Abortion time limits
A briefing paper from the BMA
Part one - Background to the debate
It is a legal requirement for any registered medical practitioner who terminates a pregnancy to provide notice of the termination to the relevant Chief Medical Officer. The Abortion Regulations 1991 prescribe what information has to be given and standard forms are used to collect the information. Abortion statistics are published annually, using data derived from these forms.
England and Wales
Abortion statistics for England and Wales are published annually by the Department of Health. [Go to reference 11]. The latest year for which data are available is 2003 and a summary of the key points for that year are given in the box below. The rest of this section looks at the total number of abortions carried out and abortion rates for each year since 1969 (the first full year after the 1967 Abortion Act came into force) and, for the last 10 years, the number of abortions by gestational age of the fetus. Further statistics, showing the number of abortions over the last ten years by age of the woman and legal grounds for abortion, can be found in Appendix 1.
Abortion in England and Wales in 2003: summary of key points [Go to reference 12]
- 181,600 abortions were carried out on residents of England and Wales and a further 9,100 were undertaken for non-residents (principally from Northern Ireland and the Irish Republic)
- The abortion rate was 16.6 per 1,000 women residents aged 15-44
- 87% of abortions were carried out at under 13 weeks’ gestation and 58% were at under 10 weeks
- 0.75% of abortions were carried out at 22 weeks and over
- 94% of abortions were carried out within 24 weeks on grounds that the continuance of the pregnancy involved risk of injury to the physical or mental health of the woman
- 1% were carried out because of severe abnormality
| 1969 | 54,819 | 1976 | 129,673 | 1983 | 162,161 | 1990 | 186,912 | 1997 | 179,746 | ||||
| 1970 | 86,565 | 1977 | 133,004 | 1984 | 169,993 | 1991 | 179,522 | 1998 | 187,402 | ||||
| 1971 | 126,777 | 1978 | 141,558 | 1985 | 171,873 | 1992 | 172,069 | 1999 | 183,250 | ||||
| 1972 | 159,884 | 1979 | 149,746 | 1986 | 172,286 | 1993 | 168,714 | 2000 | 185,375 | ||||
| 1973 | 167,149 | 1980 | 160,903 | 1987 | 174,276 | 1994 | 166,876 | 2001 | 186,274 | ||||
| 1974 | 162,940 | 1981 | 162,480 | 1988 | 183,798 | 1995 | 163,638 | 2002 | 185,385 | ||||
| 1975 | 139,702 | 1982 | 163,045 | 1989 | 183,974 | 1996 | 177,495 | 2003 | 190,660 |
Fig. 1
In the early 1970s a large number of abortions were carried out for non-residents of England and Wales reaching a peak of 56,581 in 1973 representing a third of all abortions carried out in that year. In the early 1980s the number was around 34,000 (20% of the total) and from 1995 the number has been around 9,500 representing 5% of the total number of abortions.
Table 2 Abortion rates per 1,000 women aged 15-44 resident in England and Wales
| 1969 | 5.3 | 1976 | 10.5 | 1983 | 12.1 | 1990 | 15.8 | 1997 | 15.9 | ||||
| 1970 | 8.1 | 1977 | 10.5 | 1984 | 12.8 | 1991 | 15.2 | 1998 | 16.6 | ||||
| 1971 | 10.1 | 1978 | 11.3 | 1985 | 13.1 | 1992 | 14.8 | 1999 | 16.2 | ||||
| 1972 | 11.5 | 1979 | 12.0 | 1986 | 13.5 | 1993 | 14.7 | 2000 | 16.3 | ||||
| 1973 | 11.7 | 1980 | 12.6 | 1987 | 14.2 | 1994 | 14.6 | 2001 | 16.3 | ||||
| 1974 | 11.5 | 1981 | 12.4 | 1988 | 15.3 | 1995 | 14.4 | 2002 | 16.2 | ||||
| 1975 | 11.1 | 1982 | 12.3 | 1989 | 15.5 | 1996 | 15.7 | 2003 | 16.6 |
Table 3 Number of abortions for residents of England and Wales by gestational age of the fetus 1994-2003
| Weeks | |||||
| Under 9 | 9-12 | 13-19 | 20-24 | 25+ | |
| 1994 | 63,456 | 75,751 | 15,468 | 1,782 | 81 |
| 1995 | 64,696 | 73,000 | 14,785 | 1,772 | 62 |
| 1996 | 67,091 | 81,728 | 16,904 | 2,095 | 97 |
| 1997 | 70,178 | 81,489 | 16,369 | 2,045 | 64 |
| 1998 | 73,625 | 84,702 | 17,229 | 2,252 | 63 |
| 1999 | 73,882 | 80,800 | 16,552 | 2,401 | 66 |
| 2000 | 75,908 | 79,000 | 18,079 | 2,478 | 77 |
| 2001 | 75,501 | 79,368 | 18,718 | 2,700 | 77 |
| 2002 | 100,624 (1) | 53,106 (1) | 19,328 | 2,790 | 84 |
| 2003 | 105,072 (1) | 53,377 (1) | 20,206 | 2,9272 | N/A |
1. From 2002 the way in which data are presented was changed to 0-9 weeks and 10-12 weeks. Therefore abortions undertaken at 9 weeks are now included in the first category rather than in the second.
2. In 2003 data for abortions at 25+ weeks were not presented separately. In this table they are included in 20-24 weeks.
Fig. 3a
(a) for 2002 and 2003 this is 4-9 weeks
(b) for 2002 and 2003 this is 10-12 weeks. This means that for 2002 and 2003, terminations undertaken at 9 weeks were shifted from the second category to the first.
(c) In 2003 data for abortions at 25+ weeks were not presented separately. On this graph they are included in 20-24 weeks.
Fig. 3b As percent of total
(b) for 2002 and 2003 this is 10-12 weeks. This means that for 2002 and 2003, terminations undertaken at 9 weeks were shifted from the second category to the first.
(c) In 2003 data for abortions at 25+ weeks were not presented separately. On this graph they are included in 20-24 weeks.
In 2003 the Department of Health changed the way it presented its data in relation to gestational age because of concerns about privacy and confidentiality. Separate figures are no longer provided for abortions post-24 weeks but instead these are grouped as 'more than 20 weeks’ gestation'.
Scotland
Abortion statistics for Scotland are published annually by the Information and Statistics Division (ISD) Scotland. [Go to reference 13]. The latest year for which data are available is 2003 and a summary of the key points for that year are given in the box below. The rest of this section looks at the total number of abortions carried out and abortion rates for each year since the 1967 Abortion Act came into effect and, for the last 10 years, the number of abortions by the gestational age of the fetus. Further statistics, showing the number of abortions over the last ten years by age of the woman and legal grounds for abortion, can be found in Appendix 1.
Abortion in Scotland in 2003: summary of key points [Go to reference 14]
- 12,195 abortions were carried out on residents of Scotland and a further 22 were undertaken for non-residents
- The abortion rate was 11.5 per 1,000 women aged 15-44
- 92.6% of abortions were carried out at gestation of 13 weeks and under, and 65.4% were at under 10 weeks
- 0.49% of abortions were carried out at 20 weeks and over
- 96.1% of abortions were carried out within 24 weeks on grounds that the continuance of the pregnancy involved risk of injury to the physical or mental health of the woman
- 1.4% were carried out because of severe abnormality
Table 4 Total number of abortions carried out in Scotland (residents and non-residents)
| 1969 | 3,556 | 1975 | 7,327 | 1981 | 9,007 | 1987 | 9,460 | 1993 | 11,076 | 1999 | 12,168 | |||||
| 1970 | 5,254 | 1976 | 7,219 | 1982 | 8,425 | 1988 | 10,128 | 1994 | 11,392 | 2000 | 11,997 | |||||
| 1971 | 6,333 | 1977 | 7,334 | 1983 | 8,459 | 1989 | 10,209 | 1995 | 11,143 | 2001 | 12,128 | |||||
| 1972 | 7,609 | 1978 | 7,451 | 1984 | 9,155 | 1990 | 10,219 | 1996 | 11,978 | 2002 | 11,772 | |||||
| 1973 | 7,542 | 1979 | 7,784 | 1985 | 9,189 | 1991 | 11,068 | 1997 | 12,109 | 2003 | 12,217 | |||||
| 1974 | 7,568 | 1980 | 7,905 | 1986 | 9,628 | 1992 | 10,818 | 1998 | 12,485 |
p = provisional
Fig. 4
Table 5 Abortion rates in Scotland per 1,000 women aged 15-44
| 1969 | 3.5 | 1976 | 6.9 | 1983 | 7.6 | 1990 | 9.1 | 1997 | 11.1 | ||||
| 1970 | 5.1 | 1977 | 7.0 | 1984 | 8.2 | 1991 | 9.9 | 1998 | 11.5 | ||||
| 1971 | 6.2 | 1978 | 7.0 | 1985 | 8.2 | 1992 | 9.8 | 1999 | 11.2 | ||||
| 1972 | 7.4 | 1979 | 7.3 | 1986 | 8.6 | 1993 | 10.0 | 2000 | 11.1 | ||||
| 1973 | 7.3 | 1980 | 7.3 | 1987 | 8.4 | 1994 | 10.3 | 2001 | 11.3 | ||||
| 1974 | 7.4 | 1981 | 8.2 | 1988 | 9.0 | 1995 | 10.1 | 2002 | 11.0 | ||||
| 1975 | 7.1 | 1982 | 7.6 | 1999 | 9.1 | 1996 | 10.9 | 2003 | 11.5 |
p=provisional
Table 6 Number of abortions performed in Scotland, by gestational age of the fetus, 1994-2003
| Weeks | ||||||
| Under 10 | 10 - 13 | 14 - 17 | 18-19 | 20-24 | 25+ | |
| 1994 | 6,898 | 3,687 | 620 | 124 | 49 | 8 |
| 1995 | 7,068 | 3,399 | 533 | 94 | 44 | 5 |
| 1996 | 7,494 | 3,716 | 594 | 125 | 42 | 7 |
| 1997 | 7,435 | 3,960 | 558 | 104 | 50 | 2 |
| 1998 | 7,720 | 3,973 | 600 | 133 | 57 | 1 |
| 1999 | 8,013 | 3,308 | 641 | 146 | 57 | 3 |
| 2000 | 7,989 | 3,264 | 582 | 102 | 54 | 6 |
| 2001 | 8,013 | 3,354 | 589 | 120 | 46 | 6 |
| 2002 | 7,703 | 3,242 | 661 | 116 | 49 | 1 |
| 2003 | p 7,994 | 3,319 | 696 | 148 | 52 | 8 |
p = provisional
Fig. 6a As percent of total
Northern Ireland
Although a small number of abortions are carried out in Northern Ireland, there are no official published data.
Factors affecting the timing of abortion
In England, Wales and Scotland, the vast majority of abortions take place in the first trimester of pregnancy. In 2003, 87% of abortions in England and Wales were carried out at 12 weeks or less, and 92.6% of abortions in Scotland were carried out at 13 weeks or less. These percentages have remained constant over the last decade (see tables 3 and 6). Although the number of abortions in the second and third trimester of pregnancy is small, in terms of public policy on abortion time limits, it is essential to consider the reasons why women seek abortion at those stages of their pregnancy.
Why women have second trimester abortions
There is very little documented evidence available about why women seek abortions in the second trimester of pregnancy. The Pro+choice forum published a briefing paper in November 2004 [Go to reference 15] that outlined four main reasons why women have abortions in the second trimester:
- Failure to recognise the pregnancy earlier
Some women do not realise that they are pregnant until late into the pregnancy. These are often younger women, whose bodies are still developing, and pre-and peri-menopausal women, who do not expect to be pregnant at this stage of their lives. Women may fail to recognise the pregnancy earlier because of irregular, infrequent periods, failed contraception (particularly with methods that can cause amenorrhoea or irregular bleeding) or denial of the pregnancy (sometimes associated with occasional episodes of bleeding that are interpreted as menstruation).
- Delay in seeking abortion due to personal circumstances
Delays in seeking abortion are often due to the woman’s apprehension (including difficulty in confiding in parents or partner), failure of anticipated emotional or economic support (from family, partner, or employer) or an unanticipated change in the woman’s socio-economic circumstances (in relation to her partner, parents, or others dependent on her as a carer).
- Diagnosis of fetal abnormality
Many abnormalities are not diagnosed until the latter part of the second trimester (see page 20 on diagnosing fetal abnormality) and the woman needs time to consider the information provided, to come to terms with it and make a decision about how to proceed. Some cases of second trimester abortions are because of the diagnosis of a maternal infection that is known to cause abnormalities in the fetus.
- Difficulty in accessing abortion
Some women make a decision to have an abortion earlier in pregnancy but experience delays in accessing the service. This may be because the local NHS services are insufficient to meet the need (long waits for assessment and treatment), the local NHS service applies restrictions to the service offered (for example, some will not terminate pregnancies under ground C after 12 weeks) and/or the woman is unable to afford treatment in the independent sector. Difficulties may also arise where English is not the woman’s first language and she is not familiar with the services provided; this is a particular problem for refugees and asylum seekers.
This analysis of women’s reasons for seeking second trimester abortions reflects anecdotal evidence reported by those providing the service.
In a study from the USA [Go to reference 16] based on data collected in 1987 similar reasons were cited for abortions after 16 weeks’ gestation:
| Reason given | Percentage of women seeking abortion after 16 weeks |
| Woman did not realise she was pregnant | 71 |
| Difficulty making arrangements for abortion | 48 |
| Afraid to tell parents or partner | 33 |
| Needed time to make decision | 24 |
| Hoped relationship would change | 8 |
| Pressure not to have abortion | 8 |
| Something changed during pregnancy | 6 |
| Didn’t know timing was important | 6 |
| Didn’t know she could get an abortion | 5 |
| Fetal abnormality diagnosed late | 2 |
| Other | 11 |
| Average number of reasons given | 2.2 |
Why women have third trimester abortions
In the UK, the vast majority of abortions beyond 24 weeks are on grounds of serious fetal abnormality. In 2002, of the 117 abortions carried out at greater than 24 weeks in England and Wales, 114 (97.4%) were because of serious fetal abnormality; the remaining 3 were because the abortion was necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman. [Go to reference 17]. Information about the diagnosis of fetal abnormality and how women make decisions following such a diagnosis is given here.
Access to services
Most people take the view that where a woman seeks a lawful abortion, it is better for the abortion to be carried out earlier in pregnancy rather than later, where this is an option. It is safer for women, with a lower risk of complications, [Go to reference 18] and is less traumatic for all concerned. For those who take a gradualist approach to the moral status of the fetus, it is more acceptable to terminate a pregnancy earlier than later. It is important therefore to consider the reasons why women seek second trimester abortions and to assess what factors would make earlier abortion a possibility for more people.
Where women meet the legal criteria for abortion, and have decided to terminate their pregnancy, delays should be kept to a minimum. Removing obstacles that cause delay and ensuring adequate service provision for earlier abortions could reduce the number of second trimester abortions in these cases. Evidence that women experience difficulties in accessing abortion services is provided in a report by the Joseph Rowntree Foundation. This found that 'waiting times for abortion are generally reported to be in line with government guidelines, although abortion services appear to be struggling to meet targets in some areas…There is a commonly perceived problem in accessing abortion after the first trimester' [Go to reference 19] (emphasis added). Waiting times were also highlighted in a survey carried out in 2004 and published by the All Party Parliamentary Pro-Choice & Sexual Health Group. This found that although 75% of Primary Care Trusts (PCTs) had set a maximum waiting time for abortion of 21 days, only 52% consistently met this target. A further 27% of PCTs reported waiting times of more than 21 days, with 11% reporting waits of between 5 and 8 weeks.[Go to reference 20].
Concerns have also been expressed that access to second trimester abortions may be further hampered by changes in the health service and the way in which services are delivered. For example, the outsourcing of abortion services or certain aspects of abortion services (e.g. post 20 weeks) to an independent contractor, [Go to reference 21] and the reduction in junior doctors’ working hours due to the European Working Time Directive, could both result in doctors in the training grades in the NHS having less exposure to abortion and in some cases in women not being able to access abortion services, particularly second and third trimester abortion services, in their local area.
Improved access to and provision of early abortion services, combined with greater education about how to access services may help to reduce the number of second trimester abortions in some cases. Nevertheless, given the nature of some of these requests, as outlined above, it is clear that demand for second trimester abortions will never be totally eradicated and provision must be made for such services to be available where abortions comply with the legal framework.