Five in six abortions are now at home

In recent years, across England and Wales, there has been a huge shift in how and where abortions are performed. Data published by the Department of Health and Social Care for 2023 show that five in every six abortions are now performed at home by the woman herself. Only five years prior to this, in 2018, no woman was managing her NHS abortion at home, all abortions were performed in hospital or at an abortion clinic.

[i] [ii]

Medical abortions are not always fully effective, resulting in some women needing further medical intervention to treat the complications arising. In 2023, 12,000 women were admitted to an NHS hospital for such treatment, a total of 54,000 in the five years from March 2020—as recently stated by Baroness Sugg in the House of Lords and outlined in this earlier post: 54,000 complications to medical abortion over the past five years – Baroness Sugg

In response to Baroness Sugg’s comment about the decline in the complications rate since the start of telemedicine and pills-by-post in 2020, I have considered how this might be, largely, caused by a change in how treatments are being coded into the Hospital Episode Statistics.

Are women stating miscarriage rather than induced abortion?

It is plausible that because women are now self-referring to hospital when suffering from abortion complications—whereas in 2018 and before they would have been referred by an abortion provider—some might choose not to disclose their use of the abortion pills, and instead claim that their symptoms are resulting from a natural miscarriage.

The HES data for admissions to treat complications from a Spontaneous abortion (Miscarriage) are coded as O03.x and distinct from those coded for Medical abortion, O04.x. Comparing the total miscarriage treatments recorded in 2018 with the same for 2023, we find a drop in the total number in 2023 [iii] but this is in the context of fewer pregnancies and live births; an indicated rate of miscarriage treatments was 7% higher in 2023. It is not likely that the incidence of miscarriage would have increased by so much, pregnancies have not become less healthy to that extent. However, it is plausible that this increase is due to some women reporting miscarriage when in fact their complications are from an at-home medical abortion. Our analysis indicates that this may have been the case for 2,100 women in 2023, meaning that the total medical abortion complications treated, if correctly coded, would have been 14,100, a complications rate of about 5.8%, 1-in-17.

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[i] There were a total of 277,970 abortions; 200,750 in which mifepristone and misoprostol were self-administered at home and 27,820 in which the misoprostol was taken at home. 13,635 medical abortions performed at hospital or in a clinic and 35,765 surgical abortions.

[ii] Abortion statistics for England and Wales: 2023. (2026, January 15). GOV.UK. https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2023

[iii] Hospital admitted patient care activity – NHS England Digital. (n.d.). NHS England Digital. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity