Abortion Statistics, England
and Wales: 2014
Summary information from the abortion notification
forms returned to the Chief Medical Officers of
England and Wales.
medium, under the terms of the Open Government Licence. To view this licence, visit
© Crown copyright
Introduction ................................................................................................................... 6
Commentary ............................................................................................................... 10
Index to tables ............................................................................................................. 23
Annex A: Data quality and methods ................................................................................ i
Annex B: Further information …………………………………………………………………vi
For women resident in England and Wales, 2014:
The total number of abortions was 184,571. This was 0.4% less than in 2013 (185,311) and
The age-standardised abortion rate was 15.9 per 1,000 resident women aged 15-44. This is
2013 was also for women aged 22 (at 30 per 1,000).
The under-16 abortion rate was 2.5 per 1,000 women and the under-18 rate was 11.1 per
the year 2004 (3.7 and 17.8 per 1,000 women respectively).
Location and funding of abortions
98% of abortions were funded by the NHS. Of these, two thirds (67%) took place in the
92% of abortions were carried out at under 13 weeks gestation, 80% were at under 10
Method of abortion
Medical abortions accounted for 51% of the total. This was slightly higher than in 2013
medical procedures than surgical procedures.
Ground E abortions
3,099 abortions (2%) were carried out under ground E (risk that the child would be born
37% of abortions in 2014 were to women who had already had one or more abortions.
In 2014, there were 5,521 abortions for non-residents carried out in hospitals and clinics in
and the 2014 total is slightly higher than in 2013.
the thirteenth in an annual series published by the Department of Health (DH), the first of
which was for abortions in 2002. These are available on the GOV.UK website
their Abortion Statistics Series AB, Nos 1 to 28. The reports for 1991 to 2001 are available
electronically on request to email@example.com. Statistics for years from
1968 to 1973 were published in the Registrar General’s Statistical Review of England and
Wales, Supplement on Abortion.
The legislative context
1.2 The Abortion Act 1967, as amended by the Human Fertilisation and Embryology Act 1990,
permits termination of a pregnancy by a registered medical practitioner subject to certain
conditions. Legal requirements apply to the certification and notification of abortion
procedures. Within the terms of the Abortion Act, only a registered practitioner can
terminate a pregnancy. The doctor taking responsibility for the procedure is legally
required to notify the Chief Medical Officer (CMO) of the abortion within 14 days of the
termination, whether carried out in the NHS or an approved independent sector place and
whether or not the woman is a UK resident. The Department of Health provides form
HSA4 for this purpose. Further details are available on the GOV.UK website:
carried out in an NHS hospital or in a place approved for the purpose by the Secretary of
State. After 24 weeks gestation, the abortion can only be carried out in an NHS hospital.
Through contractual arrangements with Clinical Commissioning Groups (CCGs), some
approved independent sector places perform NHS-funded abortions.
1.4 A legally induced abortion must be certified by two registered medical practitioners as
A the continuance of the pregnancy would involve risk to the life of the pregnant
amended, section 1(1)(c))
mental health of the pregnant woman (section 1(1)(b))
C the pregnancy has not exceeded its twenty-fourth week and that the continuance of
injury to the physical or mental health of the pregnant woman (section 1(1)(a))
D the pregnancy has not exceeded its twenty-fourth week and that the continuance of
injury to the physical or mental health of any existing children of the family of the
pregnant woman (section 1(1)(a))
E there is a substantial risk that if the child were born it would suffer from such
or, in an emergency, certified by the operating practitioner as immediately necessary:
F to save the life of the pregnant woman (section 1(4))
G to prevent grave permanent injury to the physical or mental health of the pregnant
How the statistics are produced
1.5 The doctor taking responsibility for an abortion is legally required to notify the Chief
Medical Officer (CMO) within 14 days of the termination. Abortion notification forms
(HSA4s) can be submitted online or on paper.
1.6 The Department of Health use a thorough process for inspecting and recording the
the extent to which best practice guidance from the Department of Health is followed. The
methods used ensure that good quality accurate statistics can be derived from the data.
Annex A contains further information about data quality.
1.7 The format of the tables have been revised in the light of the judgment handed down by
condition for abortions performed under ground E. A more limited degree of suppression
has been applied, where necessary, to avoid the disclosure of personal data. This is in
line with the Disclosure Control Protocol for Abortion Statistics which was published in
June 2015. (See Annex A xvii for more detail.)
1.8 This publication is a National Statistic. It is a statutory requirement that National Statistics
should be produced in accordance with the standards set out in the Code of Practice for
Official Statistics. The UK Statistics Authority assesses all National Statistics for
compliance with the Code of Practice. The results of the assessment of abortion statistics
were published in February 2012 and are available at:
The Statistics Authority confirmed that the statistics could continue to be designated as
Implementation of the 2013 European Standard Population (ESP)
1.9 The European Standard Population (ESP) is an artificial population structure which is used
in the weighting of mortality or incidence data to produce age standardised rates (ASRs).
Eurostat, the statistical institute of the European Union, decided to update the population
structure to be more representative of the current population of Europe.
1.10 The 2013 ESP replaces the 1976 ESP used in calculating age standardised rates. Further
. Annex A gives detail of the
effect on abortion age standardised rates from the implementation of the 2013 ESP.
1.11 All age standardised rates presented in this publication are based on the 2013 ESP. The
table 1. To see rates using the 1976 ESP users should refer to earlier publications.
Ground E notifications
1.12 During 2013, it was brought to the Department of Health’s attention that the number of
anomaly registries. As there is currently no national register, the Department of Health has
worked closely with the National Down’s Syndrome Cytogenetic Register (NDSCR) to
explore this discrepancy.
1.13 A matching exercise was carried out between the NDSCR data and Department of Health
Department of Health notification was made for about 54% of NDSCR records. Hence
there is potentially an undercount presented in the ground E notification tables in this
1.14 In response, the Department of Health asked the Royal College of Obstetricians and
on the grounds of fetal abnormality and make recommendations for improvement. Results
from the matching exercise and RCOG recommendations are published at
. Between 2011 and 2013, there has been a 17.8% increase in the
submission of HSA4 Abortion Notifications for Down’s syndrome. The Department of
Health will continue to work closely with RCOG and other organisations in implementing
the recommendations where possible.
2 . Commentary
Unless specified, the following commentary, charts and tables relate to abortions carried
out in England and Wales for residents of England and Wales only, rather than all
abortions carried out in England and Wales. Figures in all but Table 13 exclude
abortions for residents of England and Wales that are carried out in other parts of the
United Kingdom or outside the UK.
Overall number and rate of abortions
2.1 In total, there were 190,092 abortions notified as taking place in England and Wales in
2014. There were 184,571 abortions to residents of England and Wales in 2014. This
represents an age-standardised abortion rate of 15.9 per 1,000 resident women aged 15-
. This is the lowest rate since 1997: 0.2% lower than in 2013, 6.4% lower than in 2004
and Figure 1).
Figure 1: Age-standardised abortion rate per 1,000 women aged 15-44 (2013 ESP), England and Wales,
1969 to 2014
and 100 of these were to girls aged under 14.
2.3 737 (7%) of abortions to women aged under 18 were to women who had undergone a
See Annex A for the 2013 ESP and how the rate is derived.
were 698 abortions to women aged under 15 (less than one per cent of the total) and 719
to women aged 45 or over (less than a half of one per cent) (Table 4a and Figure 2).
England and Wales, 2004, 2013 and 2014
2.5 The under-16 abortion rate was 2.5 per 1,000 population in 2014 compared with 2.6 in
and 17.8 in 2004.
2.6 Rates for women up to age 23 were all lower than in 2013, and rates for women over age
2.7 Since 2004 the rates for women aged 30 to 34 have gone up from 14.5 in 2004 to 16.5 in
2.8 About four-fifths (81%) of abortions in 2014 were carried out for single women, a
2.9 The revised HSA4 forms introduced in 2002 allowed for the recording of ethnicity, as self-
reported by the women involved. This information was not previously recorded. Ethnicity
was recorded on 97% of the forms received for 2014 compared with 80% in 2004, the
second full year of collection. Of women whose ethnicity was recorded in 2014, 77% were
Table 3a.vi). This differs from the ethnicity population estimates based on the 2011
where 86% are reported as White, 7.5% as Asian or Asian British and 3.3% as
2.10 The percentage of women having an abortion in 2014 who had one or more previous
abortions varies by ethnic group. 34% of Asian women having abortions in 2014 had
previously had an abortion, compared with 48% of Black women (See Table A below).
36.6% of White women had previously had an abortion.
Table A: Percentage of women who had one, two and three or more previous abortions, by
Asian or Asian British
Black or Black British
Any other ethnic group
Not known/not stated
2.11 Table 3a.i and Figure 3 show that in 2014, 32% of abortions were performed in NHS
named NHS Agency), making a total of 98% of abortions funded by the NHS. The
remaining 2% were privately funded. The proportion performed under NHS contract has
been rising steadily since this information was collected in 1981, while the proportions of
NHS hospital and private abortions have been falling since 1995 and 1988 respectively.
Figure 3: Abortions by purchaser / provider, England and Wales, 1981 to 2014
2.12 Two medical practitioners must agree upon the grounds under which an abortion can be
2.13 In 2014, the vast majority (98%; 179,967) of abortions were undertaken under ground C. A
under ground D, Grounds A and B together accounted for about a tenth of one per cent of
abortions (252). The proportion of ground C abortions has risen steadily with a
corresponding reduction in ground D cases (See Table 3a.ii).
2.14 The vast majority (99.93%) of ground C only terminations were reported as being
(mental disorder, not otherwise specified) is included in the International Classification of
Diseases and therefore no further breakdown is possible within the report.
2.15 Main medical diagnoses for abortions performed under ground C alone which were not
pregnancy (71 cases) including hypertension, excessive vomiting, diabetes, amniotic fluid
disorders and premature rupture of membranes; diseases of the circulatory system (15
cases); diseases of the nervous system (2 cases); diseases of the genitourinary or
musculoskeletal system (2 cases), and other maternal conditions unrelated to pregnancy
such as cancer and epilepsy (24 cases).
2.16 At the time of publication, 170 cases performed under ground C did not have enough
Legal abortions performed under ground E
2.17 The methods used for abortions performed under ground E are of interest to those working
performed medically compared to 51% of all abortions (Tables 9c and 7a).
2.18 The average age for a woman who has an abortion performed under ground E is 33.
2.19 Congenital malformations were reported as the principal medical condition in nearly half
(46%; 1,441) of the 3,099 cases undertaken under ground E. The most commonly
reported malformations were of the nervous system (22% of all ground E cases; 693) and
the cardiovascular system (7%; 231). Chromosomal abnormalities were reported as the
principal medical condition for just over a third (37%; 1,148) of ground E cases. Down’s
syndrome was the most commonly reported chromosomal abnormality (21%; 662) (See
Table 9a and Figure 4).
2.20 The Abortion Notification form HSA4 allows the recording of all medical conditions and
medical condition recorded. For example, there were 2,148 mentions of a congenital
malformation within the 3,099 Ground E cases.
2.21 No abortions in 2014 were associated with rubella under ground E. In the past 10 years,
Figure 4: Principal medical condition for abortions performed under ground E (percentages)
2.22 Abortions are rarely performed under grounds F or G. In the past 10 years, 8 such
2.23 The vast majority of abortions are performed at under 13 weeks (92% in 2014). There has
2.24 In 2014, 80% of abortions were performed at under 10 weeks, compared to 79% in 2013
later: in 2014, 12% were performed at 10-12 weeks (compared to 12% in 2013 and 27% in
2004) and 8% at 13 weeks or more (compared to 8% in 2013 and 13% in 2004) (See Table
3a.iii and Figure 5).
2.25 Department of Health policy is that women who are legally entitled to an abortion should
complications increases the later the gestation.
from 54% in the Vale of Glamorgan to 89% in North Staffordshire (See Table 11a).
2.27 Abortions where gestation has exceeded its twenty-fourth week account for less than 0.1%
2.28 In previous years a distinction was made between gestations of 24 weeks plus 0 days and
included with gestations of 23 weeks and footnoted as such.
2.29 In 2014, 14 of the 190 abortions that were ‘24 weeks and over’ were for abortions that
2.30 In 2014, no abortions at 24 weeks gestation were performed under ground C
2.31 In 2014, 37% of women undergoing abortions had one or more previous abortions. The
proportion has risen from 32% in 2004 (See Table 3a.ix and Table 4b).
2.32 27% of abortions to women aged under 25 were to women who had one or more abortions
2.33 Repeat unintended pregnancy and subsequent abortion is a complex issue associated
England and Wales, 2014