Lord Moylan’s Complications from Abortions (Annual Report) Bill has passed its Committee Stage in the House of Lords and will now proceed to Report Stage.
The Bill proposes a change to the law that would require the Department of Health and Social Care to publish an annual report on medical complications from abortions.
This annual report would include more comprehensive reporting of abortion complications, along the lines of what was published in a Department of Health and Social Care review released in November 2023.
Seeking more accurate reporting of complications from abortions
During the debate, Baroness Thornton tabled an amendment to remove Clause 1 of the Bill. This would, in practice, have prevented the Bill from proceeding, as the Bill contains only two clauses, Clause 1 being the substantive part and Clause 2 a short implementation clause. Lord Moylan spoke in support of his Bill, seeking more accurate reporting of complications from abortions. He reminded peers that a one-off government review in November 2023 found that current records miss many complications by failing to include many complications that follow pills-by-post abortions. Abortion complications statistics are currently based on data provided by abortion providers, which means that complications arising after pills-by-post are often missed. These complications are generally presented at A&E rather than being reported through the Abortion Notification System. This means that the true abortion complication rates are likely much higher than previously reported in the annual abortion statistics.
Responding to a comment by Baroness Thornton, who said that The Royal College of Obstetricians and Gynaecologists believes the “proposal in this Bill is neither practical nor deliverable”, Lord Moylan said “The Royal College says it is impossible to capture the complication statistics, but it seems to be completely unaware that, in November 2023, the Office for Health Improvements and Disparities produced a report that, with some labour, did actually capture them and showed that it could be done”.
“All that is in this Bill is a requirement that that report, which is being treated by the department as a one-off and not to be repeated, should be repeated. It is wrong to suggest that this cannot be done; it has been done, and it can be done again”.
Key review shows abortion complications are likely higher than reported annual statistics
The review that Lord Moylan referenced in his speech was published in November 2023 and undertaken by the Office for Health Improvement and Disparities (OHID). It analysed Hospital Episode Statistics (HES) for England from the years 2017 to 2021. It compared the complication rate derived from this analysis to the currently reported complications rate derived from the Abortion Notification System (ANS) that relies on data provided by abortion providers, and which is reported in the annual abortion statistics.
The review found the ANS-derived data shows an average complication rate over the 5 years from 2017-2021 of 1.52 per 1,000 abortions whereas their analysis of HES data over the same period showed a complication rate of 4.06, over 2.6 times higher than the ANS data that is reported in the annual abortion statistics.
When their HES data analysis also included incomplete abortions, the complication rate over the same period was 18.16, which is over 11.9 times higher than the ANS-derived complication rate that does not include incomplete abortions.
Communication with the Office for Statistics Regulation to improve transparency
Lord Moylan updated the Committee on his attempts at introducing improved data collection through correspondence with Ed Humpherson, the Director General for the Office for Statistics Regulation. Lord Moylan said “[T]hese statistics are referred to as national statistics and they are required to comply with the statistics code”, and called for a new compliance check, which is described by the Office for Statistics Regulation as “short, focused reviews, typically providing a high-level investigation of the extent to which statistics meet the standards of the Code of Practice for Statistics – Trustworthiness, Quality and Value”.
Since the previous compliance check was carried out in 2012, Humpherson “agreed with DHSC [Department of Health and Social Care] that a compliance check of the statistics would be beneficial”. Lord Moylan said “It is very unlikely that any compliance check would consider that the current system was successfully capturing complications arising from abortions”.
Saying he is “very pleased” with Humpherson’s response, Lord Moylan also confirmed that “[a] great deal of what the Bill seeks to achieve is likely now to be pursued by the Office for Statistics Regulation in consultation with the DHSC”. He added a call for Humpherson’s timetable to be reversed, so that the compliance check takes place before digitisation, which Baroness Lawlor echoed, saying “I suggest that, as my noble friend Lord Moylan proposed, the compliance check should be instituted in advance of digitisation so that the statistics authority can then report on—and, as a result, the Department of Health can be made aware of—where and what digitisation is needed, so that the records can be used in digital form cheaply and with the transparency that we need for statistics”.
Baroness Lawlor explained her reasons for supporting the Bill, saying “The position has changed since the statistics were last checked for compliance with the code of practice for statistics in 2012, with the increase of medically induced abortions from 48% to 85%”.
“In England and Wales, 75% of abortions were completed at home. As a result, complications may not be recorded on the HSA4 forms that are the basis for the present statistics under the abortion notification service”.
“We do not know how reliable the current data is”
The need for more effective data collection around abortion was highlighted by Lord Weir in connection with the 2023 report. He said “An enormous gap—or, at least, a level of gap—was highlighted by the OHID report in 2023, because of the changing situation with how abortions are carried out. That means, frankly, that we do not know how reliable the current data is”.
Lord Weir confirmed his support for Lord Moylan’s Bill, describing it as “a productive way forward” and saying “It is critical for any individual patient that they have the strongest and most reliable data, and that is what the Bill will achieve”.
A key section of Lord Moylan’s speech referenced the increase in the number of abortions taking place using abortion pills and in the proportion of abortions that take place at home after discharge from a clinical setting, meaning that ANS data, based solely on HSA4 forms, is increasingly likely to underestimate complications. He said “Currently, the majority of abortions take place by the use of pills at home. Therefore, if there are complications, they are presented, in most cases, at hospitals in A&E and they are not part of the Abortion Notification System, so the majority of those complications are no longer captured by the current system”.
Lord Sandhurst, responding on behalf of the Opposition, was critical of the “deficiencies” in the current recording of abortion complications and called for data to be “gathered on a more reliable and consistent basis”. Lord Frost and Lord Alton were also present in support of the Bill but were unable to speak due to lack of time.
Spokesperson for Right To Life UK, Catherine Robinson, said “This Bill is a much-needed step forward in improving transparency around abortion complications. It proposes a common-sense change to policy that MPs and Peers, regardless of where they stand on the issue of abortion, should support”.
“It is vital that up-to-date and accurate reporting on abortion complications is provided by the Government.
“A Government review published in 2023 revealed that abortion complication rates are likely much higher than has been previously reported in the annual abortion statistics, which are based on reporting from abortion providers”.
“The Government needs to urgently introduce measures to ensure that abortion complications data is accurately collected and reliably reported on”.
