches, league officials and fans say the speed of the Swedish game has gotten quicker, as players make smarter and faster decisions.

For many, it restores the balance between skill and physicality that is important in making the sport an entertaining watch.

“It creates some tension in the game that you otherwise don’t get,” said Luc de Keijzer, a 27-year-old student who is a regular at MoDo games.

One big hope is that increased physical play makes Sweden more competitive at the international level against traditional hockey powers like the United States, Canada and Finland. Sweden's women's team regularly goes deep in world championships and Olympic Games but hasn't won the gold medal at either tournament.

For some female players, the biggest effect has been to make them feel more empowered. That’s because they are essentially following the same rules as the men, except for one key difference: hits on open ice — when players are skating freely away from the boards — are forbidden in women’s hockey.

“We’re trying to close the gap between men’s and women’s hockey, so this is one way we are doing it — to have similar rules as they do,” said Alexie Guay, another Canadian playing for MoDo. “It’s not as intense and there are different rules still — I don’t know if there will be fighting in women’s hockey in the future — but we’re definitely closing the gap and I think it’s a cool thing.”

According to research by Lund University in Sweden, 88% of the 159 players from the league who responded to a questionnaire said they were in favor of checking.

Jared Cipparone, the coach of MoDo’s women’s team, said he hasn’t encountered any resistance from his players about checking.

“Everyone was excited about it,” said Cipparone, who is also from Canada. “The first year was trial and fire for many, but last year and this year you see the significance it’s made in the game and I’ve only heard good things about it.”

At MoDo’s home game against HV71 at Hagglunds Arena in early January, a MoDo player was almost knocked off her skates by a full-body hit. Many others were smashed into the boards but went on with the game. There were no roughing penalties and certainly no brawling.

The 5-foot-7 Bellefontaine, who describes herself as “pretty small,” has had to adapt her game. She said she trains harder, watches what she eats to “bulk up a little bit” and is making use of the sauna in her apartment for post-match recovery.

“I’m definitely squeezing my core a little more,” she said. “Before, I wouldn’t even expect to be hit so now it’s head on a swivel, always looking, always watching, and just being ready to take a hit. You have to make sure you’re not in a position to jeopardize yourself.

“It’s definitely changed the way we play and made us better players.”

USA Hockey and Hockey Canada do not allow checking in girls and women's hockey. In Sweden, body checking is part of the rules for boys and girls starting at the age of 12. League officials say being educated so early prepares players for when they are older.

MoDo fan Marie Johansson said her 18-year-old daughter, Amanda, started with checking from age 12, initially while playing with boys.

“All parents are worried about their children getting injured,” Johansson said, “but when they learn to do the checking, they train a lot, they learn how to hold their heads up high, and she learnt how to avoid injuries. I don’t think because she’s a girl I’ve been more worried than if she’d been a boy.”

Morgan Johansson, an official who helped to launch the Zero Vision project, said he has shared information with the IIHF and the PWHL about the effects the rule change has had on the Swedish league. Norwegian and Danish leagues have also contacted him.

Last year, the IIHF had PWHL officials in North America outline the league’s rules on checking and officiating in a potential first step to modify its rulebook and provide a new standard at international competitions, league vice president of hockey operations Jayna Hefford said.

Contacted by the AP, the IIHF said its rulebook “does not prohibit competitive body contact between players” but noted its staff was working with its membership "to clarify the interpretation of this part in women’s hockey.”

As for the Swedes, they are happy to have made the bold step that others are starting to follow.

“We are kind of a trailblazer when it comes to women’s hockey in challenging the old structures that said, ‘Women can’t,’” said Angelica Lindeberg, operations manager for the Swedish league. “Now we say, of course they can. We are very proud of that.”

AP Hockey Writer John Wawrow contributed.

AP women's hockey: https://apnews.com/hub/womens-hockey

Modo's Ebba Hedqvist, second right, in acton during a Swedish Women's hockey league match against HV71 in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

Modo's Ebba Hedqvist stand on the side of the ice during a Swedish Women's hockey league match against HV71 in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

HV71's Kennedy Bobyck, left, collides with Modo's Alexa Gruschow during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

Modo's Wilma Sundin, right, is challenged by HV71's Audrey-Anne Veillette during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

Modo's Andrea Brändli prepares for a Swedish Women's hockey league match against HV71 in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

Modo's Ella Albinsson, left, and Mariam El-Mahmadi, challenge HV71's Kennedy Bobyck during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

Modo's Sanna Halsius, right, challenges HV71's Emmi Rakkolainen during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

HV71's Kennedy Bobyck, left, collides with Modo's Alexa Gruschow during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

HV71's Malva Lindgren and Modo's Darcie Lappan clash during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

HV71's Teghan Inglis, left, challenges Modo's Alexie Guay during their Swedish Women's hockey league match in Örnsköldsvik, Sweden, on Jan. 10, 2025. (AP Photo/Johan Löf)

SALT LAKE CITY (AP) — U.S. Health Secretary Robert F. Kennedy Jr. on Monday said he plans to tell the Centers for Disease Control and Prevention to stop recommending fluoridation in communities nationwide. Kennedy also said he’s assembling a task force to focus on the issue.

Also on Monday, the U.S. Environmental Protection Agency announced it is reviewing “new scientific information" on potential health risks of fluoride in drinking water. The EPA has primary authority to set the maximum level of fluoridation in public water systems.

Kennedy told The Associated Press of his plans after a news conference with EPA Administrator Lee Zeldin in Salt Lake City.

Kennedy can’t order communities to stop fluoridation, but he can tell the CDC to stop recommending it and work with the EPA to change the allowed amount.

Utah last month became the first state to ban fluoride in public drinking water, pushing past opposition from dentists and national health organizations who warned the move would lead to medical problems that disproportionately affect low-income communities.

Republican Gov. Spencer Cox signed legislation barring cities and communities from deciding whether to add the cavity-preventing mineral to their water systems. Water systems across the state must shut down their fluoridation systems by May 7.

Kennedy praised Utah for emerging as “the leader in making America healthy again.” He was flanked by Utah legislative leaders and the sponsor of the state’s fluoride law.

“I’m very, very proud of this state for being the first state to ban it, and I hope many more will,” he said.

Kennedy oversees the CDC, whose recommendations are widely followed but not mandatory. State and local governments decide whether to add fluoride to water and, if so, how much — as long as it doesn’t exceed a maximum set by the EPA, which is currently 4 milligrams per liter.

Zeldin said his agency was launching a renewed examination of scientific studies on the potential health risks of fluoride in drinking water to help inform any changes to the national standards.

“When this evaluation is completed, we will have an updated foundational scientific evaluation that will inform the agency’s future steps,” Zeldin said. “Secretary Kennedy has long been at the forefront of this issue. His advocacy was instrumental in our decision to review fluoride exposure risks, and we are committed to working alongside him, utilizing sound science as we advance our mission of protecting human health and the environment.”

Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the CDC. In 1950, federal officials endorsed water fluoridation to prevent tooth decay, and in 1962 set guidelines for how much should be added to water.

Kennedy, a former environmental lawyer, has called fluoride a “dangerous neurotoxin” and said it has been associated with arthritis, bone breaks and thyroid disease. Some studies have suggested such links might exist, usually at higher-than-recommended fluoride levels, though some reviewers have questioned the quality of available evidence and said no definitive conclusions can be drawn.

In November, just days before the presidential election, Kennedy declared that Donald Trump would push to remove fluoride from drinking water on his first day as president. That didn't happen, but Trump later picked Kennedy to run the U.S. Department of Health and Human Services, where he has been expected to take some kind of action. Meanwhile, some localities have gone ahead and decisions whether to keep fluoridating water.

Related to all this: A massive round of staffing cuts last week across federal agencies included elimination of the CDC's 20-person Division of Oral Health. That office managed grants to local agencies to improve dental health and, in come cases, encourage fluoridation.

Fluoride can come from a number of sources, but drinking water is the main one for Americans, researchers say. Nearly two-thirds of the U.S. population gets fluoridated drinking water, according to CDC data. The addition of low levels of fluoride to drinking water was long considered one of the greatest public health achievements of the last century.

About one-third of community water systems — 17,000 out of 51,000 across the U.S. — serving more than 60% of the population fluoridated their water, according to a 2022 CDC analysis. The agency currently recommends 0.7 milligrams of fluoride per liter of water.

But over time, studies have documented potential problems. Too much fluoride has been associated with streaking or spots on teeth. Studies also have traced a link between excess fluoride and brain development.

A report last year by the federal government’s National Toxicology Program, which summarized studies conducted in Canada, China, India, Iran, Pakistan and Mexico, concluded that drinking water with more than 1.5 milligrams of fluoride per liter — more than twice the recommended level in the U.S. — was associated with lower IQs in kids.

Utah Oral Health Coalition chairperson Lorna Koci said Monday that she hopes other states push back against the removal of fluoride and that Kennedy’s visit to celebrate her state's fluoride ban underscores the political motivations of those who support it.

She predicted children will have more cavities as a result and said backers of the fluoride legislation in Utah spread false information that raised doubts about its effectiveness. Opponents of the law warned it would disproportionately affect low-income residents who may rely on public drinking water containing fluoride as their only source of preventative dental care.

“This seems to be less about fluoride and more about power,” Koci said.

Stobbe reported from New York. Associated Press writer Matthew Brown in Billings, Montana, contributed reporting,

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Health Secretary Robert F. Kennedy Jr., right, arrives at University of Utah to discuss Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. to appear in Salt Lake City with the EPA administrator and state lawmakers to talk about Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City, Utah. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. to appear in Salt Lake City with the EPA administrator and state lawmakers to talk about Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City, Utah. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. exits a bus as he visits University of Utah to discuss Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. to appear in Salt Lake City with the EPA administrator and state lawmakers to talk about Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City, Utah. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. visits University of Utah to discuss Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. visits University of Utah to discuss Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City. (AP Photo/Melissa Majchrzak)

Health Secretary Robert F. Kennedy Jr. to appear in Salt Lake City with the EPA administrator and state lawmakers to talk about Utah's new fluoride ban and food additives legislation, Monday, April 7, 2025, in Salt Lake City, Utah. (AP Photo/Melissa Majchrzak)