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A quarter of abortions due to contraception failures

Charity says women cannot control their fertility through contraception alone

Mark Gould

Monday, 10 July 2017

One in four women who had an abortion in 2016 were using the most reliable methods of contraception, according to a new report by the British Pregnancy Advisory Service (BPAS).

The report ‘Why women present for abortions after 20 weeks’ reveals that 24.1% of 60,592 women who had an abortion at any gestation at BPAS clinics in 2016 were using either a user-dependent hormonal method of contraception (pills, patches or rings) or a long-acting reversible contraceptive (injections, implants, IUD and IUS) when they presented for treatment.

BPAS says these are among the most effective methods of contraception. Including non-hormonal methods such as condoms and diaphragms, over half (51.2%) of women were using a method of contraception. 

The report stresses that no method of contraception is 100% effective, yet it finds that public discourse and some family planning initiatives frequently imply that abortion can always be avoided through the use of contraception. However, each year, nine in every 100 women using the contraceptive pill, the most popular method of contraception in the UK, six in every 100 using the contraceptive injection, and nearly one in every 100 using the IUD (copper coil), will become pregnant.

The report also indicates that the use of hormonal contraception is a factor in delaying identification of pregnancy, which in turn increases the likelihood that women will present for abortion care at a later gestation.

Hormonal contraception can cause side effects which may mask the symptoms of pregnancy, including suppressing menstrual bleeding completely, or causing irregular or light periods. Women using a method of contraception may also not identify their pregnancy at an earlier stage because they, unlike those not using any method of contraception, had not anticipated falling pregnant.

Long-acting reversible contraceptive methods (LARCs) such as the contraceptive implant are routinely promoted due to their efficacy. While it is true that failure rates for LARCs are extremely low, they are not non-existent. Unplanned pregnancies can also occur in the event that the method was not correctly inserted, moves or falls out. BPAS data from 2015 shows that women who had abortions at later gestations were more likely to have been using LARCs than those ending a pregnancy at an earlier stage, with 5.3% of those having an abortion at 20+ weeks reporting using a LARC compared to 3.4% of those between 0-19 weeks of pregnancy.

BPAS chief executive, Ann Furedi, said: “The answer to unsafe abortion is not contraception, it is safe abortion. When you encourage women to use contraception, you give them the sense that they can control their fertility – but if you do not provide safe abortion services when that contraception fails you are doing them a great disservice. Our data shows women cannot control their fertility through contraception alone, even when they are using some of the most effective methods. Family planning is contraception and abortion. Abortion is birth control that women need when their regular method lets them down.”

The sexual health charity FPA said people did not always use contraception consistently or correctly. It also said some of the most effective methods of contraception were not always made as available as they should be.

"In a survey of GPs, we found that one-fifth don't offer the intrauterine device (IUD), and almost a quarter said they don't offer the contraceptive implant," the FPA said. GPs told the FPA that this was partly because of a lack of training qualifications and a lack of funding.

However NICE (National Institute for Health and Care Excellence) guidance suggests that long-acting methods of contraception can reduce unintended pregnancy and be cost-effective for the NHS.

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