2 May 2012

Statistics briefing (6): Provision, funding and geographical location

Who provides abortions? What are the geographical variations in abortion provision? How is abortion regulated? Relevant commentary.

Who provides abortions?

In England and Wales, the proportion of abortions funded by the National Health Service (NHS) has risen steadily, and in 2011, 96% of abortions were funded by the NHS.

The availability of abortion in England and Wales has been assisted by the fact that over half (61%) of abortions are carried out in approved independent sector places (such as clinics run by bpas and Marie Stopes) but publicly paid for, showing a trend towards giving women increasing access to specialist services outside the general NHS.

The commissioning arrangements for abortion, as with other health services, may change slightly as a result of the health reforms outlined by the current Coalition Government. The exact scope of these changes is presently being worked through by the government. However, there is no indication that the level of public funding for abortion, or the role of the independent sector in abortion provision, will change significantly.

What are the geographical variations in abortion provision?

The number of abortions, and the abortion rate, is broken down by the national statistics, and presented in Tables 10a and 10b respectively. Table 11 shows, by region, how NHS-funded abortions are split between NHS hospitals and the independent sector, and what proportion of the remainder are privately funded.

There are some striking regional variations: for example, in East Midlands Strategic Health Authority (SHA), 67% of NHS-funded abortions take place in NHS hospitals and 30% in the independent sector; in West Midlands SHA, only 7% of NHS-funded abortions take place in NHS hospitals and 91% are provided by the independent sector; and in East of England SHA the proportion is a more even split. In London SHA, 76% of NHS-funded abortions take place in the independent sector; in Wales, this figure is 26%.

How is abortion regulated?

Abortion in England and Wales is regulated, first, by the Abortion Act (1967), which stipulates the grounds under which doctors can certify a woman’s eligibility for abortion, and the premises on which an abortion must be carried out. Beyond that, abortion is subject to a number of health regulations, including those of the Care Quality Commission, and doctors and nurses are regulated by their professional codes of practice.

Best clinical practice for abortion, based on systematic reviews of clinical evidence, is provided by the Royal College of Obstetricians and Gynaecologists (RCOG), in its guideline The Care of Women Requesting Induced Abortion. This guideline was produced in 2000, updated in 2004, and updated again in 2011. In 2009 the New Labour government developed, after many years of discussion, a National Service Specification for Termination of Pregnancy Services, which lays out some of the basic standards that abortion services should meet.

Relevant commentary

Our 10-year struggle to improve abortion care. Ann Furedi reports on her fight with health officials for sensible abortion services.  Abortion Review, 17 February 2011

Q&A: The National Service Specification for Termination of Pregnancy Services, by Donagh Stenson. Abortion Review, 24 January 2011

Do abortion services really make a ‘vast amount of money’? A blog on the Liberal Conspiracy website challenges Nadine Dorries MP’s claims. Abortion Review, 11 November 2010

UK: Health Secretary launches shock wave of inspections on abortion clinics. The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports. Abortion Review, 23 March 2012

Read on:

7) Further resources

Return to Understanding Abortion Statistics contents page.

Download the full briefing as a .pdf here.

Read more articles in Statistics and policy section.

Last updated 29 May 2012.