Inequalities in abortion rates and accessibility to abortion services in England and Wales – a spatial analysis for 2017-2021

Background . Even where abortion care is legally granted as a right, formal and informal barriers reduce people’s access to safe abortion. The present research investigates how abortion rates vary across different areas of England and Wales. Methods . Utilising longitudinal data at the local authority level for the years 2017-2021, we measure the spatial correlation between access to abortion services and abortion rates controlling for area level characteristics and policy changes such as the availability of early medical abortion at home (EMAH) from 2020. Results . The travel time to the nearest abortion clinic is negatively associated with disparities in abortion rates. Spatial multivariate analyses show that this association is not statistically significant when sociodemographic and socioeconomic area level factors are included. However, an additional abortion clinic within 30-minutes travel time increases abortion rates by 1.41 per 1,000 women (p<0.001), while the availability of EMAH is correlated with an increase by 1.31 (p<0.001). Other key factors explaining higher abortion rates are the percentage of population of Black ethnicity, urbanity, lower educational level, lower income level, English as foreign language and a lower gender pay gap at local authority level. Conclusion . The availability of abortion services in people’s proximity is a key factor explaining disparities in abortion rates. However, key sociodemographic and socioeconomic factors remain significant, which highlights the need for providing reproductive health care in areas where affected populations concentrate. More extensive provision of in-person abortion care and EMAH increase the take-up of abortion services and could be effective ways of meeting demand for abortion.