We need a Complications from Abortions (Annual Report) Bill – this is why

Abortion is a generally safe procedure for women. It is not my purpose in bringing this Bill forward to dispute that. Rather the question this Bill raises is how safe it is. To know that we need statistics that reflect real experience.

The Abortion Act 1967 provides that a record of each termination is to be submitted to the Chief Medical Officer (or appropriate authority in Scotland). This is known as the Abortion Notification System. The Act requires that this record include complications arising from the procedure. These complications may include part of the pregnancy remaining and needing an operation to remove it; haemorrhage; damage to the womb; and infection, including sepsis.

The Department of Health and Social Care monitors and publishes statistics on abortion and they use the Abortion Notification System for this purpose. The published rate of complications is low: generally about 1.2 to 1.4 per thousand in recent years.

Abortion as provided in the UK is unusual in that it is the only common procedure that is made available by the NHS but in the great majority of cases (80%) is provided by independent clinics, such as the charities BPAS and Marie-Stopes (though there are other smaller providers too).

And that is where the statistical issues start. Independent abortion providers report information on terminations, including on complications arising, to the chief medical officer, as required by law. In the case of an independent provider, however, the complications it captures are principally those that arise within the clinic, since many women who experience a complication after discharge from the clinic will present to their GP, to 111 or to A&E at a hospital. In these cases, the complications will not be captured by the Abortion Notification System.

Until recently nobody has attempted to collate figures on the level of complications not captured by ANS data.

Then three years ago the Office for Health Improvement and Disparities, a branch of the NHS, turned its hand to this task and in November 2023 produced its report. The task was more challenging than one might have thought. There were of course many of the usual statistical conundra: what to count and what not to count; whether definitions in different datasets were the same, and so forth. In fact the first half, almost, of their report is a careful and thorough essay on the methodology they used: indispensable, since they were doing it for the first time. They focused entirely on incidents arising in a hospital setting, using Hospital Episode Statistics and, importantly, separated out incomplete abortions that were nor accompanied by a further complication.

They broke the complication rate down by age, showing what I think is generally accepted, that risk is somewhat higher for older women, and by type, for example as between haemorrhage (the most common complications), sepsis, cervical tear and so forth.

Their headline finding was that the complication rate was between 3.5 and 4.4 per thousand in the period 2017 to 2021, depending on the year, somewhat higher than ANS data alone and I understand statistically significant. However, this rose significantly, to about 17, 18 or 19 per thousand if incomplete abortions without further complications were included.

The importance and relevance of this information is all the more significant when one considers changes in the way in which terminations are administered. Because, of course, a surgical abortion is nowadays a rarity. Currently about 85% of abortions are medically induced, that is, by taking a sequence of pills, up from 48% in 2012. These terminations frequently take place at home and indeed since the Covid pandemic it is possible for a woman to obtain the medication from an abortion provider without an initial in-person interview or examination.

This shows that the abortion landscape is shifting rapidly and clinicians need to have available the most robust data about complications, as indeed women do, for the purpose of informed consent.

It is unfortunate therefore that it appears that there are no plans for the OHID to continue to collect the valuable data contained in their report. My Bill would place an obligation on the Government to do so.

This is not to suggest abolishing the existing Abortion Notification System, which provides valuable and necessary information on other matters.