Explainer Article: Unravelling the abortion statistics relevant to the 3-day reflection period by Waterford Prolife Group Déise4Life
There have been some wildly different claims in the media recently, about our abortion statistics, especially those statistics that relate to the 3-day reflection period in the current abortion legislation.
The recent Abortion Review Report, in particular, highlighted the lowest figure it could find for the percentage of women not continuing with an abortion, and ignored the rest.
This article attempts to provide some clarity, using all the relevant data we could find - official annual data from HSE and Department of Health, data from an individual abortion provider (see [4], [6]), and the 2019 START study ([5]).
The article assumes that there is no double counting (women attending two different abortion providers) in the official payment data for initial abortion consultations – 8284 of these payments in 2021, for example, is interpreted here to mean 8284 separate women attended for an initial consultation. We also assume that initial consultations, with women who are outside the 12-week gestational limit, are included in the official payment data i.e that the abortion provider is paid the initial fee in these circumstances too. Déise4Life have been informed that parliamentary questions have recently been tabled in order to ask about these matters. The information in this Explainer Article will be modified and updated, should that be necessary, when the Minister for Health replies to these parliamentary questions.
The approach of the State from the outset, following Repeal of the Eighth Amendment, has been to provide the bulk of the abortions here at arm’s length from the State, and to collect as little data as possible about how it is working out in practice. Carrying out a proper abortion review, in these circumstances, would have bordered on the impossible.
Nevertheless, due mainly to the persistence of pro-life campaigners, we have enough data to answer some important questions. Questions which the official Abortion Review never actually asked.
1. What percentage of women in Ireland attending for an initial consultation do not proceed to an abortion?
This question has arisen a lot recently, as part of the debate about retaining or jettisoning the three-day reflection period.
There is a straightforward way of answering it, at the aggregate national level. In 2021, for example, there were 8284 payments for first visits to abortion providers, but the number of abortions here in that year was 6683, suggesting that 1601 women in 2021 did not proceed with an abortion after the initial visit.
In that year, therefore, 19.3% of women did not proceed to an abortion after the initial consultation.
2. Does this mean that 19.3% of women changed their minds about abortion in 2021?
It used to be assumed e.g as in reference [3] below, that nearly all uncompleted abortions were due to women changing their minds. But the answer to the question posed here is actually No, mainly because some of the 19.3% might have had a miscarriage in the course of the 3-day reflection period.
Some others, who booked an initial consultation for an abortion, might not have proceeded because they were found to be outside the 12-week gestational limit.
One study – see [2] – attempted to estimate the size of each subgroup among the 1600 women nationally who did not proceed with an abortion in 2021. It estimated, based on 2019 data from the IFPA annual report, that about 200 women nationally were outside the 12-week limit, and (from international data on miscarriage rates for each week of pregnancy) that a further 370 women might have had miscarriages during the 3-day reflection period. The estimate of women changing their minds in 2021 was therefore 1030.
In short, that study estimated that nearly 65% of the women, who did not proceed with the abortion after the initial consultation in 2021, did not proceed because they had changed their minds. On this estimate, the 19.3% national figure for 2021, therefore, breaks down roughly as 12.4% changing their minds about abortion, and 6.9% either miscarrying or being outside the 12-week gestational limit.
Data from individual abortion providers or studies (see below) sometimes separate these different subgroups of women who did not proceed to an abortion. However, because it is not possible to separate these subgroups in the national aggregate data, these subgroups have to be combined also with data from these other sources, otherwise we cannot compare these other sources with the national data. We have done this amalgamation of subgroups for the 2021 IFPA and 2019 START data below.
It is worth remarking, in passing, that the reported numbers not aborting in all three subgroups would likely all have been lower had the 3-day reflection period and the 12-week gestational limit not been in the legislation. We would likely have had less women changing their minds, more women aborting rather than miscarrying, and more women aborting outside the 12-week limit. We would have had more abortions, in short, in all three subgroups.
3. Would the percentage of women not proceeding to an abortion vary much across the different abortion providers?
We have data from just one individual abortion provider for 2021. The Irish Family Planning Association has put its 2021 data into the public domain.
In 2021, according to the IFPA
484 of their clients presented for an initial abortion consultation
12 of these did not return and 11 others proceeded with the pregnancy
25 others were outside the 12-week gestational limit
In summary, therefore, 436 of the initial 484 IFPA clients proceeded with an abortion through IFPA in 2021, and 48 (= 12 + 11 + 25) did not. That is, 9.9% of these women did not proceed with an abortion.
We also have aggregate national data for 2021, and we can separate the IFPA data from the rest to obtain this Table:
The IFPA percentage not proceeding with an abortion is less than half the percentage for the other providers.
Clearly, therefore, not all abortion providers are the same in this regard. The IFPA has a much higher percentage of completed abortions.
4. The Abortion Review estimates that just 2% of women who present for first consultation do not proceed with an abortion. How can that low figure of 2% be reconciled with the above figures of 19.9% nationally for other providers and 9.9% for the IFPA?
The 2% figure (it is actually 2.3%) came from a START study carried out in the first 6 months of 2019 (START is an organisation of GP abortion providers). For purposes of comparing with aggregate national data, it needs to be augmented with other data from the same study, the percentage of women who miscarried (also 2.3%) and the percentage who were outside the 12-week limit (1.1%).
The appropriate figure from this particular study is 2.3% + 2.3% + 1.1% = 5.7%, therefore. That is still very low compared with the national figure for 2021 of 19.9% for other providers, and quite low compared with the IFPA figure of 9.9% for 2021.
There is one other relevant statistic in the public domain, from the year 2019. The 2019 IFPA annual report states that “12% of clients did not continue through our abortion service” in that year.
In summary, and in increasing order, the percentages of women not continuing with an abortion were
5.7% in the START study of 2019
9.9% reported by IFPA for 2021
12% reported by IFPA for 2019
19.9% in 2021 for all abortion providers except IFPA.
Clearly, then, there is a lot of variation among abortion providers in the percentages of women not proceeding to an abortion.
Since there is no reason to expect that miscarriage rates, or percentages of women presenting outside the 12-week limit, would differ widely among providers, the conclusion has to be that the observed variation among providers is due mainly to variation in the percentages of women who decide to continue with their pregnancies.
It appears, in short, that some providers may be more actively directing women towards abortion rather than continuing with their pregnancies.
5. Is there any other evidence that abortion percentages vary widely among providers?
Yes, from the data for county of residence of the women who had abortions. It is well known that abortion ratios vary in different regions of countries, depending in particular on population density in these different regions. In Ireland, however, neighbouring counties in the same region, with similar population densities, have produced abortion ratios that are quite different from each other. One explanation for this is different abortion percentages among abortion providers in these neighbouring counties. See [1].
6. Finally, if it turns out (as the Abortion Review Report suggests) that the aggregate national data for first visits is inflated by women attending more than one abortion provider, does that undermine the case for retaining the 3- day reflection period?
No.
In 2021 the IFPA reported (see 3. above) that 2.5% of clients decided to keep their babies and a similar percentage did not reappear i.e may have decided to keep their babies too. The IFPA, and Irish Times who published this data, clearly thought that these low figures undermined the case for the 3-day reflection period, but they are wrong, because the numbers now presenting for an initial consultation appear to be of the order of 10,000 each year, and 2.5% - 5% of 10,000 is 250 to 500 babies a year saved by the 3-day clause in the legislation.
And those numbers come from applying IFPA percentages to the national data. IFPA percentages of women not proceeding to an abortion are, clearly, on the low side compared with most providers. It would be hard to make a case for removing this legislative safeguard, therefore, when the number of lives saved by it appears, at an absolute minimum, to be of the order of 250 – 500 each year.
References
[1] Irish abortion figures by county in 2020 | The Iona Institute
[2] Could miscarriage explain the uncompleted abortions each year in our official abortion data? -
[3] Advice of doctors may have a big effect on abortion numbers | The Iona Institute
[4] https://www.ifpa.ie/app/uploads/2020/11/IFPA_AR_2019_LR.pdf
[5] Termination of pregnancy services in Irish general practice from January 2019 to June 2019
Patricia Horgan et al Contraception 104 (2021) 502-505
[6] https://www.irishtimes.com/ireland/social-affairs/2023/04/19/over-95-per-cent-of-women-who-
sought-abortions-at-family-planning-service-went-ahead-with-decision/
