Accredited official statistics

Guide to abortion statistics, England and Wales: 2022

Published 23 May 2024

Applies to England and Wales

Introduction

This guide is a supplementary document to the main commentary of the Abortion statistics for England and Wales: 2022 publication, which presents statistics on abortions carried out in England and Wales in 2022. This document provides more detail on those statistics and is intended to give the legal context as well as a technical guide to the concepts and methodology used.

The Department of Health and Social Care (DHSC) has published abortion statistics annually since 2002. These are available in the Abortion statistics for England and Wales collection. As of 2022, abortion statistics are published by the Office for Health Improvement and Disparities (OHID), which is part of DHSC.

Statistics for years from 1968 to 1993 were published by the Office of Population Censuses and Surveys, then by their successor the Office for National Statistics (ONS), from 1994 to 2001. The reports for years up to and including 2001 are available electronically on request to abortion.statistics@dhsc.gov.uk.

This publication is a national statistic. It is a statutory requirement that national statistics should be produced in accordance with the standards set out in the Code of Practice for Statistics. The UK Statistics Authority assesses all national statistics for compliance with the code. The last assessment of abortion statistics was published in February 2012 (PDF, 80KB), but there have been a number of internal reviews since to ensure that the publication continues to meet the high standards required of a national statistics publication.

The legislative context

The Abortion Act 1967, as amended by the Human Fertilisation and Embryology Act 1990 and the Health and Care Act 2022, permits termination of a pregnancy by a registered medical practitioner subject to certain conditions. Legal requirements apply to the certification and notification of abortion procedures.

Within the terms of the Abortion Act, only a registered practitioner can terminate a pregnancy. The doctor taking responsibility for the procedure is legally required to notify the Chief Medical Officer (CMO) of the abortion within 14 days of the termination, whether carried out in the NHS or by an approved independent sector provider, and whether or not the woman is a UK resident. DHSC provides a HSA4 form for this purpose.

Usually, any treatment for the termination of pregnancy can only be carried out in an NHS hospital or an independent clinic approved for the purpose by the Secretary of State for Health and Social Care. The only exceptions to this are in cases of emergency and in the case of early medical abortion up to 10 weeks’ gestation, where both medications can be taken at home (see section below on ‘Early medical abortions: home use’). After a pregnancy has reached 24 weeks’ gestation (defined as 24 weeks and 0 days and beyond), the abortion can only be carried out in an NHS hospital.

Through contractual arrangements with NHS integrated care boards (ICBs), a large number of approved independent sector clinics perform NHS-funded abortions. The main independent providers are the British Pregnancy Advisory Service (BPAS), Marie Stopes International (MSI) and the National Unplanned Pregnancy Advisory Service (NUPAS).

A legally induced abortion must be certified by:

• 2 registered medical practitioners as justified under one or more of the following grounds (A to E)
• in an emergency, the operating practitioner as immediately necessary (grounds F and G)

These grounds are set out as follows in Table A below.

Table A: grounds for abortion

Ground	Definition	Relevant section of Abortion Act 1967 (as amended)
Ground A	That the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.	1(1)(c)
Ground B	That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.	1(1)(b)
Ground C	That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman.	1(1)(a)
Ground D	That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child (or children) of the family of the pregnant woman.	1(1)(a)
Ground E	That there is substantial risk that, if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.	1(1)(d)
Ground F	To save the life of the pregnant woman.	1(4)
Ground G	To prevent grave permanent injury to the physical or mental health of the pregnant woman.	1(4)

Recent changes to abortion legislation

Funding of abortions for women from Northern Ireland

On 29 June 2017, the government announced that it would fund - via the Government Equalities Office (GEO) - abortions for women ordinarily resident in Northern Ireland, where abortions were only available in very limited circumstances. The central booking system went live on 8 March 2018.

This provision for Northern Irish women currently remains in place despite the decriminalisation of abortion in Northern Ireland. This followed a free vote by Westminster MPs in July 2019 during the period that the Northern Ireland Executive was suspended (effectively becoming law when the Executive did not reconvene before 21 October 2019). This required the Northern Ireland Office to provide a framework for abortion services to come into effect from 31 March 2020.

On 19 May 2022, the Abortion (Northern Ireland) Regulations 2022 were laid, which remove barriers to commissioning and mean that the Northern Ireland Department of Health no longer needs to seek Executive Committee approval in relation to commissioning abortion services. If the Northern Ireland Department of Health does not commission and fund abortion services, the regulations give the UK government equivalent powers to a Northern Ireland minister or department for the purpose of ensuring that abortion services are provided as decided by Parliament in 2019.

Early medical abortions: home use

Women in Wales, from late June 2018, and Women in England, from late December 2018, can take the second of the 2 abortion pills, misoprostol, at home for early medical abortions. This brought England and Wales in line with Scotland, which allowed the second pill to be taken at home from October 2017. Before this change, medical abortions could only be carried out in an approved NHS hospital or independent clinic.

From 30 March 2020, the Secretary of State for Health and Social Care approved temporary measures in England to limit the transmission of COVID-19 by approving the use of both pills for early medical abortion, without the need to first attend a hospital or clinic. Similar measures were put in place by the Welsh Government’s Minister for Health and Social Services on 31 March 2020.

On 30 March 2022, Parliament voted to amend the Abortion Act 1967 to allow eligible women in England and Wales to take one or both pills for early medical abortion up to 10 weeks at home, following a telephone or e-consultation with a clinician. The legislation came into force on 30 August 2022, as part of the Health and Care Act 2022.

In April 2023, the HSA4 form was amended to reflect the change in legislation. For medical abortions where both medications are taken at home, the name and address of the place of termination is no longer required. Instead, there is an additional mandatory question asking whether any part of the consultation or treatment was provided face to face (in person) by a registered medical practitioner, nurse or midwife. See ‘Form HSA4: abortion notification - summary of the information collected’ on Abortion notification forms for England and Wales for more information on the new questions asked.

Further details on home use are available from the Royal College of Obstetricians and Gynaecologists (RCOG) in its Clinical Guidelines for Early Medical Abortion at Home – England. Data collection on HSA4 forms allows uptake of home use early medical abortions to be monitored.

Methods of abortion

Different methods can be used to terminate a pregnancy, depending on the duration of gestation and other circumstances relating to the individual woman. There is one principal medical method, involving the use of the abortifacient drug Mifegyne (mifepristone, also known as RU486).

Early medical abortion in the first 10 weeks of pregnancy requires the administration of 2 tablets. Medical abortions can also happen after the first 10 weeks of pregnancy, but this is less common.

The main surgical methods are:

• vacuum or suction aspiration, where the pregnancy is removed using suction, which can be used up to 14 weeks’ gestation
• dilatation and evacuation, where the pregnancy is removed using forceps, which can be used after 14 weeks’ gestation

Dilatation and evacuation may be used in combination with vacuum aspiration. Such cases are recorded in the statistics as dilatation and evacuation.

Chlamydia screening

The HSA4 form also allows for the collection of data on whether women were screened for chlamydia.

RCOG recommends that all women undergoing an abortion should be screened for Chlamydia trachomatis and undergo a risk assessment for other sexually transmitted infections (STIs). Chlamydia is the most commonly diagnosed STI in England.

Infection of varying degrees of severity may occur after medical or surgical abortion and is usually caused by pre-existing infection. Prophylactic antibiotic use and bacterial screening for lower genital tract infection reduces this risk.

Data quality

Validation

DHSC uses a thorough process for inspecting and recording the information received on the HSA4 forms to monitor compliance with the legislation and the extent to which DHSC best practice guidance is followed. Selected forms are scrutinised by a medical practitioner who may request further detail from the patient’s medical record via the terminating doctor.

At the time of publication, 5% of the additional checks by the medical practitioner had been completed. These additional checks are performed on 1% of all forms. Further details of the checks that are made on the data are available.

Data collection

Not all of the information collected on the HSA4 form is necessary for statistical purposes. Some of the information that is used to monitor the Abortion Act is only stored as scanned images of the forms. The scanned images of the forms are part of the system for processing the forms and they are kept for a minimum of 3 years.

The ‘Form HSA4: abortion notification - summary of the information collected’ on Abortion notification forms for England and Wales outlines what information is collected.

The following information is not stored in the statistical data sets:

• terminating and certifying doctors’ addresses
• patient name
• patient reference including NHS number
• patient address
• details about any medical conditions (although information on medical conditions associated with the procedure is stored in the form of ICD10 codes)

Derived fields

Some of the data used in the tables is derived variables. More detail about these calculations is shown below: 

• ‘reported date of termination’ is from the date of the surgical treatment or, for medical abortions, the date of misoprostol or other medical agent. If a feticide is used, this date takes priority. When both medications have been taken at home for early medical abortions, the date misoprostol had been supplied is used
• ‘age at termination’ is taken from ‘reported date of termination’ (see above) minus date of birth. ‘Age at termination’ is collected in whole years
• ‘purchaser’ is derived from information given about how the abortion was funded (NHS or privately) together with clinic type (NHS hospital, independent sector or private hospital). For example, a privately funded abortion within an independent sector organisation will be ‘privately funded’ and an NHS-funded abortion within an independent sector clinic will be ‘NHS funded: independent sector’
• ‘area of residence’ (ICB, local authority or region) is derived from postcode of the woman’s residence

Incomplete information and imputation

Incomplete and incorrectly completed forms are returned to practitioners for completion and clarification. In a very small number of cases (less than 1%), the information remains unavailable at the time of publication. For example, date of birth was missing from 95 records in 2022, gestation information from 230 records, postcodes from 187 records and grounds from 62 records.

For the purposes of constructing statistics, values for missing items are imputed. Records with missing ages were assigned to the 20 to 24 age group, as this is the modal (most common) age group, accounting for 26% of abortions. Missing gestations were imputed using mode gestation (under 24 weeks) for grounds and method. Missing postcodes were imputed with a random postcode from within the main local authority of other residents attending the same hospital or clinic. Missing grounds were imputed as ground C unless information on the form suggested otherwise, as this is the modal ground accounting for 99% of abortions.

Forms returned after the publication cut-off date

The 2022 figures in this annual bulletin are based on a snapshot of the records taken about 7 weeks prior to publication.

A small number of notifications have been, and will continue to be, received after this cut-off date.

While these additional notifications are processed and the information retained in line with our retention policy, they are not included in future statistical releases.

Under-reporting of ground E notifications

Ground E abortions are for cases where there is substantial risk that, if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. The medical diagnoses are coded to ICD-10.

During 2013, it was brought to DHSC’s attention that the number of ground E HSA4 notifications was lower than the number reported to the congenital anomaly registries. DHSC worked closely with the National Down’s Syndrome Cytogenetic Register (NDSCR) to explore this discrepancy.

A matching exercise was carried out between the NDSCR data and DHSC notifications for 2011, 2012 and 2013 data. Results from the matching suggest that a DHSC notification was made for about 54% of NDSCR records and that almost half of ground E notifications are missing.

As recommended by RCOG, DHSC has been working with clinics to rectify this under-reporting. In December 2016, DHSC wrote to all Fetal Medicine Units, antenatal screening midwives and administration staff reminding colleagues of doctors’ responsibility to submit HSA4 forms to the relevant CMO. The letter was jointly signed by DHSC, RCOG, and the Maternal and Fetal Health Medicine Society.

However, despite some progress being made, it is likely there is still a significant undercount presented in the ground E notification tables in this publication, so overall figures related to ground E notifications should be treated with caution.

View results from this matching exercise in 2013.

Classification of ground E notifications in the publication

Changes were made in the 2019 publication to the reporting of medical conditions for abortions performed under ground E.

There can often be multiple reasons listed for an individual abortion under ground E. Previous publications reported both the total number of abortions mentioning each medical condition and, more specifically, the number of abortions for each principal medical condition. However, where there are 2 or more medical conditions provided in free text by the terminating doctor, it is not always clear which is the principal medical condition.

From 2019, we therefore decided to no longer report the principal medical condition.

Complications

Data on complications should be treated with caution. It is not possible to fully verify complications recorded on HSA4 forms, and complications that occur after discharge may not always be recorded.

For terminations where either both or the second stage were administered at home, complications may be less likely to be recorded on the HSA4.

OHID undertook a project to review the system of recording abortion complications data to address this and released the statistical publication Complications from abortions in England, 2017 to 2021, a comparison of Abortion Notification System (ANS) data and Hospital Episode Statistics (HES) for the years 2017 to 2021. The publication explores whether HES can be used as a supplementary source for data on abortion complications.

Statistical methods

Population estimates used for rates of abortion

Abortion rates in this publication are calculated using the conventional age range for women in their child-bearing years, 15 to 44.

Abortion rates per 1,000 women for 2022 at a national level and at ICB level were calculated using the mid-2022 lower-layer super output area population estimates (supporting information), England and Wales, as published at 19 March 2024.

Rates for earlier years were calculated using the latest population estimates available at the time the relevant annual reports were produced and have not been revised, either by using population estimates for the year in question or by using updated population estimates.

Deriving age-standardised rates of abortion

Age-standardised rates allow comparison between populations that may contain different proportions of people of different ages.

The European Standard Population (ESP) is a widely used artificial population structure for the calculation of directly age-standardised rates.

The replacement of the ESP first used in 1976 with an updated version published in 2013 means that figures using the 1976 and 2013 ESPs are not comparable. Information about this change in methods can be found on the ONS website.

The effect of implementing the 2013 ESP for abortion age-standardised rates is small. The vast majority of abortions occur within the age range 15 to 44. The 1976 ESP assumed equal populations at each single age between 15 to 44 (see Table B below). The 2013 ESP made only a small change to the populations within age range 15 to 44 such that, although not equal, it remains fairly uniform. Thus, the 2013 ESP brings the abortion age-standardised rates down by about 4% in recent years and 2% in earlier years. The time series using 2013 ESP age-standardised rates back-dated to 1968 is presented in Table B below.

Figure 1: formulae used to calculate the age-standardised abortion rates

For the analysis of trends in abortion rates for England and Wales:

The crude rate is the number of abortions in a specified population per year, divided by the total number of women in that population.

The age-standardised rate is equal to the sum of crude rate for women multiplied by the population of women in the 2013 ESP for women of all ages, divided by the sum of population of women aged between 15 and 44 in the 2013 ESP.

For the area analyses in Table 10b: age-standardised rate is equal to the sum of crude rate for women multiplied by the population of women in the 2013 ESP for women between the ages of 15 and 44, divided by the sum of population of women aged between 15 and 44 in the 2013 ESP.

Rate for women aged under 16 (for example, 15 years old) is equal to the number of abortions to women under 16, divided by the population of 15 year olds.

Rate for women aged 44 and over (for example, 44 years old) is equal to the number of abortions to women aged 44 and over, divided by the population of 44 year olds.

Table B: 1976 vs 2013 European Standardised Population (ESP)

Age group	1976 ESP	2013 ESP
Under 1	1,600	1,000
1 to 4	6,400	4,000
5 to 9	7,000	5,500
10 to 14	7,000	5,500
15 to 19	7,000	5,500
20 to 24	7,000	6,000
25 to 29	7,000	6,000
30 to 34	7,000	6,500
35 to 39	7,000	7,000
40 to 44	7,000	7,000
45 to 49	7,000	7,000
50 to 54	7,000	7,000
55 to 59	6,000	6,500
60 to 64	5,000	6,000
65 to 69	4,000	5,500
70 to 74	3,000	5,000
75 to 79	2,000	4,000
80 to 84	1,000	2,500
85 and over	1,000	Not applicable
85 to 89	Not applicable	1,500
90 to 94	Not applicable	800
95 and over	Not applicable	200
Total	100,000	100,000

Source: Eurostat

Confidence intervals

The figures recorded in this report are the outcome of a stochastic process - that is, they are influenced by chance or random processes such as fertilisation. Each recorded figure is only one of a range of results that could have occurred under the same circumstances if those random processes had led to different outcomes.

It is often the underlying circumstances or process that is of interest and the actual value observed gives only an imprecise estimate of this ‘underlying risk’. For example, users are often interested in understanding whether there has been a change in rates of abortion, perhaps reflecting a change in the prevalence of risky sexual behaviour, a change in attitudes towards the options available in pregnancy or a change in access to services.

To assess this, it is necessary to determine if the observed change is one that is unlikely to be the result of random fluctuation and therefore offers evidence that a real change has occurred.

A confidence interval can be calculated around each observed value, which gives a range in which the expected or average value resulting from the underlying process is likely to fall. The 95% confidence intervals have been calculated for some of the observed values in Tables 10a, 10b, and 10c. These are known as such because, if it were possible to repeat the underlying process under the same conditions a large number of times (that is, ‘rerun’ the year over and over again), 95% of the confidence intervals calculated in this way would contain the average value from those runs. When assessing the observed results for the year, it is usual to assume that there is only a 5% chance that the expected or average value falls outside the 95% confidence interval.

The confidence interval may be used to compare an estimate against a target or benchmark value. If the target or benchmark value is outside the confidence interval, it can be inferred that the difference between the estimate and the target is statistically significant at the 95% confidence level.

Confidence intervals are also often used to compare 2 observed values (for example, abortion rates within 2 regions). Sometimes in such cases statistical testing is undertaken by seeing if the 2 confidence intervals overlap. This is quick and easy to do, but not necessarily conclusive: while it is safe to assume that non-overlapping confidence intervals indicate a statistically significant difference, it is not always the case that overlapping confidence intervals do not.

The method for estimating a confidence interval varies depending on whether it is for a percentage, count, crude rate or standardised rate. The methods used are those detailed in the Association of Public Health Observatories’ (APHO) Technical Briefing 3: Commonly used public health statistics and their confidence intervals (listed under ‘APHO Technical Briefings’).

For example, the 95% confidence interval associated with:

• the figure of 251,377 for the total number of abortions of residents in England and Wales is 250,395 to 252,362 (see Table 10a)
• the age-standardised rate of 20.6 abortions per 1,000 resident women aged 15 to 44 in England and Wales is 20.5 to 20.7 (see Table 10b)

Disclosure control

All official statistics activities and outputs are subject to the UK Statistics Authority Code of Practice for Statistics, the Statistics and Registration Services Act 2007, the Data Protection Act 2018 and the General Data Protection Regulation (GDPR) (2016/679). The GDPR and the Data Protection Act 2018 replaced the 1998 act from 25 May 2018. 

The disclosure control policy applied to abortion statistics is consistent with this legislation. OHID, as part of DHSC, will publish more detailed information on the policy for disclosure control for abortion statistics in due course.

Perturbed values in Tables 10 and 11

In Tables 10 and 11, values in 6 local authorities have been randomly perturbed to prevent disclosing numbers of abortions in areas with very small population sizes that lie in the intersections of local authorities and ICBs. This allows the values to be presented for these local authorities rather than being supressed as in previous years.

A review of local authorities is conducted for each annual publication to ensure that perturbation is necessary and correctly applied.

These local authority pairs were York and North Yorkshire, Buckinghamshire and Oxfordshire, and Stoke-on-Trent and Staffordshire.

Values have been randomly perturbed by a number between −5 and +5, excluding 0. While these adjustments affect the values and totals within these local authorities, the overall totals at national level are preserved. The level of adjustment has a minor impact on the local authorities total - the minimum total for any local authorities is around 500, so each individual adjustment would be a maximum change of 1%.

A patient record was randomly selected in a local authority requiring perturbation in each age category (under 18, 18 to 19, 20 to 24, 25 to 29, 30 to 34, and 35 and over) and each funding category (NHS funded, NHS independently funded and privately funded). Each of these records was allocated a value at random (uniform probability) from −5 to +5, excluding 0.

A corresponding record was randomly selected from the adjacent local authority in each of the age and funding categories. These records were randomly selected from records with matching age category, funding category, gestation group, method, and previous abortions. The corresponding record was weighted inversely - for example, if the first record was assigned +2, the corresponding record would be −2. This ensured that relative proportions in these groups were retained through the tables.

These records were weighted in the data set such that the perturbed values feed through all calculations relating to these local authorities. For example, a record allocated a 2 for perturbing would be weighted twice as much as other data points in the analysis.

Worked example:

• in LA1, there are 10 records for women aged under 18. One of these is randomly selected, and assigned a random weighting from −5 to +5, excluding 0 - for example, a weighting of 2
• this record has gestation 3 to 9 weeks, was surgical, had zero previous abortions and was NHS independently funded
• in LA2, there are 12 records for women aged under 18. Of those there are 7 records with gestation 3 to 9 weeks, surgical method, zero previous abortions and NHS independently funded. One of these 7 is picked at random, and assigned the opposite weighting - for example, −2
• this is repeated for each age category and each funding category

Table C1: example to show local authority totals before perturbing

Local authority	Total abortions	NHS funding	NHS independent funding	Privately funded
LA1	600	200	200	200
LA2	600	200	200	200

Table C2: example to show perturbed values

Local authority	Total abortions	NHS funding	NHS independent funding	Privately funded
LA1	2	1	4	−3
LA2	−2	−1	−4	3

Table C3: example to show final local authority totals after perturbing

Local authority	Total abortions	NHS funding	NHS independent funding	Privately funded
LA1	602	201	204	197
LA2	598	199	196	203

Geographical coding and naming

This publication includes statistical analysis by ICBs (England) and local health boards (Wales) in Tables 10a, 10b, 11a and 11b.

In England, ICBs commission most of the hospital and community NHS services in the local areas for which they are responsible.

On 1 April 2013, clinical commissioning groups (CCGs) assumed commissioning of termination of pregnancy services under the health system reforms. From 1 July 2022, ICBs replaced CCGs in the NHS in England. Further information on coding and naming for statistical geographies is available.

In Wales, NHS services are delivered through 7 local health boards.

 Index of multiple deprivation

Since 2017, the abortion statistics publication has included an analysis by index of multiple deprivation (IMD). The report previously featured IMD deciles based on England and Wales combined data. However, following consultation with the ONS, we changed this in 2019 to cover only English indices of deprivation. From 2022, the abortion statistics publication includes analysis by IMD for England and Wales separately.

Both the English and Welsh IMD measure relative deprivation in small areas in England and Wales respectively. These small areas are called lower-layer super output areas (LSOAs). The English IMD is based on deprivation across 7 weighted domains (or types) of deprivation, while the Welsh IMD is based on deprivation across 8 weighted domains of deprivation. Examples of domains of deprivation include education, health and housing. The weight given to each domain also differs between the English and Welsh IMD. For this publication, the IMD is divided into 10 equal deciles, with decile 1 being the most deprived and decile 10 the least deprived.

The English and Welsh IMD should not be compared as each country measures deprivation differently.

The English IMD data comes from the Department for Levelling Up, Housing and Communities, while the Welsh IMD data comes from the Welsh Government. English and Welsh population data is from ONS. In both cases, these 2 data sources are linked to the abortion data using the LSOAs. It is therefore possible to categorise women who have had abortions by age, geography and IMD decile, and to calculate rates for these categories for women between the ages of 15 and 44 years.

For further information about the indices see the English index of multiple deprivation and Welsh index of multiple deprivation.

Rounding

Percentages are subject to rounding and totals may not agree with the sum of the component figures shown. Rates are also rounded.

Symbols

The following symbols are used in the tables: 

• [z] = not applicable 
• [c] = suppressed value to protect patient confidentiality

Further information

Enquiries

Enquiries about the data or requests for further information should be addressed to: 

Abortion Statistics
Department of Health and Social Care
10 South Colonnade
London
E14 4PU

Email: abortion.statistics@dhsc.gov.uk

Extracts from this publication may be reproduced provided a reference to the source is given. 

Useful links

• Information on abortions carried out in Scotland
• Information about the release of abortion statistics in Scotland
• Information on the incidence and recent trends in legal abortion worldwide
• Conception statistics for England and Wales
• Statistics on the national chlamydia screening programme
• An exploratory briefing by the Kings Fund on understanding trends in the use of abortion service in England