Termination of pregnancy

The data below are taken from the following source: 

Termination of Pregnancy Report: Year Ending December 2021.   

Terminology: 

• While there is debate over the use of ’abortion’ or ‘termination of pregnancy’ when presenting this data, since the majority of information used is sourced from the PHS report, we use their preferred terminology. 
• There have been calls to shift language from gendered terms (women, girls) to more inclusive expressions (such as people with uteruses) so as to incorporate those individuals accessing termination services that do not identify as women. However, the current iteration of the PHS report does not explore the gender identity of patients, so we defer to the vocabulary used in this publication. 

Key service changes:

Due to the COVID-19 pandemic, from March 2020, Scottish Ministers approved the patient’s normal place of residence in Scotland as a place where the first drug (mifepristone) could be administered. Prior to this, in October 2017, ministerial approval was granted for second stage of early medical abortion treatment to be undertaken in a patient’s home in certain circumstances. The inclusion criteria include, but are not limited to: 

• Fulfils the criteria set out in the Abortion Act 1967; 
• Should be 16 years of age or above; 

• No significant medical conditions or contraindications to medical abortion; 
• Less than or equal to 9 weeks + 6 days confirmed pregnancy on the day of mifepristone administration i.e. the date the first drug is administered. 

This approval will remain until an independent evaluation to assess the impact of early medical abortion at home is undertaken.

In 2021 there was 13,758 terminations undertaken in Scotland (13.4 per 1,000 women aged 15 to 44), a slight reduction from 2020 (13,896 terminations; 13.5 per 1,000 women aged 15 to 44).

Terminations by age group 

There continued to be more terminations undergone by women aged 20-24 in 2021, with 3,685 terminations carried out (27% of all terminations carried out in Scotland). The lowest number reported was amongst the under 16 group (98), dropping to the lowest level since 1969, and accounting for less than one percent (0.7) of terminations in Scotland in 2021. The proportion of terminations involving teenagers was the lowest since reporting started with 11.4% in 2021 in comparison to 31.6% in 1984. Older age groups (30 to 34; 35 to 39; 40 and over) recorded their highest number of terminations in 2021 since 1968, with 2,748 (20%); 1,798 (13%) and 660 (5%) respectively.

Association between deprivation and the rate of termination

While the gap between the rates of termination in the most and the least deprived areas has reversed slightly, the strong association between deprivation and the rate of termination remains in 2021, with rates almost twice as high in women from the most deprived areas (18.9 per 1,000 women aged 15-44) in comparison to those from the least deprived areas in Scotland. Women from the least deprived areas were more likely to have a termination under 9 weeks gestation compared to women from the most deprived areas. This was evident across age groups, and particularly true for under 16s with 72% of terminations under nine weeks’ gestation performed in the most deprived areas in comparison to 100% in the least deprived areas.

Terminations by area of residence 

The PHS report states that when calculating termination rates by area of residence, the denominators are based on permanent residents, which may give artificially high rates in areas where there is a high proportion of temporary residents (e.g. students). Similarly, a small number travel to Scotland from countries where access to terminations is restricted and may be counted as Scottish residents if they provide a temporary Scottish address. Some care should also be applied when examining rates by deprivation for specific health board areas, as numbers of terminations occurring in specific deprivation categories in the less populous NHS Boards may be small. 

The highest terminations continued within urban east coast health board areas (NHS Tayside) and remained lowest in the Islands (NHS Orkney, NHS Shetland and NHS Western Isles). Termination rates were highest in NHS Tayside in 2021 with a rate of 16 per 1,000 women aged 15-44, and in Dundee City with 18.7 per 1,000 women aged 15-44. The lowest rates were in remote rural localities, including the islands (6.0 per 1,000 women aged 15 to 44) and Moray (9.6 per 1,000 women aged 15to 44). Since 2019, four NHS Boards have reported year on year increases, including NHS Dumfries and Galloway (11.4 to 12.0 per 1,000 women aged 15 to 44), NHS Greater Glasgow and Clyde (13.6 to 14.5), NHS Lanarkshire (13.2 to 15.0), and NHS Tayside (14.9 to 16.0).

Termination by gestation/method  

The latest figures show a continued increase in terminations taking place at less than nine weeks gestation, rising from 81% in 2020 to 84.3% in 2021. This increase may be fuelled by service changes due to COVID-19 impacts and a move to more terminations using the Early Medical Abortion at Home approach.

Previous termination of pregnancy  

In 2021, the rate of women with no previous terminations has slightly decreased from 8.5 in 2020 to 8.1 per 1,000 women aged 15 to 44, while the rate of women with one or more previous terminations has increased to 5.2 per 1,000 women aged 15 to 44 from 4.9 in 2020.

Recent mixed-method research (Purcell et al, 2017) explored the issue of women undergoing more than one abortion within the relatively short timeframe of two years. This research found that women undergoing more than one abortion within two years may experience particular challenges and vulnerabilities, and suggested service provision should recognise this and move away from stigmatising discourses of ‘repeat abortion’ that has until recently been commonly used in policy and research. 

Termination under ground E of the 1967 Abortion Act (fetal anomaly)  

As in previous years, the vast majority of terminations in 2021 (13,565; 98.6%) were carried out under Ground C of the Act, i.e. where “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.