Organic sows are kept in a variety of different production systems, with some countries having totally outdoor management at pasture, some keeping animals indoors with concrete outside runs and others having combinations of these systems. The basis for estimation of the nature and prevalence of sow health and welfare problems on organic units is extremely limited, as few large scale-published surveys exist. In general, reports suggest that relatively few health and welfare problems are seen. The most widely discussed problem is that of parasites, both ectoparasites and endoparasites, which have been reported to be more prevalent than in conventional systems due to the housing conditions and restrictions on prophylactic chemical measures. General risk factors for health and welfare conditions can be extrapolated from knowledge gained in conventional systems. Issues with particular importance for organic production include outdoor access, roughage feeding, later weaning, less sophisticated diets and lack of good health management strategies. When considering the presence of hazards with the potential to give rise to sow health and welfare problems, organic sows therefore have more behavioural freedom, but may be exposed to greater climatic challenges, parasite infestation and risk of body condition loss.