24 May 2011

England and Wales: Abortion statistics 2010

This bpas briefing highlights key trends from the latest national statistics.

General trend

This year’s national abortion statistics show that there were 189,574 abortions in England and Wales in 2010, a very small rise of 0.3% from 2009; and that the age-standardised abortion rate was 17.5 per 1,000 women, the same as last year. These figures are in line with those of recent years and indicate that abortion continues to be a fact of life in the UK: one in three women will have an abortion over her lifetime, and access to abortion continues to be crucial to women’s ability to plan the timing and size of their families and to play a full role in society.

Aggregated statistics can tell us very little about the reasons why individual women have abortions, which continue to be varied and complex. Other research suggests a range of reasons why women may end up with unwanted pregnancies, from contraceptive failure to relationship breakdown. bpas is proud to be at the forefront of helping women in this position to find a solution to the problem of unwanted pregnancy. 

Ann Furedi,  chief executive of bpas, said: ‘It is notable that numbers have remained stable despite increasing investment in and promotion of longer-term methods of contraception.  This shows how difficult it is for women to prevent unwanted pregnancies.  Abortion is not a problem in itself. For many women abortion is a back-up to their contraception. It is a rational and ethical solution to the problem of a pregnancy that they cannot continue with.

‘We must do what we can to reduce the need for abortion while accepting that it will always be an important back-up for women whose contraception has failed, or whose circumstances have changed. Our challenge is to ensure abortion remains as accessible as possible for those women who need it.’

Early abortion

The 2010 abortion statistics show a welcome continuation of the trend towards abortions taking place earlier in pregnancy. Over three-quarters (76%) of NHS-funded abortions now take place at under 10 weeks’ gestation, compared to 74% in 2009 and half (51%) in 2002. At bpas in 2010, over half of first trimester abortions were performed at under 8 weeks’ gestation. The proportion performed within the first six weeks increased from just 9% to 29% in the last decade. Almost two thirds (62%) of abortions at under 8 weeks’ gestation are performed by organisations like bpas, in the independent sector under NHS contract.

Highly sensitive tests, which can diagnose pregnancy just 8 days after conception, mean that women who suspect a pregnancy can confirm this much sooner, while increasing numbers of Primary Care Trusts (PCTs) now allow self-referral, so that a woman can access services without the delays that might be caused by waiting for a referral from her GP. But it is the increasing availability and acceptability of Early Medical Abortion, also known as the ‘abortion pill’ - a method pioneered in the UK by bpas - that has played a key role. Early medical abortion now accounts for half of all abortions performed nationally at gestations of under 9 weeks. (Table 5)

Later abortion and concerns over choice of method

The rise in ‘early abortion’ does not reduce women’s need for abortion at later gestations. In 2010, approximately 9% of abortions took place in the second trimester of pregnancy – a similar proportion to previous years. This reflects the variety of reasons that contribute to women’s need to seek ‘later’ abortion, which range from delays in suspecting/confirming a pregnancy to relationship breakdown, diagnoses of fetal anomaly, and difficulty accessing services. (See Second-Trimester Abortions in England and Wales, By Roger Ingham, Ellie Lee, Steve Clements and Nicole Stone, University of Southampton 2007.)

The national statistics indicate the significant role played by NHS-funded independent sector in providing access to abortion and choice of methods for women. The majority of abortions at 13 weeks and beyond are carried out by the independent sector, which is usually able to offer women a choice of either medical (labour induction) or surgical abortion. For women who can only access abortion within NHS settings – either due to local contracts or medical reasons such as a high Body Mass Index (BMI) – choice may be restricted, with 79% of NHS hospitals providing abortion offering medical methods only after 13 weeks. This may be due to a lack of surgical skills, conscientious objection among clinicians, or hospital policy.

A recent piece of research by Kelly et al (2010) found that women undergoing second trimester abortions found surgical methods less painful and more acceptable than medical, with more than half of those undergoing medical reporting the experience to be worse than expected. The authors also noted that there was ‘urgent need to introduce novel training strategies’ if women were to be offered the method most suited to them.

Repeat abortion

The phrase ‘repeat abortion’ implies that women are having serial abortions: this is not the case. The phrase used by the national statistics is ‘previous abortion’, which is a more accurate and less sensational description of the issue.

The statistics show that one third of women (34%) who have abortions have had ‘one or more’ previous abortion. The proportion of women who have had more than one previous abortion is roughly 8 per cent. When one considers that, in England and Wales, there are an estimated 2million acts of heterosexual coitus in women per day, it is striking that only one in 1000 acts of sex result in an abortion.

In modern Britain, women may require more than one abortion because they are exposed to greater risk of unwanted pregnancy than women of previous generations. This is because more women choose not to have children, and those who do choose motherhood tend to delay having children until their late 20s or early 30s. The age at which women have children is gradually but steadily rising. In 2009, the average age of women giving birth was 29 years (28 years at first birth), and 20% of babies born had mothers aged 35 and over. Between 2008 and 2009, conception rates among women aged 30-34 and 35-39 rose by 3.5% and 3.4% respectively. The existence of a longer ‘window’ between women becoming sexually active and starting their families may mean that women are more exposed to unintended pregnancy. 

Abortion has become more widely available, and less stigmatised. This means that women may well be more likely to report having had a previous abortion than they would in the past. Policymakers’ interest in the rate of previous abortions has also encouraged the assiduous collection of these statistics, and flagged ‘repeat abortion’ as an issue of media interest. Because statistics on previous abortions are reported voluntarily by the woman undergoing abortion, we should be aware that the ‘repeat abortion’ statistics reflect an emphasis on reporting as much as they reflect the numbers of procedures taking place.

The national statistics indicate that ‘25% of abortions to women under 25 were repeat abortions’, and this figure is often used to present repeat abortion as a problem of feckless young people. However, it should be borne in mind that the abortion rate is highest (at 30 per 1,000 women) for women aged 20-24, who are at the peak of their fertility and increasingly less likely to be actively considering starting a family. Abortions to women under 25 account for over half of all abortions, so it is not surprising that a significant proportion of previous abortions are accounted for by this age group.

The discussion of ‘repeat abortion’ tends to focus on teenagers, but as the national statistics note, this is ‘a complex issue associated with increased age as it allows longer time for exposure to pregnancy risks’. Simplistic attempts to stigmatise ‘repeat’ abortion ignore the fact that women who will have more than one abortion are less likely to be teenagers than older women who have had previous abortions when they were younger.

Research on repeat abortion suggests that women who have more than one abortion are no different to those who have one abortion: they are no less likely to use contraception, and are certainly not using abortion as a means of contraception.

(Rowlands, S. ‘More than one abortion?’ Journal of Family Planning and Reproductive Health Care 2007 33:155-158; Rowlands, S. Is repeat abortion a problem? Abortion Review Special Edition 2, Winter 2008/9)

Age at abortion

The under-18 conception rate is estimated to be the lowest rate since the early 1980s, and half of conceptions to girls under 18 now end in legal abortion. We hope that this indicates that younger women are gaining an increased ability to manage the causes and consequences of unintended pregnancy.

However the focus on abortion and young women can obscure the need for abortion indicated by women in their twenties, at a time where many women are starting their families later. The abortion rate remains highest for women aged 20-24, at 30 per 1,000 women; for women aged 25-29 the rate is 23 per 1,000 women, and the rate is 22 per 1,000 women aged 15-19. Given the trends towards delayed motherhood (noted above), we can expect a continuing need for abortion amongst women in their twenties.  (Table 4a)

Abortion for fetal anomaly

Advances in pre-natal screening and diagnostic testing, alongside trends in later motherhood, mean that more women are faced with a diagnosis of fetal anomaly in the second trimester of pregnancy. Many women opt for abortion in these circumstances: for example, 94% of pregnancies with a prenatal diagnosis of trisomy 21 (Down’s Syndrome) will be terminated. This indicates the continuing need for the provision of second-trimester abortion services, and that women are offered a choice between medical induction and surgical methods of abortion.

One issue of concern to bpas is that women seeking abortions for fetal anomaly in the second trimester of pregnancy can choose the method of abortion that is best for them. Most abortions for fetal anomaly take place in the NHS, where medical induction is often the only method available: for those women who would prefer a surgical procedure, it is important that their doctors are able to refer to the NHS-funded independent sector when appropriate.

Under UK law, it is legal to terminate a pregnancy beyond 24 weeks’ gestation if a woman and her doctors agree that this is necessary, reflecting the fact that a diagnosis may not be made until the second trimester of pregnancy or later, and that women need time to decide what to do. This is a humane reflection of the personal nature of the abortion decision: women are not told to have an abortion following a diagnosis of anomaly, and women are not forced to continue a pregnancy that is likely to end in a disabled child. Those women for whom antenatal screening picks up a diagnosis of fetal anomaly need and deserve understanding and support, whether they decide to terminate the pregnancy or continue it to term.

The focus on the statistics of abortion for fetal anomaly obscures the more subtle and complex reasons why women come to their decisions, which are unique to them and affected by their circumstances. But the statistics do show that abortion for fetal anomaly account for a tiny proportion of all abortions: only 1% are carried out on Ground E (risk of ‘serious handicap’ ) and less than 0.1% of all abortions take place after 24 weeks’ gestation – 147 abortions in total in 2010.

The 2011 bpas briefing, which may be of particular interest to journalists and students, can be downloaded as a .pdf here: Understanding Abortion Statistics.

The 2010 abortion statistics for England and Wales are published by the Department of Health and available here.