Trends in termination of pregnancy in Glasgow, Liverpool and Manchester

Research published in 2010 showed that premature mortality in Glasgow over the period 2003-2007 was 30% higher than that in Liverpool and Manchester, despite the three cities sharing almost identical levels and patterns of socio-economic deprivation. A number of theories have been proposed to explain this discrepancy, including [in the light of US research linking variations in the termination of pregnancy (ToP) rate to differences in social and health outcomes] the suggestion that variations in current levels of mortality across the cities could be influenced by differences in earlier ToP rates.

To undertake further analyses of mortality data for Glasgow, Liverpool and Manchester to assess the likelihood of differences in ToP rates influencing rates of excess mortality in Glasgow; to analyse long-term trends in numbers and ToP rates in the three cities (and, for comparison, between Scotland and England); and to investigate potential explanations for any differences in ToP rates.

Mortality analyses were based on the same age-, sex- and deprivation-standardized data that were used in the previous research on the three cities. ToP data (and population denominator data) covering the period 1980-2009 were obtained from Scottish and English national organizations. Historical national ToP data for the years 1969-1979 were obtained from an additional published source. Rates were calculated per female aged 15-44 years and, for analyses of ToP among teenagers, per female aged 15-19 years. Potential explanations for differences in rates were investigated by means of literature searches and discussions with key informants.

The ToP rate in Glasgow was lower than the ToP rates in Liverpool and Manchester over the total period analysed (as was the case for Scotland compared with England and Wales), although the gap has narrowed considerably, especially among females aged <20 years. This is due to a greater increase in the ToP rate in Glasgow (and Scotland), attributed, in part, to better access to ToP services. The differences in ToP rates do not appear to have been influenced by women travelling to England from Ireland for access to ToP facilities, nor by Glaswegian women travelling outside Scotland for the same reason. However, 90% of 'excess' deaths that took place in Glasgow compared with Liverpool and Manchester between 2003 and 2007 related to individuals born prior to the 1967 Abortion Act; these excess deaths, therefore, are not influenced by earlier variations in ToP rates.

Differences in ToP rates between the cities are unlikely to impact on variations in later mortality rates. Thus, while the topic of ToP is important, investigation into the reasons behind Glasgow's excess mortality levels should focus on other hypotheses.