Pregnancy, birth and maternity: birth outcomes

Miscarriage 

Miscarriage is the most common cause of pregnancy loss. Between 8-24% of clinically recognised pregnancies end in miscarriage. Risk factors include advanced maternal or paternal age, congenital abnormalities, endocrine disorders, smoking, and environmental risk factors such as pollution. The overall figure is difficult to quantify due to many miscarriages happening before women know they are pregnant. 

Data on miscarriage is captured if the woman requires hospital admission (inpatient or day case) for care related to their miscarriage (admissions to gynaecology or maternity units are captured on Scottish Morbidity Record 01 (SMR01) and Scottish Morbidity Record 02 (SMR02), respectively).  

There is no central record of miscarriages where the women are treated in outpatient settings, or at their GP, or for women who didn’t seek any medical intervention.  

Management of miscarriage has changed over the years: many women suffering experiencing a miscarriage are no longer admitted to hospital (either as a day case or an inpatient).  

As a result, the decline in miscarriage numbers seen in hospital data over recent years is unlikely to be a true decline in miscarriages – only a decline in those recorded in SMR01/02. 

Terminations 

Termination of pregnancy has been legal in the UK since the implementation of the 1967 Abortion Act.  

Terminology:

o          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.

o          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

In March 2020, to ensure termination or pregnancy continued as an essential service during the COVID-19 pandemic, Scottish Ministers gave approval for antiprogesterone, the first medication administered in a medical termination, to be taken at home, in addition to the second stage of early medical termination treatment (prostaglandin).  In May 2022, approval was revised to allow antiprogesterone to continue to be taken at home where a clinician decides that it is clinically appropriate.

Termination Rates and Trends

The data below are taken from PHS Termination of pregnancy statistics, unless otherwise stated.

Termination services in Scotland undertook 18,207 terminations in 2023, representing a 10% increase in service demand from 2022 (from 16.1 per 1000 women aged 15-44 years in 2022 to 17.6 in 2023). Increases were observed across all age groups and in all NHS board areas.

Termination rates rose between 2022 and 2023 in all age groups. The highest rates were for women aged 20 to 24 years (29.3 per 1,000 women) and 25 to 29 years (24.3 per 1,000 women).

The strong association between deprivation and the rate of termination remains in 2023, with rates almost twice as high in women from the most deprived areas (24.1 per 1,000 women aged 15-44 years) in comparison to those from the least deprived areas in Scotland (12.4 per 1,000 women aged 15-44 years). There is a strong association between terminations and deprivation: the rate in the most deprived areas was almost twice as high as in the least deprived areas of Scotland. 

Similar to previous years, there remains a gradient across deprivation groups in accessing termination services early (under nine weeks' gestation). The rate was lowest for women from the most deprived areas. In 2023, 76.4% of terminations were performed under nine weeks' gestation in the most deprived areas (SIMD quintile 1) compared with 82.8% in the least deprived areas (SIMD quintile 5).

In 2023, 98% of terminations were medical and less than 2% were surgical.

As in previous years, the vast majority of terminations in 2023 (17,893; 98.3%) 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.” 

Previous termination of pregnancy 

In 2023, the rate of women with one or more previous terminations increased to 7.0 per 1,000 women aged 15 to 44 years, from 4.9 per 1,000 in 2020.

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.

Live births 

Unless otherwise stated the data shown on this page are drawn from the PHS data on Births in Scotland using Scottish Morbidity Record 02 (SMR02) data. 

Lowest birth rate since records began: 

In 2023, there were 45,935 live births recorded across Scotland (Source: NRS, 2024), the lowest number since records began in 1855.

Increase in caesarean sections: 

Caesarean sections per 1,000 live singleton births increased from 9% (5% elective and 4% emergency) in 1976 to 39% in 2022/23 (19% elective and 20% emergency). 

Birthweight has remained stable: 

Babies with a birthweight of less than 2,500 grams are generally considered to be of a low birthweight. Very low birthweight is often considered less than 1,500 grams. However, it can also be useful to consider birthweight in relation to gestational age.

In 2022/23, 81.1% of live babies were born with a birthweight appropriate for gestational age. This rate has been fairly consistent over time. However, the percentage of babies that are small for gestational age has fallen from 8.9% in 2003/04 to 5.0% in 2022/23. The percentage of babies who are large for gestational age has increased from 11.7% to 13.9% in the same period.