Abortion Statistics, England and Wales: 2014
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- This report presents statistics on abortions carried out in England and Wales in 2014.
- 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
- United Kingdom or outside the UK.
- Ethnicity 1 2 3 or more
- All women 27% 8% 3%
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June 2015 Abortion Statistics, England and Wales: 2014 Summary information from the abortion notification forms returned to the Chief Medical Officers of England and Wales.
2 You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/
© Crown copyright Published to gov.uk, in PDF format only. www.gov.uk/dh
3 Contents
Executive Summary ...................................................................................................... 5 Introduction ................................................................................................................... 6 Commentary ............................................................................................................... 10 Index to tables ............................................................................................................. 23 Annex A: Data quality and methods ................................................................................ i Annex B: Further information …………………………………………………………………vi
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Abortion Statistics, England and Wales: 2014
5 Executive
summary This report presents statistics on abortions carried out in England and Wales in 2014.
For women resident in England and Wales, 2014: Total number •
0.6% less than in 2004 (185,713).
Abortion rates •
The age-standardised abortion rate was 15.9 per 1,000 resident women aged 15-44. This is 0.2% lower than in 2013 and 6.4% lower than in 2004 (17.1); the lowest rate for 16 years. •
The abortion rate was highest for women aged 22 (at 28 per 1,000). The highest rate in 2013 was also for women aged 22 (at 30 per 1,000). •
1,000 women. Both lower than in 2013 (2.6 and 11.7 per 1,000 women respectively) and in 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 independent sector under NHS contract, up from 64% in 2013
Gestation •
92% of abortions were carried out at under 13 weeks gestation, 80% were at under 10 weeks compared to 79% in 2013 and 60% in 2004.
Method of abortion •
Medical abortions accounted for 51% of the total. This was slightly higher than in 2013 (49%), and far higher than in 2004 (20%). This is the first year that there have been more 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 handicapped).
Repeat abortions •
37% of abortions in 2014 were to women who had already had one or more abortions.
Non-residents: •
In 2014, there were 5,521 abortions for non-residents carried out in hospitals and clinics in England and Wales (5,469 in 2013). The 2013 total was the lowest in any year since 1969 and the 2014 total is slightly higher than in 2013. 6
7 1. Introduction
1.1 This report presents statistics on abortions carried out in England and Wales in 2014. It is 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 1 . Statistics for years from 1974 to 2001 were published by the Office for National Statistics (ONS) in their Abortion Statistics Series AB, Nos 1 to 28. The reports for 1991 to 2001 are available electronically on request to abortion.statistics@dh.gsi.gov.uk. 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:
https://www.gov.uk/government/organisations/department-of-health/series/abortion- statistics-for-england-and-wales#statistical-data-sets
1.3 Except in an emergency, any treatment for the termination of pregnancy can only be 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 justified under one or more of the following grounds:
A the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated (Abortion Act, 1967 as amended, section 1(1)(c))
1 http://transparency.dh.gov.uk/category/statistics/abortion 8
B the termination is necessary to prevent grave permanent injury to the physical or 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 the pregnancy would involve risk, greater than if the pregnancy were terminated, 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 the pregnancy would involve risk, greater than if the pregnancy were terminated, 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 physical or mental abnormalities as to be seriously handicapped (section 1(1)(d))
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 woman (section 1(4))
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 information received on the forms in order to monitor compliance with the legislation and 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 the High Court in the case relating to the release of information on principal medical 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.)
Abortion Statistics, England and Wales: 2014
9 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: http://www.statisticsauthority.gov.uk/assessment/assessment/assessment-reports/index.html .
The Statistics Authority confirmed that the statistics could continue to be designated as National Statistics.
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 information about the ESP and the effect on UK age standardised rates is available at http://www.ons.gov.uk/ons/guide-method/user-guidance/health-and-life-events/revised- european-standard-population-2013--2013-esp-/index.html . 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 time series for age standardised rates using the 2013 ESP back to 1968 is presented in 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 Ground E HSA4 notifications was lower than the number reported to the congenital 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 notifications for 2011, 2012 and 2013 data. Results from the matching suggest that a 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 publication.
1.14 In response, the Department of Health asked the Royal College of Obstetricians and Gynaecologists (RCOG) to consider the possible reasons for under-reporting of abortions on the grounds of fetal abnormality and make recommendations for improvement. Results from the matching exercise and RCOG recommendations are published at https://www.gov.uk/government/publications/under-reporting-of-abortions-for-fetal- abnormalities . 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.
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2 . Commentary
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- 44 2
but double the rate of 7.8 per 1,000 resident women aged 15-44 recorded in 1970 (Table 1 and Figure 1). Figure 1: Age-standardised abortion rate per 1,000 women aged 15-44 (2013 ESP), England and Wales, 1969 to 2014
Age
2.2 There were 2,399 abortions to girls aged under 16. 698 of these were to girls under 15 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 previous abortions. For women under aged 16, 57 (2%) were repeat abortions.
2 See Annex A for the 2013 ESP and how the rate is derived. Abortion Statistics, England and Wales: 2014
11 2.4 The crude abortion rate in 2014 was highest for women aged 22 (at 28 per 1,000). There 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).
Figure 2: Abortion rate per 1,000 population by single year of age, England and Wales, 2004, 2013 and 2014
2013 and 3.7 in 2004 and the under-18 rate was 11.1 in 2014, compared with 11.7 in 2013 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 23 were similar to the 2013 rate.
2.7 Since 2004 the rates for women aged 30 to 34 have gone up from 14.5 in 2004 to 16.5 in 2014, and rates for women aged 35 or over have gone up from 6.8 in 2004 to 7.4 in 2014. (Table 3b).
Marital status
2.8 About four-fifths (81%) of abortions in 2014 were carried out for single women, a proportion that has risen slowly from 77% since 2004 (See Table 3a.v).
Ethnicity 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
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reported as White, 9% as Asian or Asian British and 8% as Black or Black British (See Table 3a.vi). This differs from the ethnicity population estimates based on the 2011 census 3
Black or Black British.
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 Ethnic group, England and Wales, 2014
1 2 3 or more White
27% 7%
2% Mixed
31% 11%
4% Asian or Asian British 26% 6%
2% Black or Black British 32% 11%
5% Chinese
22% 5%
2% Any other ethnic group 25% 8%
3% Not known/not stated 23% 6%
2% All women 27% 8% 3%
Location and funding of abortions
2.11 Table 3a.i and Figure 3 show that in 2014, 32% of abortions were performed in NHS hospitals and 67% in approved independent sector places under NHS contract (previously 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.
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http://www.ons.gov.uk/ons/dcp171776_290558.pdf Abortion Statistics, England and Wales: 2014
13 Figure 3: Abortions by purchaser / provider, England and Wales, 1981 to 2014
Statutory grounds for abortion
2.12 Two medical practitioners must agree upon the grounds under which an abortion can be performed. For more information about the grounds for abortion see Section 1.4.
2.13 In 2014, the vast majority (98%; 179,967) of abortions were undertaken under ground C. A further 2% were carried out under ground E (3,099) and a similar proportion (1%: 1,249) 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 performed because of a risk to the woman’s mental health. No further breakdown for F99 (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 due to mental health (114 cases) were those performed because of; complications of 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 information to allocate a diagnosis code and are being followed up.
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Legal abortions performed under ground E
2.17 The methods used for abortions performed under ground E are of interest to those working in fetal anomaly screening and medicine. In 2014, 73% of ground E abortions were 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 other details associated with the ground. Table 9a shows totals for all mentions of any 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, there have been 5 abortions associated with rubella: 3 in 2005, 1 in 2006 and 1 in 2007.
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 abortions have been reported, 1 in each of the years 2006, 2011, 2012 and 2013 and 4 in 2014.
Abortion Statistics, England and Wales: 2014
15 Gestation period
been a continuing increase in the proportion of abortions that are performed under 10 weeks since 2004.
and 60% in 2003. In 2014 and 2013, there were similarities in the proportion performed 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).
have access to the procedure as soon as possible. Evidence shows that the risk of complications increases the later the gestation.
Figure 5: Abortions by gestation weeks, England and Wales, 2004 to 2014
2.26 Over three quarters (80%) of NHS funded abortions took place at under 10 weeks, ranging 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% of the total. There were 211 such abortions in 2014 (See Table 5 and Table 9a).
2.28 In previous years a distinction was made between gestations of 24 weeks plus 0 days and 24 weeks plus 1 or more days. In tables, abortions that were 24 weeks plus 0 days were 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 were 24 + 0 days. 16
2.30 In 2014, no abortions at 24 weeks gestation were performed under ground C
Previous abortions 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 (See Table 11b).
2.33 Repeat unintended pregnancy and subsequent abortion is a complex issue associated with increased age as it allows longer for exposure to pregnancy risks (See Table B).
Table B: Percentage of women who had one or more previous abortions, by age, England and Wales, 2014
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