Thursday 26 June 2014

Young people and 'repeat abortion'

Thanks to a small grant from the European Society of Contraception and Reproductive Health we have been able to undertake a project looking into repeat unplanned conceptions amongst young people in London. This blog gives an overview of what we found out from our workshops with young people in Croydon.

Readers of this blog will probably already know that a third of women in Britain experience abortion. What you might not know is that over a third (37%) of those accessing abortion have already had one or more terminations. Recent statistics for England and Wales show that in 2013 27% of abortions to women aged 25 and under were ‘repeat abortions’. In Croydon, 50% of abortions (for all ages) were ‘repeat’ procedures.

The Telegraph claims the statistics show that women are having ‘lifestyle abortions’ and ‘using abortion as a contraceptive’. But what’s the real story? Why do some people have more than one abortion? Is it a problem? If so, when and why? We produced this document, Frequently Asked Questions about Repeat Abortion, to try to answer some of these questions and to offer recommendations for professionals supporting young people to prevent unwanted pregnancies. It’s free to download so please do have a read, and pass on to your colleagues. 

There are of course a number of factors which might contribute to someone experiencing one or more unplanned pregnancies – including failure rates of contraceptive methods. For example, the pill and the condom, the two most popular methods of contraception, come with actual-use failure rates of 8% and 15% respectively. In order to get young people’s input with the project we carried out workshops and focus groups in Croydon.  We talked about the fact that pills and condoms are the most common forms of contraception for young people and discussed some of the problems they might have in using these methods effectively:
“Pills - sometimes you don’t remember to take them. You have to take it at a certain if you don’t actually remember to take it, you’re kind of unprotected.”
“As a female, you might not know how to put on a condom for instance, yeah I know it sounds really silly but let’s say you get to do the deed, you might not actually know how to put on a condom and stuff, and you kind of feel a bit stupid asking.”
“A lot of my friends didn’t (carry condoms) when we were younger, because no one wanted to be called a’ve been out with your boyfriend and you pull out a condom, he’s gonna think ‘Oi, you’re ready!’ Nah, he might not be thinking that, but in your mind you could possibly think it. 
He’s probably thinking, ‘Ah, I’m well up for this!’ But like it would be a bit embarrassing.”
Many of the young people formed opinions about contraceptive methods based on the experiences of their friends, often expressing an objection to LARC methods, seeing them as ‘invasive’:
“My friend’s got it (the implant) yeah, and I went with her and it’s horrible. It’s like this massive thing yeah, and to get it out she has to have an operation, she cuts it open, urgh, it’s horrible. Like, you can feel it.”
“I know it sounds silly, and you’re probably gonna laugh but it reminds me of something out of a movie, like an alien movie, you know like when they put things under your skin! The fact that you can feel it, in your day to day life, just, I don’t like that thought.”
“I went to the clinic with my friend, she got that (IUD) and the curtain was there - she was on that side and I was on this side, and I could hear her like ‘owwwww’!”
“And you have to be on your period to have it done don’t you, that’s what they said to my friend.  And I was like, dignity?! Come on!”
The young people (who were 16+) said that their school education had lacked details on the full range of contraceptive methods:
“Whenever you had any lessons at school it was always about condoms or the pill, it was never anything else about any other contraceptions.”
“When you’re at school, there’s not enough. All you hear about is the pill, not the implant or the injection, I never heard of that until a couple of years ago and I was like ‘what’s that?’. But then you are put off as well, by other people’s stories – of when they’ve put it in and you’re like, ‘Oh god, that doesn’t sound very nice’.”
These young people made various suggestions for improving knowledge about reproductive health and the range of contraceptive methods available:
“Make it less scary... if you see a picture like that (diagram of IUD), like they need to draw it to scale maybe! You know when you look at that, even though it’s small, in your mind, you’re gonna think, oh my god it’s massive...instead of drawings (you need) an actual picture of what it actually looks like. Cos you wouldn’t know what it looked like until you actually went there would you?”
“Maybe nurses do talks or something about how they put it in, ‘cause someone like me, could never do that ‘cause I’d just cry my eyes out. I’m really squeamish.” 
“I feel like there should be more talks within schools, about different types, like it is only condoms and the pill that are discussed.”
“Tell teenagers about contraception through videos, so they can just watch it – when people give me leaflets on the street I just throw them away, or just put it in my bag and it will stay in there for like a year! Whereas if, I don’t know, there was like pop up ads or something .”
“A video to show in schools, ok, these are the different types of contraception. These are the facts.”
So young people are telling us that they would like more practical demonstrations of contraceptive methods – we’ve certainly had positive reactions when using the FPA’s contraceptive display kit, which allows young people to see and touch different methods. There is also the suggestion that educators use more videos – and since we know young people respond to other people’s experiences, how’s about a UK version of these Bedsider videos? Someone fund us and we’ll do it!

For more information on young people and repeat unintended conceptions have a look at EFC's own research from 2007 and Hoggart and Phillips' 2010 research report.

Thursday 12 June 2014

Abortion rate continues to drop in England and Wales

The latest statistics for abortion in England and Wales (2013) have been released today and can be viewed here on the Gov.UK website. Here's a summary.
For women resident in England and Wales, in 2013:
  • The total number of abortions was 185,331 
  • The abortion rate (for ages 15-44) was 15.9 per 1000 women, 0.8% lower than last year's abortion rate, and 4.7% lower than in 2003
  • The abortion rate was highest for women aged 22
  • The under-16 and under-18 abortion rates are both lower than last year, and than in 2003
  • 37% of women having an abortion had had one or more previous abortions
  • 53% of women having abortions had one or more previous pregnancies that resulted in a live birth or a still birth
  • 91% of abortions were carried out at under 13 weeks gestation
  • In 2013, there were 5,469 abortions for non-residents carried out in England and Wales. The 2013 total is the lowest in any year since 1969

So those are the numbers but what do they tell us?
Well, first of all, the abortion rate is the lowest it's been for 16 years, the 2013 stats show a continued decrease. The same is true for the rate of abortion for under 18s - this has gone down from 18.2 per 1000 women to 11.7 per 1000 women in the last ten years. This drop reflects the reduced rate of teenage conceptions in general and is likely a result of young people's increased access to contraception. The rate of women accessing abortion early on in pregnancy is a positive sign that most are able to have their pregnancy confirmed early and access abortion when it is safest.
When asked, people often assume abortion rates will be highest for teenagers, when in fact, the most common age to have an abortion was 22, and there was a slight increase in the abortion rate for women aged 25-29. Bpas suggests that that this may well reflect the increasing desire to have children later (the average age for first time motherhood in the UK is now over 28). Over half of women accessing abortion are already mothers.
In 2013, approximately 5500 abortions were performed in England and Wales for non-resident women. The majority of these women (67% and 15%) were from Ireland and Northern Ireland respectively. This shows a continuing decline in the numbers of non-resident women accessing abortion in England and Wales. The FPA suggests that this could be due to under-reporting, or women travelling to other countries for the procedure. We also suggested last year that these women may well be (illegally) finding abortion medication online, rather than travelling for the procedure, which can be very expensive.
We join the FPA in calling for Northern Irish women's right to free, safe, legal abortion in line with women in other parts of the UK, and with bpas that, "we should stop politicising abortion and accept that it is a standard part of women's healthcare."