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6 February 2014

UK: Abortion and contraceptive failure

Data released by the British Pregnancy Advisory Service (bpas) indicates that two thirds (66%) of women having an abortion at its clinics reported using a form of contraception when they conceived.

bpas looked at contraceptive use of more than 150,000 women aged 15 and over receiving care at its clinics over the past 3 years. The analysis showed:

• Two thirds (66%) of women having an abortion at bpas reported using a form of contraception when they conceived. 40% of these say they were using the contraceptive pill, the most popular prescribed contraceptive in the UK. Contraceptive pills have a ‘perfect use’ failure rate of just 1% when used exactly as instructed,  but with ‘typical use’ around 9 in 100 women will become pregnant a year. Reasons for failure may include missed pills, stomach upsets, or taking other medications.

• Just over a third of women (35%) having an abortion at bpas became pregnant while using condoms, which are used by 1 in 4 people in the UK. With perfect use, 2 in every 100 women using condoms will experience an unintended pregnancy each year. With typical use - in which the condom is sometimes not put on or taken off properly - that increases to 12 in every 100.

• A third of all women having an abortion at bpas reported not using contraception when they conceived. The proportions of women reporting not using contraception when they conceived are lowest among younger women undergoing abortion, with 31% of women aged 15-24 reporting no use, rising to over 42% of women over 40.

The reasons for not using contraception are diverse: sex may be unplanned and women are not prepared.  A small group of women will be ending a planned pregnancy, and there will also be instances of coercion into unprotected sex.

But many do not use contraception because they under-estimate their fertility and the risk of pregnancy. For older women this may be linked to public health messaging about the difficulties their age group faces conceiving wanted pregnancies. For younger women, the belief that a previous diagnosis of chlamydia may have permanently damaged their fertility is not uncommon, or if they have had unprotected sex and did not become pregnant they assume they are infertile.

An increasing number of women across all age groups report being unhappy with the side-effects of some hormonal contraception, or believe they are not having sex frequently enough to warrant long-term contraception. Some then switch to fertility awareness and/or withdrawal which requires a lot of attention, commitment and control.

Ann Furedi, chief executive of bpas, said:

‘Contraception fails and sometimes we fail to use it properly. In our experience women are trying hard to avoid unwanted pregnancy, or sometimes vastly underestimate their own fertility.

‘An unintended pregnancy is often a happy accident – and a large proportion of births in this country are unplanned. But for many women an unplanned pregnancy causes considerable distress, coming at a time in their lives when they are not in the position to start or expand their family.  Ultimately women cannot control their fertility through contraception alone, and need accessible abortion services as a back-up for when their contraception lets them down.

‘We need new contraceptive options. We are excited by research into a “pericoital” pill that women could take at the time of sex. This would be of great benefit to those women who don’t feel they are having sex often enough to need an on going method, but who do not wish to rely solely on condoms.’

Women trying hard to avoid unwanted pregnancy, research shows. British Pregnancy Advisory Service, 4 February 2014

How the contraceptive pill fails to stop abortions. Metro, 4 Feb 2014

Contraception failures behind many abortions. Nursing Times, 5 February 2014

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