Abortions

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 Dept for Health show that for women resident in Blackpool in 2020:

• • The total number of abortions was 669 in 2020, up from 630 in 2019.
  • The age standardised abortion rate in 2020 was 26.8 per 1,000 women aged 15-44. This is an increase from the rate of 25.2 in 2019 and significantly higher than the England average of 18.3 per 1,000.
  • While nationally the all age abortion rate has been rising gradually from 2016, Blackpool has seen quite a sharp increase in the rate (Figure 1).
  • Like the national picture, the abortion rate was highest for women aged 20-24 years (at 46.1 per 1,000) though rates in Blackpool are significantly higher than the England average of 29.9 per 1,000 (Figure 3).
  • Over a third (38%) of abortions in Blackpool are to women aged under 25, this compares to 35% nationally.
  • The under 18 abortion rate, while higher than the England average, has generally followed the same decreasing pattern. 
  • There were 24 abortions to young women aged under 18 in Blackpool in 2020, a rate of 11.0 per 1,000. This compares to the England average of 6.8 per 1,000. See Teenage Conceptions for further information on under 18 abortions. 

Figure 1: Trend in abortion rate (all ages and under 18), 2010-2020, Blackpool and England

Blackpool has seen quite a sharp increase in the overall rate of termination of pregnancy (all ages), which is now approximately 1.5 times higher than the rate for England. However, this disguises the variation in rates between the different age groups. Similar to the national picture, rates are currently highest in the 20-24 year olds and 25-29 year olds (Figure 3). Nationally, data does show rising abortion rates in those women aged over 25 years while for those aged under 25 year the picture is generally static. This is different to what we see across Blackpool where rates are rising for both the under 25's and the over 25's (Figure 2)

Figure 2: Trend in abortion rates in women aged under 25 and 25 and over in Blackpool and England, 2014 - 2020

Age specific abortion rates are significantly higher in Blackpool for all age groups (except age 35 and over) when compared to the England average.

Figure 3: Age specific abortion rates, Blackpool and England, 2020

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 2020:

• 89.8% of abortions were carried out under 10 weeks. This compares to 79% in 2010 and 81.3% in 2015.
• 96.3% of NHS funded abortions in Blackpool are carried out by the independent sector compared to 79.1% across England.

Medical abortions now account for 84% of the total of all 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 anaesthetics¹.

• • In Blackpool in 2020, 586 (97.7%) of the abortions performed under 10 weeks was medical.
  • This compares to 93.1% nationally.

Repeat abortions and abortions after birth

More than 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. 

Across Blackpool in 2020:

• • Almost half (46.8%) of all abortions were repeat abortions. This compares to 42% across England.
  • Of the 313 repeat abortions, 88 were in women aged under 25 and 225 in women aged 25 and over.
  • The proportion of repeat abortions in women aged under 25 years was 34.2% in 2020. This compares with 29.2% nationally.
  • For women aged over 25 years, the proportion of repeat abortions was 54.6% across Blackpool compared to 48.9% nationally.
  • The repeat abortion rate has been increasing gradually both locally and nationally over the last few years. Across Blackpool, 2020 saw a stepped increase in the under 25 repeat abortion rate with the main increase being in those women aged 19-24 years. This may be explained by the way some services were delivered in 2020 due to the pandemic.

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.

• There were 100 (38.9%) women aged under 25 who had an abortion after a previous birth.
• This is significantly higher than the national average of 27.1% and the highest rate in the North West.

Figure 5: Proportion of repeat abortions and having and abortion after a birth, 2020

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 and guidance

Comprehensive Abortion Care (Best Practice Paper No. 2), Royal College of Obstetricians and Gynaecologists, 2015 - The paper sets out the essential elements of a high-quality abortion care service including comprehensive post-abortion care and contraception.

Comprehensive Postabortion Care (Best Practice Paper No. 3), Royal College of Obstetricians and Gynaecologists, 2016 - sets out the essential elements of postabortion care. 

NICE guideline [NG140] Abortion care, September 2019

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

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