Termination of pregnancy in Scotland

Considerations of recent data

This is another ‘thinking out loud’ post. We’ve noticed some strange trends in this dataset, and curious what people think about it.

Public Health Scotland gather data on ‘Terminations of Pregnancy’ in Scotland, and those are published on the ‘Shinyapps’ site at the link below. Note that these are separate from miscarriage, the data above are medical terminations of pregnancy.

https://scotland.shinyapps.io/phs-covid-wider-impact/

As the PHS site notes “Termination of pregnancy (also referred to as a therapeutic or induced abortion) is provided under the terms of the Abortion Act 1967 and subsequent regulations.” Those regulations state

So in theory termination is only offered for limited medical reasons. However in practice we understand it is not handled like that, and basically no-one requesting a TOP is really refused these days. So when interpreting these data we should think changes could be medically driven, but more likely by choice.

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So looking at the chart we can see;

• Terminations were pretty steady, until we saw a significant spike in the first lockdown - which is in itself intriguing.

• Of greater note is that the number returned to stability, before suddenly rising from late summer 2021, and it’s never come back down again from that level.

Since mid-2021 Scotland is seeing 200 more terminations of pregnancy per month (around 15-20% increase), meanwhile actual births are down. This means terminations are much higher as a percentage of total pregnancies. By that we mean that if the total birthrate were 20% higher, terminations could also be 20% higher and that would still be a ‘normal’ number. But births being notably down and terminations much higher seems rather strange.

Public Health Scotland used to provide a commentary on this data (seee 'Commentary’ section on that website), but the last one was in July 2021 (just before this took off) and there has been no update since. They do publish an annual report which covers this subject - the next report should be due middle of this year, so it will be interesting to read the analysis. But in the meantime the PHS auto-generated chart is itself flagging a warning that this is unusual.

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In the meantime we can break the data down in a little more detail.

Firstly we can compare the 2022 period to the 2018/19 stable period, and look at changes by Deprivation level, and by Age Group.

• Deprivation: The change is quite stable across deprivation level, except that the wealthiest people experience the biggest change, particularly the second wealthiest group increase by almost 20%.

• By Age Group: Basically terminations increase with age. It’s somewhat the opposite of what we might expect to see.

One other way we can look at the data is by the gestation period at which the termination was carried out, as this is included. You can see below the chart which shows the total terminations, and when those were carried out (<10 weeks, between 10 & 12 weeks, and >12 weeks).

The increase comes mainly in the <10 weeks, with the other two being quite steady. Speaking to those who work in the field, <10 weeks is most likely mainly elective, women who decide they don’t want the pregnancy as soon as hearing about it. A termination for something like fetal abnormality would usually occur later, as screening for that is not carried out until later.

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It’s a really marked increase and we’re curious people thoughts and suggestions. And of course please download the data (click the ‘Data’ section on the site above) and analyse yourself.

• One interpretation can of course be that the timing of the increase is immediately post COVID-19 vaccination in those age groups. However why would that cause an elective termination, and also the gestation period of the termination is too early for something like that.

• So far this more seems to suggest that for some reason a much higher proportion of pregnancies are being chosen to be terminated. Given that we have a background of fewer pregnancies overall, perhaps that is not surprising? Economic or social uncertainty, people not wanting to commit to such a decision in that background?

So those are the data, and interested in your thoughts?

Edit: Neglected to add that it was reading the below Substack that got us thinking we should publish these data for thoughts. Although their data are mixing elective terminations, miscarriages and medical terminations, the fact that they saw such high numbers prompted to think that if it were the case we MUST see the same in other countries.

The miscarriage of medicine

Best wishes

Scottish Unity Edinburgh Group

EDIT: Added stacked line chart of numbers by gestation period

EDIT: Added for Yarrow, 2020 data by SIMD deprivation