Record Abortion Rates in England and Wales: A Complex Picture of Contraception Decline
Abortion rates in England and Wales have surged to their highest level since the Abortion Act was introduced in 1967, with a striking 11% increase between 2022 and 2023. The age-standardised rate now stands at 23 abortions per 1,000 residents, according to recent data. This rise comes amid a backdrop of declining contraceptive use, growing hormonal hesitancy, and systemic challenges within the healthcare system.
A Positive Lens on Access and Rights
Experts caution against framing this increase as inherently negative. Dr Zara Haider, president of the College of Sexual and Reproductive Healthcare, emphasises that the figures reflect improved access to abortion services in the UK. "These abortion figures are a story of two parts," she says. "They are firstly testament to the fact that it is easy to access an abortion in this country – and I think it is absolutely a woman’s right to decide whether she continues with a pregnancy or not."
Dr Rosie McNee, a public health registrar, agrees that the rise indicates the healthcare system is meeting population needs, though she notes resource strains. The political context is crucial, with the overturning of Roe v Wade in the US highlighting the importance of defending abortion rights. In the UK, the Reform party has faced criticism for embracing anti-abortion politics, underscoring ongoing debates.
The Decline in Contraceptive Use
Despite unprecedented access to information, contraceptive use has declined sharply. A 2024 World Health Organisation report found condom use among sexually active adolescents in Europe dropped significantly between 2014 and 2022, contributing to a 5% rise in STI cases in England from 2022 to 2023. Vasectomy rates have also fallen, halving between 2008 and 2014 and failing to recover post-pandemic.
For women, hormonal methods like the pill decreased by 7.5% between 2018 and 2023, while long-acting reversible contraception use fell by over three-quarters. Those reporting no contraception at conception jumped by 14%, according to a BMJ study led by McNee.
Hormonal Hesitancy and Medical Mistrust
Dubbed "hormonal hesitancy," a growing suspicion of hormonal contraception is fueled by misinformation on social media. Dr Haider warns that fearmongering about side effects creates a cohort of people too scared to use beneficial methods. Research, including a Sheffield University study from September 2025, highlights the "nocebo effect," where misinformation drives real side effects.
Structural sexism in healthcare exacerbates this mistrust. A 2022 UCL study found gender stereotypes lead to women's pain being discounted, while a 2024 paper on endometriosis described experiences of "medical gaslighting." "We’ve seen an increasing awareness that women are not being listened to in health settings, and so they’re tolerating that less, and managing their fertility themselves – taking back a bit of autonomy," says McNee.
Innovation Gaps and Male Contraception
Little innovation in women's contraceptive choices over the past 60 years has left many dissatisfied. Katherine O’Brien of the British Pregnancy Advisory Service notes that side effects like bad skin, reduced libido, or low mood are increasingly seen as unacceptable burdens. Meanwhile, male contraceptive methods, such as gels and pills, remain unavailable due to lack of funding and perceived unprofitability, despite trials showing side effects similar to those women endure.
Education and Alternative Methods
Poor sex education persists, with pandemic disruptions leaving a cohort without formal instruction. McNee points to variability in UK sex ed, while O’Brien highlights myths about fertility declining sharply at 30, leading to risky behaviour. In response, natural family planning methods have gained traction, with use rising from 0.4% to 2.5% among abortion seekers from 2018 to 2023.
Period tracking apps like Natural Cycles, certified as birth control in the UK, offer 93% efficacy with typical use but require rigorous daily temperature readings. Dr Haider cautions that human error is a risk, and data privacy concerns loom as femtech companies monetise personal health information.
Systemic Barriers and Economic Pressures
Access to contraception is hampered by an overstretched NHS, with women facing long waits for services like coil fittings. Sexual health clinics have slashed services due to underfunding. Additionally, the cost-of-living crisis plays a significant role, with many abortion seekers already being mothers who cite financial strain as a key factor. "For some women, it would be a very much wanted pregnancy if finances were different. And that’s very hard," says O’Brien.
The rise in abortions reflects a nuanced interplay of social, economic, and healthcare factors. Blaming women is unproductive; instead, addressing their concerns through improved education, access, and systemic support is essential for meaningful change.
