A fundamental tenet of abortion care is the choice of the woman. This choice is not just about whether to have an abortion or not, but also about the choice of method by which the abortion is performed.
Data provided by the Department of Health for England and Wales show that being able to access the abortion method of your choice might depend on where you live.
Women being served by the Clinical Commissioning Groups in eg NHS Hartlepool and Stockton-on-Tees, and NHS South Tees, are very much less likely to receive their abortion method of choice – why?
In 2016, 190,406 abortions were provided across England and Wales, 4,810 of which were provided to non-residents.
There is a trend towards a choice for medical abortion (taking tablets – mifepristone and misoprostol) – in 2016 62% of abortions were medical, the remaining 38% by a surgical method.
Medical abortion is usually only provided up to 10 weeks gestation and in 2016, 81% of abortions in England and Wales were performed at under 10 weeks. This means that some women who present for an abortion at under 10 weeks choose a surgical method.
Across England and Wales, 98% of abortions are funded by the NHS; 30% are provided in NHS facilities and 68% by the Independent Sector, eg MSI and BPAS.
We expect abortion data trends and averages to be broadly the same across the country, and so when we note large variances we should ask why? Variation from one Local Authority to another could of course be for a large number of reasons, including some random factors, but these differences might also be influenced by local policy decisions.
The above graph shows that in places in which the lowest proportion of abortions are being provided by the Independent Sector, there seems to be a correlation in a lower proportion of abortions being provided by a surgical method.
NHS Hartlepool and Stockton-on-Tees, and NHS South Tees are particular outliers:
- Less than 3% of abortions are provided by the Independent Sector, compared to an average of 70% across England;
- Only 2% of abortions are provided by a surgical method, compared to an average of 38% across England;
- 78% – 80% of abortions in these two locations were performed at under 10 weeks gestation, the same as the avg across England.
Note: data for 2015 show similar results, so this is not because of the withdrawal of services by MSI in some places during Q3/4 of 2016.
Why is abortion different in these locations…
Would we be correct in thinking that it’s probably not a difference in the local women’s choice, and more likely to be caused by policy and system bias?