扒哥吃瓜

Introduction

This guide is a supplementary document to the main commentary of the Abortion statistics for England and Wales: 2023 publication. 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聽Abortion statistics for England and Wales听肠辞濒濒别肠迟颈辞苍.

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 the years 1968 to 2000 are available electronically on request to聽abortion.statistics@dhsc.gov.uk. The reports for years from 2002 and 2010 are available on the National Archives website.

This publication is an Accredited Official Statistic. It is a statutory requirement that Accredited Official Statistics should be produced in accordance with the standards set out in the聽. The Office for Statistics Regulation assesses all Accredited Official Statistics for compliance with the code.听, but there have been several internal reviews since to ensure that the publication continues to meet the high standards required of a national statistics publication.

Changes since the 2022 publication

Early medical abortions: home use

In previous publications, information on where the medication was administered for medical abortions was recorded in section 4d of the HSA4 form. This section asks for the name and address of place of treatment with prostaglandin (misoprostol) if different from the address in section 4a.

For electronic forms, DHSC added 2 home use options to the existing list of hospitals performing abortions in England and Wales:

• Home Use - one medication taken at home, one medication taken at clinic
• Home Use - both medications taken at home

For paper forms, free-text responses such as 鈥渙ne pill at home鈥� or 鈥�2 pills at home鈥� were reviewed by the team and then assigned to the corresponding home use option.

From April 2023 onwards, the HSA4 form was amended to include an explicit question about whether any of the medication was administered at home for medical abortions.

This means that there has been a change in the way home use abortions have been calculated.

As this change came into effect in April 2023, the 2023 publication contains both methods for measuring home use. From the 2024 publication onwards, all data on home use abortions will be collected using the additional question on the form and not clinic codes.

Data validation and imputation

Each year a small proportion of HSA4 forms are returned to clinics to check for missing or inconsistent information. To prevent further delays to the publication of the 2023 statistics, a cut of data has been taken before all forms containing missing or inconsistent information have been checked and, if necessary, returned to the terminating doctor. We expect this could affect up to 5,400 (2%) of forms.

As with our usual process, forms still containing missing information at the time of publication have been imputed. This is where we estimate missing values using patterns in the available data. For more information, see the 鈥楧ata validation and imputation鈥� section in the 鈥楧ata collection and quality鈥� chapter.

Selected forms are also scrutinised by a medical practitioner who may request further details from the patient鈥檚 medical record through the terminating doctor. For 2023, the additional checks carried out by the medical practitioner have been completed.

Index of Multiple Deprivation and integrated health boards

The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation for small areas, with separate indices for England and Wales. IMD deciles rank these areas from the most deprived 10% (decile 1) to the least deprived 10% (decile 10) based on multiple factors such as income, employment and health. Abortion rates for Index of Multiple Deprivation deciles and integrated care boards (ICBs) have not been published in the 2023 statistics publication. When compiling the 2023 statistics, the required population data from ONS had not been published. Counts and percentages have been provided for ICBs where applicable.

Disclosure control (rounding to nearest 5)

Following consultation with the Head of Profession for Statistics at DHSC and in line with the Code of Practice for Statistics, all abortion statistics from 2023 onwards will be rounded to the nearest 5. This replaces perturbation, where counts in areas with small populations are randomly adjusted, previously carried out on local authority data in tables 10 and 11.

This methodology prevents the disclosure of sensitive information. This change increases trustworthiness, quality and value of abortion statistics, as we are able to release more detailed information to the public.

As a result of this change, totals may not add up and counts of 0 can mean no or a small number of procedures in the given field. Percentages, rates and confidence intervals are calculated using rounded figures. Therefore, percentages may not add up to 100. Percentages are rounded to the nearest whole number and rates are rounded to one decimal place.

The legislative context

罢丑别听, as amended by the聽聽and the聽, 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.听DHSC聽provides an聽HSA4 form聽for this purpose. See 鈥楩orm HSA4: abortion notification - summary of the information collected鈥� on聽Abortion notification forms for England and Wales.

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鈥� gestation, where both medications can be taken at home (see the section below on 鈥楨arly medical abortions: home use鈥�). After a pregnancy has reached 24 weeks鈥� 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 ICBs, a large number of approved independent sector clinics perform NHS-funded abortions. The main independent providers are the British Pregnancy Advisory Service (BPAS), MSI Reproductive Choices (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 below.

Grounds for abortion

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.

Ground B

That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.

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.

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.

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.

Ground F

To save the life of the pregnant woman.

Ground G

To prevent grave permanent injury to the physical or mental health of the pregnant woman.

Changes to abortion legislation

Funding of abortions for women from Northern Ireland

On 29 June 2017, the government announced that it would fund, through 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聽聽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, could 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鈥檚 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 鈥楩orm HSA4: abortion notification - summary of the information collected鈥� on聽鈥橝bortion notification forms for England and Wales鈥櫬爁or 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聽. Data collection on HSA4 forms allows uptake of home use early medical abortions to be monitored.

Medical information

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 medications, mifepristone and misoprostol. 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鈥� gestation
• dilatation and evacuation, where the pregnancy is removed using forceps, which can be used after 14 weeks鈥� gestation

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

Chlamydia screening

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

RCOG聽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聽STI聽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 collection and quality

Revisions and corrections

The abortion statistics for England and Wales are based on the latest abortion and population data available and are a snapshot of the data at the time it was compiled. Any changes to the abortion or population data that occur after this point will not be reflected in the statistics.

Decisions regarding changes to published statistics will be made by the statistician responsible for the publication in consultation with the Head of Profession for Statistics. If deemed appropriate, revisions and corrections will only be applied to the 3 most recent publications.

For more information, refer to DHSC鈥檚 Statement on revision and corrections policy.

Data validation and imputation

DHSC聽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聽DHSC聽best practice guidance is followed. Forms containing missing information or inconsistencies are checked and, if necessary, returned to the terminating doctor for clarification. In a very small number of cases (less than 1%), the information remains unavailable at the time of publication.

For the purposes of constructing statistics, values for missing fields are imputed. Imputation is where missing values are estimated based on patterns in the existing data. For example:

• 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

Table A: number of imputed records by field, 2022 and 2023

Field	2022	2023
Date of birth	95	37
Gestation	230	159
Postcode	187	743
Grounds	62	95

Selected forms are also scrutinised by a medical practitioner who may request further details from the patient鈥檚 medical record through the terminating doctor.

Forms returned after the publication cut-off date

The 2023 figures in this annual bulletin are based on a snapshot of the records taken in November 2025.

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.

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 鈥楩orm HSA4: abortion notification - summary of the information collected鈥� on聽鈥橝bortion notification forms for England and Wales鈥櫬爋utlines what information is collected.

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

• terminating and certifying doctors鈥� 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聽)

Derived fields

Some of the data used in the tables is based on derived variables as follows:聽

• 鈥榬eported date of termination鈥� is derived 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
• 鈥榓ge at termination鈥� is taken from 鈥榬eported date of termination鈥� (see above) minus date of birth. 鈥楢ge at termination鈥� is collected in whole years
• 鈥榩urchaser鈥� 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 鈥榩rivately funded鈥� and an NHS-funded abortion within an independent sector clinic will be 鈥楴HS funded: independent sector鈥�
• 鈥榓rea of residence鈥� (local authority or region) is derived from postcode of the woman鈥檚 residence

Underreporting 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聽ICD-10.

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

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

As recommended by聽RCOG,听DHSC聽has been working with clinics to rectify this underreporting. In December 2016,听DHSC聽wrote to all fetal medicine units, antenatal screening midwives and administration staff reminding colleagues of doctors鈥� responsibility to submit HSA4 forms to the relevant聽CMO. The letter was jointly signed by聽DHSC,听RCOG, and the British Maternal and Fetal 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 published in this report should be treated with caution as it may not capture all complications. This report includes complications recorded on the HSA4 form up until the time of discharge from the abortion provider. Therefore, complications that are not recorded on the HSA4 form or that occur after discharge may not 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.

DHSC聽undertook a project to review the system of recording abortion complications data to address this and released the statistical publication聽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聽HES聽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 2023 at a national level and at聽local authority level were calculated using , as published at 15 July 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聽ESP聽first used in 1976 with an updated version published in 2013, this means that figures using the 1976 and 2013 ESPs are not comparable.听

The effect of implementing the 2013听ESP聽for abortion age-standardised rates is small. The vast majority of abortions occur within the age range 15 to 44. The 1976听ESP聽assumed equal populations at each single age between 15 to 44 (see the annex below). The 2013听ESP聽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听ESP聽brings the abortion age-standardised rates down by about 4% in recent years and 2% in earlier years. The time series using 2013听ESP聽age-standardised rates back-dated to 1968 is presented in the annex below.

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听ESP聽for women of all ages, divided by the sum of population of women aged between 15 and 44 in the 2013听ESP

For the area analyses in tables 10b and 10d:

• the age-standardised rate is equal to the sum of crude rate for women multiplied by the population of women in the 2013听ESP聽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听ESP
• the rate for women aged under 16 is equal to the number of abortions to women under 16, divided by the population of 15 year olds
• the rate for women aged 44 and over is equal to the number of abortions to women aged 44 and over, divided by the population of 44 year olds

Confidence intervals

A confidence interval is a way of expressing the precision of an estimate (or the uncertainty surrounding it). Although figures in this publication are based on a data set considered complete, imprecision can still occur from 鈥榥atural鈥� variation, which are random occurrences inherent to the world around us, such as fertilisation.

The confidence interval shows the range of values where we are reasonably confident that the true value falls, based on the observed data. For a 95% confidence interval, there is a 95% chance that the interval contains the true value.

The confidence interval may be used to compare an estimate against a benchmark value. If the benchmark lies outside the confidence interval, then it is sufficiently different from the estimate, and the difference is said to be 鈥榮tatistically significant at the 95% confidence interval鈥�.听

Confidence intervals can be used to compare 2 observed values (for example, abortion rates within 2 regions). 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 non-overlapping confidence intervals indicate a statistically significant difference, overlapping confidence intervals do not necessarily mean there is none.听

The method for estimating a confidence interval varies depending on whether the measure is a percentage, count, crude rate or standardised rate. The methods used are detailed in the鈥疉ssociation of Public Health Observatories鈥� (APHO)鈥�鈥�(listed under 鈥�APHO鈥痶echnical briefings鈥�).听

For example, the 95% confidence interval associated with:

• the figure of 277,970 for the total number of abortions of residents in England and Wales is 277,625 to 278,315 (see table 10a)
• the age-standardised rate of 23.0 abortions per 1,000 resident women aged 15 to 44 in England and Wales is 22.9 to 23.1 (see table 10d)

Disclosure control

All official statistics activities and outputs are subject to the Code of Practice for Statistics, the聽, the聽聽and the聽.听

The disclosure control policy applied to abortion statistics is consistent with this legislation.听

Symbols

The following symbols are used in the tables:聽

[z] = not applicable聽

Useful links

Statistics on the national chlamydia screening programme

Further information

Enquiries

If you have enquiries about this publication, email鈥�abortion.statistics@dhsc.gov.uk.

Requests for additional data

All available figures have been released where appropriate. Requests for additional data can be made through a Freedom of Information (FOI) request. Please note, relevant exemptions under the FOI Act apply. For example, the following requests will not be fulfilled:

• requests that require linking to other data sets
• requests that relate to fields not included in the publication
• requests for disaggregated data where counts are very low
• requests for record level data

See the for full details of exemptions under the FOI Act.

Find details on how to make an FOI request in the 鈥楳ake an FOI request鈥� section on the DHSC page on 扒哥吃瓜.

Annex: 1976 vs 2013 European Standardised Population (ESP)

Age group	1976听ESP	2013听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