The number of prisoners in England having an abortion fell by 75% in two years, sparking fears that the detention system is failing to provide proper healthcare.

Only seven women held in an English prison had an abortion in 2021, compared with 28 in 2019, according to data obtained by openDemocracy under the Freedom of Information Act.

The number of abortions among the general public rose by almost 7,000 over the same time period – reaching a record high of 214,869 in 2021 – and there have been similar numbers of pregnancies in prisons in England each year since 2019.

Kirsty Kitchen, the head of policy and communications at Birth Companions, said the findings suggest “our prison system is unable to provide healthcare for pregnant women equivalent to that available in the community”.

She added: “The Ministry of Justice, HM Prison and Probation Service and NHS Health and Justice need to look into this new data as a matter of urgency, and publish the long overdue review of health and social care in women’s prisons.”

Kitchen’s worries were echoed by Clare Murphy, the chief executive of the British Pregnancy Advisory Service (BPAS), who described the large fall in abortions in prisons as “deeply concerning”.

The increased demand for abortion care among the public – the number carried out last year is expected to be another record high when the figures are published in January – has been attributed in part to greater financial insecurity, but also to improved access in recent years.

‘Pills by post’ – where both pills needed for early medical abortion may be taken at home, without the need to attend a hospital or clinic – was introduced in April 2020 in response to Covid and made permanent in August 2022. It now accounts for around half of all terminations.

But between the service’s launch in April 2020 and June 2022, only two women in prison used it. A further five women made two separate trips from prison to a hospital or clinic for medical terminations, and the rest required surgical terminations due to gestation lengths.

Asked whether the introduction of pills by post was likely to have led to a decline in women arriving at prisons in need of abortions, Murphy said no, as “women's need has also increased in tandem”.

Murphy continued: “There is no reason why the need for [abortion] care would have reduced among [prisoners], who, in our experience, may be at a greater risk of unplanned pregnancy, and are also at a higher risk of needing terminations at a later gestation.”

She added that BPAS has a “specialist pathway in place to support prison healthcare teams to facilitate appointments for abortion care and would welcome any opportunity to work with prisons going forward.”

‘Complete contempt for women’

Pregnant prisoners are missing more than a fifth of midwifery appointments due to difficulties accessing health and care services, according to research from the Nuffield Trust. Where women must leave prison to access abortion care, any delays risk them nearing the legal time limits for abortion.

Candice, a former employee at HMP Styal who requested that only her first name be published, saw an inmate suffer a “botched” abortion as a result of a missed appointment.

The woman had been driven almost 40 miles to take the first abortion pill under supervision in late 2019, but wasn’t taken back to get the necessary second pill due to a lack of available escorts. This can lead to increased nausea, vomiting, diarrhoea, and extended periods of cramping and bleeding – all without terminating a pregnancy.

The inmate was forced to return to the clinic for a surgical abortion at a later date.

“Everything to do with the process by which women [in prison] went for terminations was so wrong,” Candice told openDemocracy. “The way [they] are treated is despicable.”

This was echoed by Ikamara Larasi, who leads Level Up’s Abortion Is Healthcare campaign. She said: “The prison system poses further barriers to accessing abortion, showing complete contempt for women who are trapped there.”

Kitchen, of Birth Companions, said: “Research has shown high levels of missed midwifery and obstetric appointments for pregnant women in custody, and there is a crisis of unmet mental health needs across the female prison estate. Prison is not, and never will be, a safe or appropriate place for pregnant women.”

In the case of the botched abortion, Candice said the situation was worsened by the ‘support’ offered to the woman by the prison chaplaincy, which she described as “like a relic from the 1950s”.

The support was delivered by Image, a crisis pregnancy service that has previously claimed “killing newborn babies is no different to abortion”.

Image has counselled prisoners experiencing child loss and abortion since at least 2010, typically through ‘The Journey’, a ten-step approach to ‘abortion recovery’ that includes steps such as ‘guilt and shame’ and ‘forgiveness’.

A third of pregnant women in HMP Styal were placed under care planning processes due to a risk of suicide or self-harm in the 18 months from April 2019 to September 2020, according to data obtained by openDemocracy under Freedom of Information.

The Ministry of Justice’s policy framework on pregnancy in prison – introduced following stillbirths at HMP Bronzefield and Styal – provides minimal guidance around abortion. It does not mention a need for consistent access to high-quality, non-judgemental support both before, during and after an abortion, in line with best practice in the community.

Larasi said: “All women have the right to have children, to not to have children, and the right to parent the children they have in a safe and healthy environment. The prison system violates all aspects of these rights, with an impact that often far outweighs any crime committed.”

A government spokesperson said: “People in prison are entitled to the same standard and range of health and social care services as they would receive in the community.

“Through the Abortion Act 1967, all women have access to safe abortions on the NHS up to 24 weeks.”