Abortion rates for 2019 were the highest on record – with terminations rising most significantly among women in their late 20s and 30s. What does this tell us about access to contraception in England and Wales?
Abortion is an emotive subject. And so the news that over 207,000 abortions were carried out in 2019 – the highest number in a year since the procedure was legalised by the historic Abortion Act 1967 – was bound to prompt questions.
Why did so many women in England and Wales need to terminate a pregnancy last year? The official statistics, published by the Department of Health, show that the anti-choice myth of reckless young women using abortion as a form of birth control is just that: a myth. In fact, there’s been a marked drop in the number of teenagers terminating pregnancies, with the rate among under-18s falling over the last 10 years to 8.1 abortions per 1,000 young women. Among under-16s, the rate stands at just 1.4 in 1,000.
Instead, abortions are on the rise among older millennial women. There has been an increase in abortion rates for women of all ages over 25, with the largest seen among those aged 30-34. The figures also show a rise in the rate of women aged over 35 terminating pregnancies, from 6.6 per 1,000 in 2009 to 9.7 in 2019.
There are many reasons why a woman might decide to end a pregnancy, and all of them are valid. These include financial instability or the desire to limit the size of one’s family – two factors that may be intimately linked, especially since the government introduced a two-child cap on benefits in 2017. But one major driver behind the rise in abortion rates appears to be the struggles many women face in accessing adequate contraceptive services in England and Wales.
“We really need to make sure our [contraceptive] services are catering well to older women,” Clare Murphy tells Stylist. Murphy is director of external affairs at the British Pregnancy Advisory Service (Bpas), a charity that sees almost 100,000 women a year at clinics across the UK for reproductive healthcare services including abortion care, miscarriage management and contraception.
Teenage pregnancy rates are now at their lowest ever recorded levels, something Murphy attributes in part to “good accessible contraceptive services for younger women”. But she says that while reducing the rate of teenage pregnancies and abortions among young women has been prioritised, “the needs of older women have fallen a little bit by the wayside”.
Contraceptive services are often geared towards under-25s, Murphy explains. “There’s almost an attitude of: oh, when you hit 25 you obviously won’t be having sex anymore. It’s a very old-fashioned framework, because actually women are waiting longer to start their families but are still expecting to have sexual fulfilment.”
The average age of first-time motherhood in England and Wales is now 28.9, according to the Office for National Statistics. “That’s a very long period in which women are trying to control their fertility, and I don’t think their [contraceptive] needs are necessarily always being met throughout that time,” Murphy says.
As a woman in my late 20s, I have experienced first-hand the profound flaws in contraceptive services in England: pills discontinued without warning; long, anxiety-inducing afternoons spent trudging from pharmacy to pharmacy trying to track down the method of contraception I’d been prescribed. Women in their late 20s, 30s and 40s may have less time to spend on securing adequate contraception than their younger counterparts, says Murphy: “The older you get, the greater your caring responsibilities or work commitments may be, and the less time you have to be traipsing around or waiting for many hours to see someone at a walk-in centre.”
Last autumn, several major public health bodies called on Boris Johnson’s government to take action to tackle shortages of contraception across the UK, saying that thousands of women and girls had been affected. But the problem is not just one of pharmaceutical supply. Local authorities have faced cuts of nearly £16 billion over the last decade, and half of councils in England cut or planned to reduce the number of sites providing contraception services between 2015 and 2019. Research by the Faculty of Sexual and Reproductive Healthcare (FSRH) shows that nearly four in 10 women in the UK are now unable to access local contraception care.
The charity Marie Stopes UK attributes the rise in abortion rates among women in their late 20s, 30s and 40s directly to the government’s failure to invest properly in contraceptive services. Jonathan Lord, the charity’s medical director, says this “has led to poor access and unacceptable waits, particularly for the most effective long acting methods, such as the implant and coil.”
Perhaps the most striking aspect of the new Department of Health statistics is the fact that more than half of women (55%) who had abortions in 2019 were mothers – an increase of 6% since 2009. Of the women aged 35 and over who had an abortion last year, the overwhelming majority (87%) were already the parent to at least one child.
These figures highlight the need for women to be properly supported in going back onto contraception – or choosing a new contraceptive method – during the antenatal period, says Bpas’s Clare Murphy. “The immediate aftermath of having a baby is so baby-focused. Giving women the opportunity to control their method of contraception post-partum, such as midwives having the ability to fit coils or implants post-delivery, definitely needs to be part of a good maternity service.”
Having an abortion is not by default a traumatic experience: it can be a hugely positive decision, one that enables women to proactively shape the course of their lives. But if more women across England and Wales were able to access comprehensive contraceptive services from their teenage years until they reached the menopause, it seems unlikely that abortion rates would be rising as they are. The current system isn’t working – and something has to change.