New study findings reveal reasons for late abortion

A new research study, by the Centre for Sexual Health Research (CSHR) at the University of Southampton and the School of Social Policy, Sociology and Social Research at the University of Kent, has explored why women have abortions in the second trimester, when they are between 13 and 24 weeks into a pregnancy.

The study considered the experiences of 883 women who had obtained second-trimester abortions.

Key findings are:

• There was no single reason why women have abortions in the second trimester: respondents reported a whole variety of reasons that explained their delay in seeking and obtaining an abortion.
• A major reason for delay in the pathway to abortion was women not realising that they were pregnant.
• Much of the delay occurs prior to women requesting an abortion: half the women questioned were more than 13 weeks pregnant by the time they requested an abortion.
• Women’s concerns about what is involved in having the abortion are also important in creating delay.
• Various aspects of relationships with their partners and/or parents played a role in delays in women’s decision-making about whether to have an abortion.
• Forty one per cent of women in the study said that they were unsure about having an abortion and therefore it took some time to make up their minds. Over half the teenage women said they were worried how their parents would react, while 23 per cent overall said that their relationship with their partners had broken down or changed.
• After requesting an abortion, delays were partly service-related, to do with waiting for appointments, and partly ‘women-related’, to do with missing or cancelling appointments. Service-related reasons for delay at this stage included delays in getting further appointments and confusion amongst doctors first approached about where a procedure should take place.

Dr Ellie Lee, senior lecturer in social policy at the University of Kent, and report co-author, comments: "There has been a great deal of media and public debate recently about second-trimester abortions, especially those performed at 20 weeks and over. What has been lacking in this discussion so far is an understanding of why women have abortions at this stage. This means few have sought to properly address how women can be helped to terminate pregnancies earlier, and how policy makers and service providers might best think about the relevant issues for those women who seek second-trimester abortion. Debate about the ‘’ethics’’ of abortion has its place, but we hope this research can help to generate discussion about these more practical concerns and issues. If as much attention were paid by policy makers to second trimester abortion as has been given to early abortion, significant gains for women could be made."

Professor Roger Ingham , Director of the Centre for Sexual Health Research at the University of Southampton and lead author of the research says: "This study is the most detailed conducted about second-trimester abortions in Britain to date; it has provided information and evidence about an under-researched area.

"The findings indicate that while it is important to keep improving the early abortion service, changes in this area will have a limited effect for the incidence of second-trimester abortion, simply because many women who terminate pregnancies in the second trimester do not realise they are pregnant until they are more than 13 weeks pregnant," he continues.

"The results indicate a need for improved education to encourage a greater awareness of women’s fertility, and an encouragement to earlier testing if a pregnancy is suspected. Other areas for discussion include how to make sure women’s concerns and fears about abortion are appropriately addressed, and how to minimise delays to women accessing abortion, which sometimes seem to relate to GPs not knowing where to refer women. This study also shows that many women who terminate pregnancies "late" experience great difficulty in deciding whether to have an abortion. Those in a position to do so need to think about how to ensure those women can make decisions in the most supportive context possible, where they do not feel rushed into a decision, yet can have speedy access to abortion when they feel sure this is the right decision for them," he adds.

Ann Furedi, chief executive of British Pregnancy Advisory Service, says: "This valuable research gives service providers, policy makers and NHS commissioners the evidence needed to ensure women receive the necessary support and services as early as possible, and as late as necessary."

She adds: "With increased NHS investment in abortion care, more UK women are able to get a funded abortion at an earlier stage than would have been available, say, five years ago. "Later" abortions have always made up a small percentage of procedures within the overall provision of abortion, but these women need specialist care. As the study confirms, they tend to be already vulnerable and in difficult personal circumstances. Our patients taking part in the research were pleased to be able to make their voices more widely heard about the reality of their situation."

The findings of the study will be presented and discussed at a seminar on 19 April for health professionals, abortion service providers and other interested parties.