Study reveals variations in local proportions of pregnant young women choosing abortion

A new study for the Joseph Rowntree Foundation finds that abortion proportions among young women who become pregnant tend to be lower in socially disadvantaged areas – even though these areas also have the highest rates of conception among the under 18s. Abortion proportions tend to be higher in areas where there is more extensive family planning provision, where there are higher percentages of women GPs and where there is easier access to independent abortion services.

The report, by researchers from the Centre for Sexual Health Research at the University of Southampton, further concludes that young women’s choices of abortion or motherhood tend to be based on their personal circumstances at the time they become pregnant, rather than their moral views in the abstract. Teenagers who saw their lives as insecure were more likely to accept motherhood as a positive change in their lives. Those who saw their lives developing through education and employment were more likely to opt for an abortion.

The report combines an analysis of national and district data on teenage pregnancy and abortion with the findings from in-depth interviews with more than 100 young women. These were evenly divided between those who had continued with an unplanned pregnancy and those who had chosen to end one. The study found that:

• Between 1999 and 2001, 44 per cent of conceptions among young women aged 15 to 17 were terminated. In England and Wales the highest and lowest proportions of teenage pregnancies ending in abortion were in Eden, Epsom & Ewell and Rochford (all over 70 per cent) and Merthyr Tydfil, Torridge and Derwentside (all under 30 per cent).
• In Scotland, where statistics are prepared on a different basis, the proportion of conceptions to 13- to 19-year-olds leading to abortion varies between 49 per cent in Grampian and 32 per cent in Shetland.
• The interviews with teenagers who had been pregnant suggested that the decision about whether to seek an abortion was generally reached before they visited a health professional.
• A strong similarity between local abortion proportions among women under 18 and those for adult women in the same area suggested that family and community views were an important influence on teenagers. Motherhood at an early age was treated as more acceptable and ‘normal’ in some neighbourhoods than others.
• Most interviewees had been shocked to discover they were pregnant. Some, young women had held clear views ‘for’ or ‘against’ abortion (although they did not necessarily act upon them); but many had not thought about abortion until they found they were pregnant.
• Young women who believed their life would lead them into higher education or a career tended to have been clear and decisive in choosing an abortion. Those who had continued with their pregnancies tended to have viewed motherhood as a new direction in life, and a rewarding opportunity to take personal responsibility without harming plans for the future.
• All the young women who chose abortion had found it stigmatising, and many had thought they should keep their plans secret from parents. They had been pleasantly surprised when they found health professionals who treated them with sympathy and without judgement.
• Most young women described their experiences of abortion services in positive terms. However, some had found doctors’ attitudes upsetting when they made their disapproval of teenage pregnancy and abortion apparent. Some clinicians showed a particular dislike of requests for abortion after the first twelve weeks of pregnancy.
• NHS clinics were less likely to offer later terminations, compelling women to travel further to independent clinics. Those who had used independent providers generally reported more positive experiences than with the NHS. 

Ellie Lee, a co-author of the report and former Research Fellow at the Centre for Sexual Health Research who now lectures at Kent University, said: “When an unplanned pregnancy occurs, it is clear that most young women perceive the outcome as first and foremost their decision. Yet the evidence shows that their views are shaped by factors that include social deprivation, the attitudes of family and friends and the accepted ‘norms’ of behaviour in the communities where they live.”

She added: “We believe it is important to accept and build on the satisfaction that many young women get from motherhood and to provide medical services that accept that choice. We would also like to see more initiatives that would help raise their expectations for the future – especially regarding educational attainment and building a career.

“At the same time, we believe that young women who choose abortion should have their choice respected and have better access to services of a more consistent quality than currently exists. Abortion needs to be de-stigmatised and the case made more strongly for viewing it as a morally acceptable aspect of reproductive health care and family planning.”

Roger Ingham, Director of the Centre for Sexual Health Research and a co-author of the report, said: “There are areas of inadequate service provision that this report has highlighted which need to be addressed. They include access to family planning and sexual health services, access to women doctors, the availability of local NHS abortion services and also whether young women have access to independent-sector provision in their part of the country.

“Young women have fairly positive experiences of medical services, but there are areas where improvement is needed. These include access to second trimester procedures and more sympathetic and caring treatment of young women during consultations and when the abortion procedure takes place.”

---------------------

England and Wales: Local authority conception rates per 1,000 young women aged 15-17 and proportions of pregnancies resulting in abortion (1999-2001)

Highest proportions

Lowest proportions

Scotland: Conceptions to women aged 13-19 (1999-2001)

* Based on 1999-2000 figures only ** deliveries + abortions + miscarriages managed in hospitals