Introduction

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Great Britain (England, Wales, Scotland)

Law

In Great Britain, legal termination of pregnancy may be carried out provided that two registered medical practitioners agree that:

a) Up to 24 weeks:

• 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 or any existing children of her family.

The woman’s actual or reasonably foreseeable future environment may be taken into account.

b) With no time limits:

• the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
• there is a risk to the life of the pregnant woman, greater than if the pregnancy were terminated
• there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

(Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990)

In 2008 the Human Fertilisation and Embryology (HFE) Bill provided an opportunity to modernise abortion law, and various amendments to the 1967 Abortion Act were tabled. Due to a procedural motion, there was no time to debate or vote on the abortion issue and this law was unchanged.

The Science and Technology Committee carried out a separate investigation into scientific developments relating to abortion law in 2007(1).

In June 2007, doctors at the BMA conference voted in favour of removing two doctors’signatures for first trimester abortion(2). In 2005, conference had debated the evidence(3) and voted in support of the current time limit.

• A young woman under 16 may consent to an abortion without parental knowledge or consent if both the doctors concerned agree that she has sufficient maturity and understanding to appreciate what is involved. 
• No person is obliged to perform or participate in an abortion to which they have a conscientious objection, but they still have a duty to participate in treatment which is necessary to save the life of or to prevent grave permanent injury to the woman. Any doctor or nurse who feels unable to give information or counselling to a woman seeking an abortion, because of conscientious objection, should refer her to another doctor without delay(4,5).

Policy and guidance

Governments in England(6), Wales(7) and Scotland(8) have published policy documents which address sexual health issues and services. These include recommendations for improving abortion services, and ensuring equitable access and minimum waiting times between the initial referral and the abortion.

Detailed guidance from the Royal College of Obstetricians and Gynaecologists(9) aims to ensure that all women considering abortion have access to a service of uniformly high quality. This guidance should be used as the basis for the development of local protocols or guidelines in the United Kingdom.

Abortion services are also included in broader recommended standards for sexual health services from the Medical Foundation for AIDS and Sexual Health(10). Although specifically intended to support the implementation of the Government’s sexual health policy in England, they can be applied elsewhere.

Statistics (England, Wales and Scotland)

England and Wales (resident women)(11)

In 2008:

• around one in five pregnancies (22.3 per cent in 2006) end in abortion every year. This proportion has remained constant for several years(12)
• the total number of abortions was 195,296, a fall of 1.6 per cent compared with 2007 
• the abortion rate was 18.2 per 1,000 women aged 15–44, compared with 18.6 in 2007
• the abortion rate was highest, at 36.0 per 1,000, for women aged 19
• teenage abortion rates were lower than in 2007: the under-16 rate was 4.2 and the under-18 rate was 18.9
• 90 per cent of abortions were carried out under 13 weeks gestation, and 73 per cent under ten weeks
• less than 2 per cent were carried out over 20 weeks gestation. This percentage has remained fairly consistent over the last ten years
• medical abortion accounted for around a third (37 per cent) of all abortions, compared with 34 per cent in 2007
• nearly half of early abortions were medical: 46 per cent of those carried out under ten weeks gestation
• nine out of 10 (90 per cent) abortions were either provided or funded by the National Health Service (NHS), compared with 87 per cent in 2005. NHS provision varied between primary care organisations (PCOs), and ranged from 69 per cent to 98 per cent
• over two-thirds (68.1 per cent) of all NHS-funded abortions were carried out under ten weeks. This varied between PCOs, and ranged from 45 per cent to 85 per cent.

Scotland(13)

In 2008:

• the total number of abortions was 13,817, an increase of 0.6 per cent over 2007
• the abortion rate was 13.1 per 1,000 women aged 15–44, compared with 13.0 in 2007
• the abortion rate was highest for women aged 16–19 (24.5) and 20–24 (24.9)
• 93.6 per cent of abortions were carried out under 14 weeks gestation, and 70.3 per cent under ten weeks. This proportion has remained relatively stable over the last five years
• about 0.3 per cent were carried out over 20 weeks gestation
• medical abortion accounted for 64.6 per cent of all abortions, compared with 61.8 per cent in 2007
• nearly four out of five (78.4 per cent) of abortions carried out at under nine weeks, were medical
• the vast majority (99.6 per cent) of abortions were NHS funded and carried out in NHS premises.

Northern Ireland

(see separate PDF factsheet on abortion in Northern Ireland for more detail)

Law

• The 1967 Abortion Act does not extend to Northern Ireland, and women from Northern Ireland are not entitled to an NHS abortion in Great Britain.
• Abortion is only legal in exceptional circumstances – if the life or the mental or physical health of the woman is at serious or grave risk, which has to be permanent or long term.
• In June 2001, FPA won the right to the first Judicial Review of medical practice relating to abortion and the provision of abortion services in Northern Ireland. The Review took place in March 2002 and in July 2002 Mr Justice Kerr concluded that the Department of Health, Social Services and Public Safety (DHSSPS) was not failing in its statutory duty to issue guidelines, but he thought it prudent if they did. FPA immediately lodged an appeal and in October 2004 Belfast High Court of Appeal ruled that the DHSSPS had failed to perform its statutory duties. In response to this, in 2005 the DHSSPS instigated a formal investigation into the provision of abortion services in Northern Ireland. Draft guidelines were issued for consultation in early 2007, but rejected by the Northern Ireland Assembly later that year. The Assembly instructed the DHSSPS to redraft the guidelines. The redrafted guidance went out for consultation in 2008, and the final guidance published in March 2009, following Executive approval.(14)
• The guidance document does not make any changes to the law governing abortion in Northern Ireland, and simply restates the existing legal position in relation to abortion services in Northern Ireland.
• An amendment to the Human Fertilisation and Embryology Bill was tabled in July 2008, to extend the 1967 Abortion Act to Northern Ireland. All amendments to the Bill were due to be debated at the Report Stage after the 2008 summer recess. However, due to a procedural motion, the amendments relating to abortion were not debated in the House of Commons.

Statistics (Northern Ireland)

• In 2007/08, 92 women had a medical abortion in Northern Ireland (defined by the DHSSPS as ‘the interruption of pregnancy for legally acceptable, medically approved indications’)(15).
• No statistics are available to indicate the age of the women, the legal grounds, where the abortion was carried out, the stage of pregnancy or the type of abortion.
• In 2008, 1,173 women travelled to England for an abortion(11). This figure, based on the addresses given by clients, is likely to be an underestimate.
• Around half (51 per cent) of those travelling to England were in their twenties, and one in six (16.7 per cent) were aged under 20.
• 86 per cent of these abortions were carried out under 13 weeks gestation and 67 per cent under ten weeks.

References

1 House of Commons. Science and Technology Committee, Scientific Developments Relating to the Abortion Act 1967. Volume 1 (London: tso, 2007)

2 British Medical Association, First Trimester Abortion. A Briefing Paper by the BMA Medical Ethics Committee (London: BMA, 2007).

3 British Medical Association Ethics Department, Abortion Time Limits. A briefing paper from the British Medical Association (London: BMA, 2005).

4 General Medical Council, Good Medical Practice. (London: GMC, 2006).

5 Nursing and Midwifery Council, Standards of Conduct, Performance and Ethics for Nurses and Midwives (London: NMC, 2008).

6 Department of Health, National Strategy for Sexual Health and HIV (London: DH, 2001).

7 National Assembly for Wales, A Strategic Framework for Promoting Sexual Health in Wales (Cardiff: National Assembly for Wales, 2000).

8 Scottish Executive, Respect and Responsibility. Strategy and action plan for improving sexual health (Edinburgh: Scottish Executive, 2005).

9 Royal College of Obstetricians and Gynaecologists, The Care of Women Requesting Induced Abortion. Evidence-based clinical guidelines 7 (London: RCOG, 2004).  

10 Medical Foundation for AIDS and Sexual Health, Recommended Standards for Sexual Health Services (London: MedFASH, 2005).

11 Department of Health, Abortion Statistics, England and Wales: 2007. Statistical Bulletin 2008/01 (London: DH, 2008).

12 Office for National Statistics, Conception statistics: Conceptions for Women Resident in England and Wales, 2006 (London: ONS, 2008)

13 ISD Scotland, ISD Scotland. Abortion Statistics, Year Ending December 2008.

14 Northern Ireland. Department of Health, Social Services and Public Safety, Guidance on the Termination of Pregnancy: the Law and Clinical Practice in Northern Ireland (Belfast: DHSSPS, 2009)

15 Northern Ireland. Department of Health, Social Services and Public Safety, 'Hospital Inpatients System' (Private communication, 2 June 2000).

Further information

For further information on the material covered in this factsheet, and other subjects related to sexual health, contact the FPA Library and Information Service. Email: libraryandinformation@fpa.org.uk. Tel: 020 7608 5282.

sexual health direct is supported by the Department of Health.