Small area analysis: abortion statistics

Abstract

Small area analysis has developed over the last two or three decades as a useful tool in health services research, as it allows the identification of areas within health or local authority districts with high rates of morbidity and mortality, and thus provides a useful base for planning the delivery of health services. A profile was compiled for Liverpool Family Health Services Authority on planned parenthood in the Liverpool District, with the aim of identifying where resources are needed most - which parts of the City, and which groups of women, are most in need. The profile included an analysis of various outcome measures, including abortion statistics, which can be used as a guide to the apparent effectiveness of services. Using a combination of statistics on NHS abortions for electoral wards, and private abortions by postal district, it became apparent that, on the whole, areas of high NHS induced abortion rates also have high private (British Pregnancy Advisory Service; BPAS) induced abortion rates, and vice versa. The maps for NHS and BPAS abortion rates suggest that total abortion rates are high in City centre wards, and low in areas south of the City. This would suggest that there are differences in social factors, family planning provision, and other factors which are influencing abortion rates. Although available indicators would suggest that City centre wards are in greatest need of improved family planning provision, these are the wards which are relatively well provided with health authority family planning clinics.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: This exercise was conducted to ascertain which ward areas or small areas were in need of improved family planning provision in England. It was determined after some discussion that abortion rates for National Health Service (NHS) abortions by ward in Liverpool and the number of private abortions performed by the British Pregnancy Advisory Service (BPAS) by postal district per household would be suitable indicators of family planning service effectiveness. The results for the NHS rates of abortion standardized per 1000 women aged 15-44 years showed a concentration of abortion for mid-1987 to mid-1990 grouped data in the city center: Granby (16.6), Abercromby (14.8), and Arundel (14.3). For Liverpool as a whole the rates were 8.5 abortions/1000 women aged 15-44 years. The only city center ward with a low rate was Dingle (6.6). The lowest rate was in south Liverpool in Grassendale ward (3.8). The highest rates for women aged 15-24 years were also in the city center. At older ages, there was a spread outside the city center, but the rates again were highest in the city center. A comparison of abortion rates by ward with deprivation scores (Townsend et al), which combine unemployment, households with no car, overcrowded households, and households not owner-occupied, showed correlations between deprivation z scores and abortion rates of 0.6 and (p 0.05). Low deprivation score areas had low abortion rates and high deprivation score areas had high scores. Correlations held when compared by age groups, except for the 35-44 age groups. A higher correlation was found between deprivation and fertility rates by ward. BPAS abortion rates by postal districts showed similar patterns with the highest rates in the city center. The exceptions were in the north end, where there were average BPAS rates and low NHS rates, and south of the city center in the Church area, where the NHS rate was high compared to the low BPAS rate. Netherley area also showed a low BPAS and a high NHS abortion rate. Differences in boundaries may account for some of the differences. The findings suggest that there are differences in family planning provision, social factors, and other factors influencing abortion rates. Since family planning clinics are well provided for in city center wards, what may be needed are improvements in access or other social changes to improve, for instance, adolescent services.