The state of health care and adult social care in England 2023/24
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Termination of pregnancy services
The level of demand for termination of pregnancy services is increasing.
In 2022, just over 251,000 abortion procedures were carried out, a 17% increase since 2021. While the reasons for this are complex, a study by the British Pregnancy Advisory Service (BPAS) found that for over half of women (57%), the decision was mainly or partly related to financial factors, with respondents citing the cost of living, childcare costs and housing considerations. In addition, over a third (33%) of women surveyed said they had been unable to access contraception or had to wait longer for it than they wanted.
Amid rising numbers of abortion procedures, we are concerned that not enough women can access termination of pregnancy services close to where they live, at a time when they need them. Integrated care boards (ICBs) commission the majority of these services, but the model is fragile, with 2 independent providers delivering the majority of abortions in England (approximately 80%) from the independent sector.
Independent termination of pregnancy services are not evenly distributed across the country, meaning some women face travelling significant distances to access them. This is particularly concerning given that women living in areas of high deprivation are twice as likely to use abortion services. In response to this, some charities cover the cost of travel to ensure women can exercise their choice.
In addition, independent services often do not provide overnight facilities and in some cases, we have seen issues when women need to be transferred back to NHS services to continue their care. Independent hospitals offering termination of pregnancy services also have criteria for admission, which women with multiple health conditions do not always meet. In these cases, access to services can be more problematic, with only 5 NHS trusts in England commissioned to provide late surgical abortions up to the legal limit for these women.
When women are able to access termination of pregnancy services, we are concerned about the quality of care they receive.
As part of our inspections, we are working to improve the quality and safety of services delivered.
Improvement through inspection
An inspection of one termination of pregnancy provider highlighted that although the organisation had a clear vision, there were issues with corporate and financial governance processes. As one of the main independent providers of termination of pregnancy services, these issues posed risks to the stability of the sector.
We issued a Warning Notice, working closely with NHS England to drive improvements at the provider, which would help to stabilise abortion services across the country. A follow-up inspection showed significant improvement, with a new executive board, better sharing of information and examples of succession planning.
Despite these improvements, we remain concerned about women’s access to termination of pregnancy services. In March 2024, NHS England published a letter setting out its objectives and vision for abortion services. It outlines actions for ICBs, including agreeing and adopting appropriate local referral pathways and procedures to ensure smooth transfers of care between independent and NHS providers when required. It also highlights the importance of appropriately funded, financially sustainable services, concluding that there are “national and regional risks if the fragility we are seeing in services is not addressed.”