Evaluation of Current Termination of Pregnancy and Related Services at Grimsby (UK) and Recommendations for Service Improvement

ObjectiveTo develop local termination of pregnancy (TOP) dataset and to identify “hotspots” for highest activity and gaps in our fertility control services.MethodsThis was a retrospective analysis of 305 women who received TOP under section C of the Abortion Act 1967 over a period of 9 consecutive months from 1st March through to 31st October 2012.ResultsThere were 275 (90.2%) British White (BW) and 30 non-BW women. Among 30 non-BW women, 10 (3.3%) were British Asian, 8 (2.6%) were Polish, 6 (2.0%) were British Black or Black, 5 (1.6%) were Chinese and 1 (0.3%) was White Latvian. The TOP rate was 8.9% in the under 18 years old and 27.9% in the over 30 years old. Totally 240 TOPs (78.7%) occurred in <10 weeks and 276 TOPs (90.5%) occurred under 13 weeks of gestation. Eight-five women who received TOP-service have had one or more previous termination(s) in the last 3 years. The contraception use was low pre-TOP and none of the women were on long-acting reversible contraception (LARCs) pre-TOP, including those who had repeat terminations.ConclusionThere are inequalities and gaps in the TOP and related services in Grimsby which must be addressed to reduce the rate of TOP. This is a major challenge involving multiple agencies. Provision of contraception across all age and ethnic groups, improving sex education, engaging with parents and women to improve their negotiation skills for safer sex, supporting vulnerable women, reducing risk factors e.g. alcohol and substance misuse and raising aspirations across the region will contribute to a reduction in termination rate.