Implementing the abortion regulations in Northern Ireland.

CBP 8909

Background

On May 22nd, 2020, the House of Commons Library published a briefing paper, CBP 8909, detailing the recent changes to the abortion legal framework in Northern Ireland.

Section 9 of the Northern Ireland (Executive Formation etc) Act 2019, changed the law on abortion in NI, decriminalising it and placing a regulatory duty on the UK Government to ensure that recommendations in paragraphs 85 and 86 of the CEDAW report are implemented.

The new regulations came into effect on March 31st, 2020. These regulations will be debated in the Commons on June 8th and in the Lords the following week, and then there will be a vote on whether to approve these or not; this parliamentary process needs to be completed before June 19th.

As one would expect, this is a highly contested matter, with strongly opposing views being expressed by all lobbies. Here are just a few of the issues which will be raised in the upcoming debates:

  • Whether it is right for Westminster to impose these regulations on the Northern Ireland Assembly, given that abortion is a devolved matter.
  • Whether there is a legal obligation on the UK Government, and thus also on the NIA, to implement the recommendations made by the UN in the CEDAW report.
  • Whether it is right for the proposed abortion regulations in NI to be much more liberal than, or different from, those applying across the rest of the UK.
  • How and by whom will the Department of Health in NI be directed to implement the required abortion services.

A lot can still change over the next two weeks, and so in writing this I am assuming that abortion services will be legal in NI and will need to comply with CEDAW. I am writing from a public health perspective and I’m not making any statement or judgement about abortion ethics. I’m not addressing every point made in paragraphs 85 and 86, just selecting three which I think are the least contentious and could be adopted by any of the lobbies.

Independent Counselling.

I recommend the implementation of professional, comprehensive counselling for all women presenting for a termination of pregnancy. This should be provided independently from the abortion service providers (ie not by them) and be designed to fully deliver against both paragraph 86(a) of CEDAW and the DHSC RSOP 12.

Women deserve to be given impartial, accurate and evidence-based information, and be offered the opportunity to discuss their options and choices with an appropriately trained counsellor. Counselling must be non-directive and non-judgemental and should not create barriers or delays. Counsellors should undergo continuous professional development and training similar to other professionals.

Support Services.

The NIA needs to focus attention and resources into improving the support services needed for women facing a crisis pregnancy and for those with concerns and worries about how they might cope with motherhood. This of course applies to those choosing to carry to term a disabled child, but equally so to those with any other concerns and issues raised by their pregnancy. The proposed grounds (indications) for a legal abortion in NI are broad and so support services need to also be just as broad, on a matching basis.

Nuance and Indications.

We need to be much more nuanced in how we regulate the indications for abortion and what we term as abortion.

An abortion on-demand by choice of the woman is not the same as a medical intervention to save the life of the woman or to remove a fetus or baby after an intrauterine death.

We need to stop conflating these.

An abortion, if we must call it that, should be accepted by all as necessary, legal, and ethical in each and all the following.

  • To save the life of the woman.
  • Intrauterine death.
  • Fatal fetal abnormalities.

These services need to be provided in NI with compassion and respect.

 

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Stand Up and Smile

SUAS-Share-ImageNext week, June 3rd, a cross-party group of MPs, led by Fiona Bruce, is bringing forward a Private Members Bill to clarify that minor disabilities are not grounds for abortion. Our current legislation states that an abortion can be performed when 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)). This is Ground E, which can be applied as the reason for an abortion at all gestations, right up to birth.

Bruce et al are contesting the inclusion of cleft lip, cleft palate, and club foot as indications for Ground E.

The NHS states that cleft lip and palate is the most common facial birth defect in the UK, affecting around 1 in every 700 babies. It goes on to detail how this can be treated and says that most children treated for cleft lip and palate grow up to have completely normal lives.

In 2018, we can estimate that 950 babies were diagnosed with cleft lip and palate, either in the womb or at birth, and DHSC data shows that 15 were aborted for this indication.

15 is quite a small number compared to the total number of abortions, 200,608. Even when compared to the total number born with cleft lip and palate, this is less than 2%.

So why bother bringing forward this Bill, what’s all the fuss about?

Mrs Bruce has said that the law as it currently stands does not consider changing attitudes towards disabilities and contradicts the 1995 Disability Discrimination Act, which makes it an offence to discriminate on the basis of disability.

Bruce, whose own son was born with club foot, said: “It’s time our legislation caught up to reflect society’s positive change in attitudes towards those born with disabilities, and medical advances in the intervening years.”

She added: “This is a sensible law change that I am inviting all MPs, regardless of where they stand on the wider issue of abortion, to get behind and support.”

Cleft lip, cleft palate, and club foot are minor disabilities which can be successfully rectified, and so I don’t consider these to be indications for Ground E. I stand with Bruce et al and wish them success with their Bill. This is a sensible law change which all MPs, and all of us, should support.

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Abortion at Home – eight weeks in

On March 30th, 2020, the Secretary of State for Health and Social Care gave approval to a change permitting women to self-administer both abortion pills at home. This temporary approval was made in the context of the Covid-19 pandemic and the need to restrict travel and clinic visits.

RCOG Changes 200321On March 21st, anticipating this approval, the Royal College of Obstetricians and Gynaecologists (RCOG) issued guidelines to be used in the provision of abortion services during the Covid-19 pandemic. This screenshot shows the changes recommended to minimise Covid-19 exposure for women and providers.

In an earlier post I noted the public health mandate for these changes, but also noted the need for an ongoing evaluation of the impact.

It is now eight weeks since the approval came into effect and I am making the following projections based on the 2018 data which are the latest published by the DHSC.

  • 24,000 women will have presented at <10 weeks gestational age and requested a termination of pregnancy.
  • Of these, some 9,500 will have noticed the differences in how the service is being provided now compared to when they last had an abortion. They will have noted that the clinic visit is no longer required and a few of the steps which they previously followed are no longer part of their client journey towards an abortion. There was no ultrasound scan and so they were asked to self-assess the GA of their pregnancy based on their recall of LMP.
  • Perhaps as many as 1,600 will have discovered that the surgical procedure, which they had chosen the last time, was either not offered or not so easily accessible due to clinic closures and the Covid-19 lockdown restrictions on travel.
  • Based on the most optimal outcome projections, for some 750 women their abortion will not have been complete after taking the prescribed treatment. They will either have needed to take the additional dose of misoprostol provided in the treatment pack or travelled to a clinic for surgical intervention.

 

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The impact of abortion on global population growth

Summary

I think we must consider the impact of abortion when discussing future population growth. Based on current data and the UN projected rates, the availability of abortion choice reduces population growth over the next eighty years by 43%, enabling the projected 11.2b rather than 16b, a reduction of 4.8 billion.

Discussion

Our global population has been growing at an exponential rate, many of us would consider that it’s been growing at an alarming and worrying rate. In 1800, the population was just one billion, it is now more than seven and a half billion, (7,800,000,000). The rate of annual increase was 2.2% fifty years ago, but this has now slowed to 1.05% pa.

The UN projects that this rate of population increase will continue to slow, becoming just 0.1% in 2100, by which time there will be 11.2 billion people alive on Earth, a 40%+ increase over the next 80 years.

We already feel crowded and have concerns about eg the environment, health and social services, tensions between those of us who have enough and those who struggle. How will we cope with another 40% globally?

The number by which our population grows is the sum of total births minus total deaths. In 2020, there will be a projected 140m births and 60m deaths, so the population will increase by 80m. In 2099, the UN projects 130m births and 120m deaths, a population increase of 10m.

The number of births each year depends on the number of women of reproductive age (WRA) and their fertility rate. The total fertility rate (TFR) in 2015 was 2.49. This means that on average a woman who survives to the end of her reproductive years, age 49, will give birth to an average of 2.49 children, based on the age-specific fertility rates current in 2015.

TFR has been falling – in 1950 the global average was 5.05, in 1980 it was 3.7, in 2000 2.67, and it is projected to be 1.96 in 2099.

It is worth noting that a TFR of about 2.1 children per woman is called replacement-level fertility and is the level of fertility at which a population exactly replaces itself from one generation to the next.

total-fertility-rate-including-un-projections-through-2100

There are many reasons for this reduction in the fertility rate. Max Roser provides a very helpful overview of the academic research attempting to answer the question, ‘why has the number of children per woman declined?’. This is accompanied by an excellent set of empirical data and analysis.

There’s little doubt that the halving of the TFR since 1950 has largely been because of the increased availability, accessibility, and affordability of modern, effective contraception.

I suggest that we must also consider the impact of abortion on this falling TFR, and on the number of live births. The WHO and the Guttmacher Institute estimate that in 2015 there were at least 50 million abortions worldwide. A small percentage of these will have been for cases in which the life of the mother was at risk, or in cases of rape or incest, or in cases of fatal fetal abnormality. In the UK, these cases account for ~3%, but for the purposes of this discussion let’s assume these are 10% of all abortions, the balance being the choice of the woman. On this basis, we could say that there is one abortion by choice for every three live births.

This is a significant factor in our consideration of the projected global population.

Without the choice of abortion, the TFR in 2015 would have been one third higher, 3.32 vs 2.49.

The Impact of Abortion on Global Population Growth

When we account for annual abortions, starting with 45m in 2021, and using the same rates of birth and of death as projected by the UN, we arrive at a total global population of 16 billion in 2100, which is double the current population and a 43% increase on the UN ‘medium variant’ projection of 11.2b.

I am not at all suggesting that abortion is a means of contraception, it clearly is not; nor am I suggesting that it should be considered as a method for family planning. I am saying that the continued choice to have an abortion will have a significant impact on the possible future size of our population.

When modelled based on the current data and the UN projected rates, the availability of abortion choice reduces population growth over the next eighty years by 4.8 billion. It’s a modelled projection and many of the underlying assumptions might of course change with time, eg the relative rate of abortions could be reduced with an increase in the uptake and improved use of effective contraception.

 

References

Max Roser, Hannah Ritchie and Esteban Ortiz-Ospina (2020) – “World Population Growth”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/world-population-growth‘ [Online Resource]

Max Roser (2020) – “Fertility Rate”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/fertility-rate‘ [Online Resource]

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Safety and acceptability of medical abortion through telemedicine after 9 weeks of gestation

BJOG Endler et al

This was a cohort study of 615 women in Poland who had requested and proceeded with a medical abortion (MA) through telemedicine with Women on Web (WoW), @abortionpil, during the period June 1st to December 31st, 2016.

The study was published online on December 28th, 2018.

The objective was to assess the safety and acceptability of abortion through telemedicine at >9 weeks gestational age, (GA is measured from the first day of LMP). This is in the context of WHO and FDA guidelines which, at the time of this study, limited the self-administration of misoprostol by women at home to GA of 9 and 10 weeks, respectively.

The key findings noted by the authors are that neither safety nor acceptability are affected by the increase in GA at the time of self-administration of the abortion pills, but there is an association for GA >9 with a higher risk, four-fold, of clinical visits by women and this risk continues to increase as their GA increases; more than one-in-eight women with GA >9 weeks made such a visit.

Other results worth noting for further investigation include:

  • Even at ≤9 weeks GA, 45% of women reported that their rate of bleeding was higher than expected, increasing to 57% for those women >9 GA.
  • One-third of all women, regardless of GA, reported that their rate of pain was higher than expected.
  • Both of the above, might indicate a weakness in the guidance and information provided during the consultation and pre-counselling.
  • The rate of surgical intervention needed to complete the abortion was much higher than expected. In the ≤9 weeks GA group this rate was 8.6% compared to a predicted 3%. For >9, the rate was 14.9% compared to a predicted 7%. One-in-nine women taking the abortion pills at home needed a surgical intervention to complete their abortion.
  • There was a high rate for lost-to-follow-up, LTFU, was 35% – it would be interesting to review what this rate is for legal abortion-at-home in GB during the COVID-19 regulations.
  • The authors noted some uncertainty about the self-reporting of gestational age.
  • Provider organisations should carefully evaluate the clarity and effectiveness of the advice and guidance which they provide to women, and how well this prepares women for self-administration and self-management of the abortion process.

 

Abortion law in Poland

Abortion access is restricted by law in Poland; the authors estimate these laws prohibit the termination of unwanted pregnancies in 97% of cases, allowing the procedure only in case of severe danger to the life of the woman or fetus, or if the pregnancy results from a criminal act, such as rape or incest. WoW, and others, consider telemedicine abortion services as an essential means of overcoming the lack of access to safe abortion in many countries. They provide online consultation and guidance and send the abortion medication by post to women who otherwise would resort to less safe, or even unsafe, methods.

 

Higher Risk of Hospital Visits

The authors conclude that medical abortion through telemedicine at >9 weeks of gestation is associated with a higher risk of same-day or day-after clinical visits for concerns related to the procedure, and this risk increases with gestational age. 22.5% of the women with a GA of 11-14 weeks made such a visit, compared to 11.7% for GA 9-11, and just 3.3% for ≤9 weeks. This means that in this study, women with GA of >9 weeks had a four-fold increased risk of clinical visits, compared to those at ≤9 weeks.

 

Bleeding and Pain – more than expected

The authors conclude that self-reported rates of heavy bleeding, low satisfaction, or unmet expectations with medical abortion do not increase with gestational age.

However, it is worth noting that a significant proportion of these women did report that the rate of bleeding and of pain were more than expected:

Among women undergoing an abortion at ≤9 or >9 weeks of gestation, the rate of bleeding more than expected was 45.6% versus 57.8% and the rate of pain more than expected was 35.6% versus 38.8%.

The experience of more bleeding or more pain did not impact the safety of the abortion procedure and did not seem to lower the level of women’s satisfaction / acceptability.

 

Lost to follow-up (LTFU)

During the study period, 1,220 women in Poland contacted WoW requesting a MA. It’s interesting that all of those who made contact were ‘approved’ by WoW for the MA and sent the medication. 13.6% of women received the medication but decided not to use it. WoW was unable to confirm what happened for 427, 35%, of the women who made no further contact after the medication was sent. The authors state that this hight rate of LTFU, 35%, was in line with other studies and so within an expected range.

This drop-our rate of almost 50% is much higher than one might expect, especially with such a large group, and is worth watching for future studies and evaluations of abortion-at-home operations in GB and other countries during this COVID-19 pandemic.

 

Surgical Intervention

A total of 615 women self-administered the abortion pills at home, of which 427 were ≤9 weeks GA and 188 >9. Follow-up data were collected from 419 of this group, of which 295 were ≤9 weeks GA and 124 >9.

37 women of ≤9 GA had a surgical intervention (vacuum aspiration or D&C after medical abortion) in order to complete their abortion. Assuming all those not participating in the follow-up were complete after the medication, the rate requiring this intervention is 37/427 = 8.6%. The rate for those who were >9 weeks is 28/188 = 14.9%.

One-in-nine (65/615) women taking the abortion pills at home needed surgical intervention in order to complete their abortion.

These rates are well above the normally stated expected failure rates for MA using a combination of mifepristone and misoprostol. BPAS shows on its website an expected failure rate requiring surgical treatment of 3% for GA ≤9 weeks and 7% for >9.

The authors note this higher than expected rate and muse if perhaps this is related to clinical practice in Poland.

This higher reported failure rate at-home compared to in-clinic, is worth further investigation.

 

Self-assessment of GA

Throughout the report, there are numerous mentions of some uncertainty about the actual GA at the time of taking the abortion medication. WoW rely on women accurately self-reporting the first day of their last period, and whilst some studies show that women do so with satisfactory accuracy, there is enough uncertainty to warrant further investigations into this.

 

Additional doses of misoprostol

It is reported that WoW routinely sends an additional dose, 800 mcg, of misoprostol to women reporting to be >9 weeks GA, though the authors note the uncertainty of predicting the GA at the time of self-administration of the pills. The reason for doing this is the expectation that for some women their abortion will not be complete after the first dose of misoprostol, but one cannot predict to which women this will apply. Providers in GB, and in other countries, are now routinely sending additional doses of misoprostol to all women participating in abortion-at-home during the COVID-19 regulations.

 

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New York Times – Abortion by Telemedicine

 

NYT TelAbortion

 

The New York Times published a piece about the Gynuity TelAbortion trial being conducted in the USA. This is an interesting read, one which I consider to be insightful about what abortion-at-home is and how it is experienced by some women. This is timely given the recent changes in regulation to permit abortion-at-home for women in GB.

Below, I have listed some takeaway points, in the order in which they appear. From these I consider the following to be worth watching and for possible further review.

 

 

For Further Review.

  • On April 22, 2020, this trial had sent abortion pills to 841 women, and 611 had so far confirmed completed abortions, ~73%.
  • For 26 out of 611, 4%, of these women their abortion was incomplete after taking the pills and they needed to attend a clinic for surgical aspiration to finish their abortion.
  • 42 of the 611 women, 6.8%, attended the ER or an urgent care centre because of issues arising from taking the pills or for other concerns related to their pregnancy – 27 of these, 64%, received some form of medical treatment.
  • Because of the COVID-19 lockdown, TelAbortion is considering waiving the requirement for women participating in the trial to first have an ultrasound to assess the gestational age of their pregnancy – ultrasound has been removed as a requirement for abortion-at-home in GB during the pandemic.

 

Takeaways.

Women choosing an abortion, often already have children.

Medical abortion is often likened to having a miscarriage.

Abortion through telemedicine is an increasing choice of method, being driven now by the COVID-19 pandemic lockdown, but it was already being trialled before this.

One such trial called TelAbortion, is being conducted by Gynuity Health Projects in the USA.

On April 22nd, 2020, this trial had sent abortion pills to 841 women, and 611 had so far confirmed completed abortions, ~73%.

In the USA 60% of women eligible for an early medical abortion, GA <10 weeks, choose MA over the alternative surgical methods – in England and Wales even more women are choosing MA, in 2018 the percentage doing so was 83%.

Some of the usual regulations have been relaxed for the trial, specifically removing the need for a woman to first visit a clinic and allowing the self-administration of the mifepristone and misoprostol by the woman at home.

Though the NYT does not say how many women it interviewed, it states that seven of these women expressed conflicted emotions when making the decision to have an abortion.

Women who have an abortion come from all walks of life, there is no one type – they are not singularly identified by anything, not by age, relationship status, gravidity, parity, medical history, occupation, income, ethnicity, location, education, faith, or worldview.

There are many different reasons why women choose abortion.

Some women don’t want others to know that they are having, or have had, an abortion – others proclaim it for all to hear.

Some women have the support of their loved ones when making the abortion decision, and some don’t and so need to go ahead alone.

The legal status of TelAbortion is still not settled in the USA, in many States it is currently being debated – the use of telemedicine and self-administration of both pills by women at home has been approved by the UK government during the COVID-19 lockdown.

Across the USA, it is difficult for some women to access abortion services close to where they live, even before lockdown – lobbyists hope that trials such as this will help to change how abortion access and service provision are regulated.

Rightly or wrongly, doctors tend to downplay the discomfort which might be experienced by a woman during the abortion, especially after taking the misoprostol.

For 26 out of 611, 4%, of these women their abortion was incomplete after taking the pills and they needed to attend a clinic for surgical aspiration to finish their abortion.

42 of the 611 women, 6.8%, attended the ER or an urgent care centre because of issues arising from taking the pills or for other concerns related to their pregnancy – 27 of these, 64%, received some form of medical treatment.

11 women decided not to proceed with the abortion and did not take the pills they were sent.

One woman continued her pregnancy after the pills failed and another also continued after vomiting the mifepristone.

16 women from this group of 611 have had two TelAbortions.

The programme operates a 24-hour telephone contact line for emotional support – just one of those interviewed by NYT had used this.

Because of the COVID-19 lockdown, TelAbortion is considering waiving the requirement for women participating in the trial to first have an ultrasound to assess the gestational age of their pregnancy – ultrasound has been removed as a requirement for abortion-at-home in GB during the pandemic.

Some women struggle with doubt about their decision to have the abortion, for some time after doing so.

Some doctors underestimate the size of the embryo, which at GA of 8.5 weeks is about the size of a raspberry, not a grain of rice.

It is unlikely that a woman will see anything recognisable as a foetus when expelling at GA of 9 weeks or less.

Misoprostol tastes like chalk.

The cramps and bleeding, for some women, might last seven hours, and be described as ‘not easy’.

 

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Abortion Should Change During COVID-19 Pandemic – but how?

ScreenClip[3]RCOG Guidance

My Twitter feed is filled with heartfelt pleas for governments to act now and to change laws which regulate the provision of abortion services. The COVID-19 pandemic is being leveraged by lobbyists to fast-track changes, which years of campaigning and protesting have not yet been able to accomplish.

What is fascinating, is that this same tactic and behaviour is being adopted by both sides.

This is a great illustration of just how contested abortion is, and how deeply lobbyists are entrenched in their own worldviews, and by the way, on this issue we are probably all lobbyists in one way or another.

Abortion is not a trivial matter, it affects some 55 million women each year, and given what it is, it is not surprising that there are these deeply held, emotionally invested, differences of opinion on how we as a society should be dealing with it.

160302172858-texas-abortion-law-0302-exlarge-169We will not be able to resolve contested issues and move forward by staying in our own trenches. It is time to try putting emotion to one side and engage with one another in objective, rational debate. Around the table, could we engage on these:

  • Is abortion a necessary, essential element of healthcare, does this depend upon medical indications or grounds for choice?
  • How should abortion services be regulated by national laws, or is it time to decriminalise?
  • Is it okay to act from your own worldview, ignoring local regulations, and advocate by doing?
  • How and where should women be able to access comprehensive safe abortion care?
  • Post-pandemic, should telemedicine be used to enable abortion at home, and if so, how can we ensure that this is as safe as face-to-face?
  • What are the issues which need to be addressed before abortion services are shifted to pharmacies and self-managed by women?
  • How should abortion services be paid for?

 

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Abortion Rate in NI is Significantly Lower

One in six

In a recent post, in response to the common statement that across GB, an estimated one in three women will have an abortion (at least one) by the age of 45, I suggested that it might be better to say:

One in six women who become pregnant
will have at least one abortion in their lifetime.

Here, I want to consider the abortion rate applying to women in Northern Ireland (NI).

The ONS indicates the 2018 population of NI to be 1,881,641, of which 359,170 are women of reproductive age (WRA). Link here.

The DHSC indicates that in 2018, a total of 1,053 women from NI had an abortion provided by a clinic in England and Wales. Link here (PDF).

From these data we can derive an abortion rate for NI women of 2.9 abortions per 1,000 WRA per annum. The rate for women resident in England and Wales is 17.4, almost six times higher.

Of course this rate of 2.9 includes only those NI women who travelled to England or Wales for their abortion procedure, but even if we assume that a similar number procured abortion pills online, the rate of 6 per 1,000 is still very significantly less than women in England and Wales.

One might conclude from all the above, that perhaps abortion is not as normal, not as common, as some might say that it is, especially in Northern Ireland.

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Global Deaths by Age

In 2014, there were approximately 55 million deaths globally.

Our World in Data provides an estimated breakdown of these by age group: link here.

Global Deaths

Not surprisingly, most deaths occur in the 70+ age group, and least in 5-14.

Under-5   5,920,000
5-14      775,068
15-49     7,730,000
50-69     14,500,000
70+       25,890,000

Official data sources do not count the number of fetuses aborted before the age of viability, in the numbers of deaths. A fetus is not a legal person, and so it makes sense from a legal perspective to not include these.

However, from a public health perspective, we do count and analyse the numbers of abortions.  It is of some interest to note that in 2014 there were approximately 56 million abortions globally; source Guttmacher Institute here.

This is the same graph when adding abortions into the above data.

Global Deaths plus abortions

 

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One in Six – not 1-in-3

There is a very common statement that across GB, an estimated one in three women will have an abortion (at least one) by the age of 45. I want to explore this and consider three points:

  1. How is this rate estimated?
  2. What are the key assumptions in the estimation?
  3. So what?

From my workings below, and because only a pregnant woman can have an abortion, I think it would be better to say:

One in six women who become pregnant will have at least one abortion in their lifetime.

How?

The DHSC reports that in 2018 there were a total of 200,608 abortions for residents in England and Wales. It reports an abortion rate of 17.4 per 1,000 resident women of reproductive age (WRA) and that 39% of women who had an abortion had one or more previous abortions (78,237). Summary report here. (PDF)

From this we can derive that there are ~11,500,000 WRA. The age range used when counting WRA is from 15 to 45, so a total number of 30 years.

In 2018, 122,371 women resident in England and Wales had their first abortion. Extrapolating this for 30 years for all WRA, we get:

(122,371 x 30) / 11,500,000 = 1/3 (one-in-three).

Assumptions?

I suppose the key assumption which I want to challenge, is that all WRA will at some point become pregnant and perhaps consider the choice of abortion. What if we recalculate this estimation based on the numbers of women becoming pregnant? After all, only pregnant women can have an abortion.

So?

The Office for National Statistics (ONS), reports that in 2018, there were 839,043 conceptions to women in England and Wales. Link here.

Let’s first exclude those women who have already chosen to have an abortion for an earlier pregnancy, which in 2018 is a reported 78,237.

That leaves us with 760,806 women who became pregnant in 2018 and who had never before chosen an abortion.

In 2018, 122,371 women choose an abortion for the first time.

The calculation is:

122,371 / 760,806 = 0.16

Conclusion?

An estimated one in six women who become pregnant, will have at least one abortion in their lifetime.

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