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Termination of Pregnancy

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Introduction

One proxy for unintended pregnancy is information on abortions to understand which women are more at risk of an unintended pregnancy. Reducing unwanted pregnancies is an ambition in the Department of Health's Framework for Sexual Health Improvement in England (2013). The Department of Health's policy also states that women who request an abortion should have early access to services if legally entitled to an abortion under the Abortion Act 1967. Although Clinical Commissioning Groups (CCGs) are now responsible for commissioning most abortion services, local authorities are responsible for commissioning comprehensive sexual health services including contraception services and advice, and sexual health specialist services such as young people's sexual health and teenage pregnancy services, outreach, sexual health promotion and services in schools, colleges and pharmacies.

No clinical procedure is entirely risk-free and it is preferable that women have access to and use reliable contraceptive methods that prevent unplanned and unwanted pregnancy.  High termination rates, along with high rates of sexually transmitted infections (STIs) are also an indication of poor sexual health in the population. 

Facts and figures

Data from the Department for Health shows that for women resident in Blackpool in 2015:

    • The total number of abortions was 531, up from 508 in 2014.
    • The age standardised abortion rate was 20.1 per 1,000 women aged 15-44. This is slightly higher than the rate of 19.8 in 2014 and significantly higher than the national average of 16.2 per 1,000.
    • The abortion rate was highest for women aged 18-19 years (at 42.5 per 1,000) unlike the national picture where the abortion rates are highest for women aged 20-24 (Figure 2).
    • Almost half (49%) of abortions in Blackpool are to women aged under 25 compared to 42% nationally.
    • There were 41 abortions to young women aged under 18 in Blackpool in 2015, a rate of 16.1 per 1,000. This is significantly higher than the national average of 9.9 per 1,000.
    • The under-16 abortion rate in Blackpool in 2012-14 was 4.7 per 1,000 women compared to 3.0 per 1,000 across England1.

Figure 1: Trend in abortion rate (18-44 and under 18), 2009-2015, Blackpool and England

Trend in abortion rate (18-44 and under 18), 2009-2015
Source: Dept of Health, Abortions Statistics, England and Wales

Blackpool has seen no significant changes in the overall rate of termination of pregnancy (all ages), which remain significantly higher than the rates for England. However, under 18 rates have shown a similar decrease to the national trend with rates falling from 22.3 per 1,000 in 2009 to 15.5 per 1,000 in 2014. 2015 has shown a slight but not significant increase to 16.1 per 1,000.

Figure 2: Age specific abortion rates, Blackpool and England, 2015

Age specific abortion rates, Blackpool and England, 2015
Source: Dept of Health, Abortions Statistics, England and Wales

Abortions under 10 weeks

The Department of Health's policy is that women who request an abortion should have early access to services if legally entitled to an abortion under the Abortion Act 1967. The earlier abortions are performed the lower the risk of complications. Prompt access to abortion, enabling provision earlier in pregnancy, is also cost-effective and an indicator of service quality.

Department of Health data shows that in Blackpool in 2015:

    • 90.4% of abortions were carried out at under 13 weeks gestation and 81.4% were carried out under 10 weeks. This compares to 77% in 2009 and 37% in 2004 carried out under 10 weeks.
    • 96% of NHS funded abortions in Blackpool are carried out by the independent sector compared to 70% across England.

 

Figure 3: The number and proportion of abortions under 10 weeks, 2015
 Purchaser (%)   Gestation-weeks (%)   NHS funded abortions under 10 weeks gestation   
  NHS Funded  Privately Funded    3-9 10-12 13+ NHS funded abortions NHS funded abortions at under 10 weeks  
  NHS HospitalIndependent Sector Number Number 
 England  27.9 70.4  1.8   80.4 11.2  8.3  174,377  140,095  80.1 
 Lancashire  42.8 56.6  0.6  81.7  10.3  8.1  4,635  3,784  81.6 
 Blackpool  3.8 95.9  0.4  81.4  9.0  9.6  529  430  81.3 
Source: Dept of Health, Abortions Statistics, England and Wales

Figure 4: Proportion of abortions under 10 weeks gestation, upper tier local authorities, 2015

Proportion of abortions under 10 weeks gestation, upper tier local authorities, 2015
Source: PHE, Sexual and Reproductive Health Profiles

Medical abortions now account for just over half the total of abortions nationally. The choice of early medical abortion as a method of abortion is likely to have contributed to the increase in the overall percentage of abortions performed at under ten weeks gestation. Early medical abortion is less invasive than a surgical procedure and carries less risk as it does not involve instrumentation or use of anaesthetics2.

    • In Blackpool 360 (83.7%) of the abortions performed under 10 weeks was medical.
    • This compares to 62.7% nationally.
    • Of the abortions over 10 weeks, 11.1% were medical in Blackpool compared to 19.2% nationally.

Repeat abortions and abortions after birth

Over a quarter of England abortions in the under 25 year old age group are repeat abortions. This is an indicator of access to (or lack of) good quality contraception services and advice as well as problems with individual use of contraceptive method. The proportion of women having an abortion after a birth is a guide to awareness of post-partum contraception need at a local level and the possible need to develop more effective "secondary prevention" interventions to help the first-time pregnant and parenting young people manage their future reproductive lives and prevent further unplanned pregnancies.

Across Blackpool in 2015:

    • There were 200 repeat abortions in women of all ages, 64 in women aged under 25 and 136 in women aged 25 and over.
    • The repeat abortion rate in women aged under 25 is similar to the national average of 26.5%.
    • The proportion of repeat abortions in women aged under 25 years was 25%. This compares with 25% in 2009 and 27% in 2005.
    • By comparison, England's repeat abortions over the same period were 26.5% in 2015, 24.7% in 2009 and 24% in 2005.
    • There were 94 (33.1%) women aged under 25 who had an abortion after a previous birth.
    • This is a reduction from 37.6% in 2014 and is similar to the national average of 28.2% .

Figure 5: Proportion of repeat abortions and having an abortion after a birth, 2015

Proportion of repeat abortions and having an abortion after a birth, 2015
Source: Dept of Health, Abortions Statistics and PHE, Sexual and Reproductive Health Profiles

Women who may need additional support

    • Women having repeat terminations
    • Women with existing health conditions, which may make having a termination a riskier procedure
    • Younger women
    • Women experiencing sexual exploitation / sexual violence
    • Women refusing post-termination contraception

Current Services

Blackpool CCG commission 3 providers of termination of pregnancy.  Early medical terminations are available in Blackpool through Marie Stopes International (MSI) and South Manchester Private Clinic (SMPC) and in Preston through MSI.  Surgical terminations are available in Stockport through SMPC and Manchester through MSI.    The British Pregnancy Advisory Service (BPAS) also provide terminations out of Blackpool and Lancashire, for those women wishing to access them out of the area. 

Locally, termination of pregnancy services offer contraception, including long acting reversible contraception (LARC) to all women using their service, in an effort to prevent subsequent unplanned/unwanted  pregnancies and repeat terminations.  They also supply condoms and undertake Chlamydia and HIV testing.

Any women with existing health conditions that may make procedures higher risk, can access medical and surgical terminations through Blackpool Teaching Hospitals Trust.   

National and local strategies

The care of women requesting induced abortion (Evidence-based clinical guideline no 7) (Royal College of Obstetricians and Gynaecologists, 2011)  - The aim of this guideline is to ensure that all women considering induced abortion have access to a service of uniformly high quality.

Termination of pregnancy for fetal abnormality in England, Scotland and Wales (Royal College of Obstetricians and Gynaecologists, 2010) - This report is intended to assist doctors and other health professionals to support women and their families when a fetal abnormality is diagnosed and to help women to decide, within the constraints of the law, whether or not to have the pregnancy terminated.

NICE advice [LGB17] What can local authorities achieve by improving contraceptive services, March 2014

NICE guidelines [PH51] Contraceptive services for under 25s, March 2014

 


[1] ONS Conception statistics, 2014

[2] PHE, Sexual and Reproductive Health Profiles, Abortions under 10 weeks that are medical