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11 July 2013

Early abortions, ‘repeat’ abortions, and terminations for fetal anomaly

Jennie Bristow analyses three issues of note in the 2012 national abortion statistics.

The 2012 abortion statistics, published on 11 July, reveal another small fall in the total number of abortions, and in the abortion rate. The key findings are reproduced here. Below, we draw attention to three issues of particular interest.

The proportion of early abortions

It is recognised that one of the ‘success stories’ of abortion provision in recent years has been the shift, within first trimester abortions, to much earlier procedures. In 2012, 77% of abortions took place at between 3 and 9 weeks, compared with 57% in 2002: reflecting advances in pregnancy testing and, in particular, the use of Early Medical Abortion (the ‘abortion pill’) (Table 3a; para 2.23). However, in 2012 the proportion of abortions at under 10 weeks (77%) was slightly lower than in 2011 (78%), and this does raise a potential cause for concern.

The year-on-year increase in ‘very early’ abortions has not reduced the need for abortion in the second trimester. While the proportion of abortions performed at 13-19 weeks’ gestation has fallen, from 11% in 2002 to 7% in 2012, the figures show a steady and continuing need for abortions at these gestations. Similarly, the proportion of abortions at over 20 weeks’ gestation remains at between 1% and 2%.

The need for abortion provision in the second trimester reflects a number of reasons women may have for delay in the abortion decision, including not knowing they are pregnant, needing time to make their decision, and having difficulties in accessing services. (See Second-Trimester Abortions in England and Wales, by Roger Ingham, Ellie Lee, Steve Clements and Nicole Stone (2007)). It also reflects the situation confronting women who have a diagnosis of fetal anomaly – discussed below – which will often take place in the second trimester, or at the very end of the first.

‘Repeat’ abortions

In 2012, 37% of women undergoing abortions had one or more previous abortions: a rise from 36% in 2011. While these figures are often disparaged as ‘repeat abortions’, it is important to note that of this 37%, the majority (27%) had had one previous abortion, 7% had had two, and 2% had had three (Table 4b).

Furthermore, as the Department of Health’s statistics report states: ‘Repeat unintended pregnancy and subsequent abortion is a complex issue associated with increased age as it allows for longer exposure to pregnancy risks’ (para 2.20). So women aged 30 or over were far more likely to have had a previous abortion (45%) than younger women.

Termination of pregnancy for fetal anomaly

The 2012 statistics list the principal medical conditions for abortions under Ground E. This is the clause that allows for abortion on the grounds of ‘serious handicap’: such abortions are permitted beyond 24 weeks, although abortions after 24 weeks must take place in NHS hospitals (rather than in independent sector clinics).

The 2012 statistics show 2,692 abortions under Ground E, 1% of the total number of abortions, of which 160 took place over 24 weeks’ gestation (Tables 2 and 9a). This compares to 2,307 and 146 respectively, in 2011. While the rise is too small to be of much significance, it is worth stressing that an increase in Ground E abortions in the current period should not be surprising. It can be seen to reflect, first, the improvements in antenatal screening tests, both in the earlier stages of pregnancy and sonography in the later stages.

Second, it could be seen to reflect the wider trend of delayed fertility. It is widely known that women who become pregnant later in life have a higher risk of carrying a fetus with anomalies; and indeed, the statistics show that 4% of all abortions to women aged 35 and over were carried out under Ground E, compared to 1% or 0% for other age groups (Table 2).

This year’s statistics also show the ‘number of mentions’, indicating that abortions for fetal anomaly are often performed because of more that one medical condition. This is a useful reminder that women terminating pregnancies for reasons of fetal anomaly are often grappling with then probability that, if they continue the pregnancy to term, their baby might have a number of conditions, which may range in severity.

One useful addition to the abortion statistics this year is that they reveal the method of termination used in cases of fetal anomaly. For abortions performed under Ground E under 13 weeks’ gestation, 55% are performed surgically and 45% medically. The proportion of surgical abortions decreases with gestation, to 43% at 13-14 weeks; 20% at 15-16 weeks; 10% at 17-18 weeks; 1% at 20-21 weeks; and 3% at 22 weeks and over. (Table 9c)

This is in marked contrast to trends in abortions performed in general. Of these, medical abortions account for a high proportion of very early abortions (from 3-9 weeks); after that, abortions are much more likely to be carried out surgically. When all grounds are taken together, surgical abortions account for 85% of abortions at 10-12 weeks; 75% at 13-14 weeks; 76% at 15-19 weeks; and 65% at 20 weeks and over (Table 7a).

This reflects that the independent sector – which carries out 62% of all abortions funded by NHS contract (Figure 3) – tends, for reasons for best practice, to use surgical methods at gestations beyond 10weeks. A particularly striking finding is that 80% of abortions at 23 weeks use surgical methods (reflecting the fact that late abortions, in general, are likely to take place in the independent sector), whereas 93% of all abortions at over 24 weeks (performed in the NHS, under Ground E) use medical methods.

This raises questions to do with the extent to which women undergoing termination for fetal anomaly do not have the choice of method available to women who access abortion for other reasons. For women with a diagnosis of fetal anomaly who present for abortion under 24 weeks, greater collaboration between the NHS and the independent sector could ameliorate this situation.

Abortion Statistics, England and Wales: 2012. Department of Health, 11 July 2013

Also read:

UK: Abortion Statistics 2012. Reproductive Review, 11 July 2013

bpas Reproductive Review print edition, Summer 2013. Download it for free here. Contents include:

- Termination of pregnancy for fetal anomaly: Diagnoses and Dilemmas, by Jennie Bristow
- Clinical update: Methods of termination for fetal anomaly, by Dr Richard Lyus
- Post-24 week termination for fetal anomaly – the chilling effect of the Jepson campaign, by Jane Fisher
- We can trust women to make decisions that are right, by Ann Furedi
- The policing of abortion services in England, by Dr Sam Rowlands
- News digest, February-April 2013
- Events
- From the Journals