Financial concerns followed by contraceptive failure were the reasons most frequently cited by women requesting a termination in a study from the NE of England.

A total of 274 women attending a termination of pregnancy (TOP) pre-assessment clinic at Hull Royal Infirmary answered a confidential, anonymous, self-administered questionnaire between January 2011 and November 2012.

The questionnaire was designed to capture demographic details and the reasons for the TOP request. Patients were asked to rank the listed reasons in order of importance and could cite other reasons that were not listed.

The age breakdown was: 28.1% under 21 years of age, 36.1% between 22 and 29 and 29.1% over 30, 6.6% did not answer.

More than half (59.5%) were single, 28.8% were married or cohabitating, 8.8% were divorced or separated and 2.9% did not answer. The sample was mainly white (93.4%) and almost half (45.6%) had at least GCSE level of education, excluding 14.2% who did not answer.

Overall, financial worry was the most frequently cited reason, followed by contraceptive failure and concerns about education or career. The most frequent reason for those under 21 was concerns about their education or career (26.2%) followed closely by financial worries (25.6%). The top two reasons cited for the 22-29 age group were financial worries (25.4%) and contraceptive failure (23.3%). Women over 30 most often cited completion of family as the main reason (24.3%) for TOP, followed by contraceptive failure (18.1%).

The same four reasons featured most frequently when the sample was analysed according to marital status. Single women cited financial worries (21%) as the most frequent reason, followed by contraceptive failure (17.4%); for married women, it was contraceptive failure (16.2%), financial worries and completion of family were ranked second equal (12.8%); for those who were divorced, completion of family was the main reason (20.4%) followed by contraceptive failure (18.3%).

There could be several reasons for citing contraceptive failure. The authors suggest that this might be a more socially acceptable response when no contraception was used; another is the concern that women may not be accessing contraception when it is needed or that access might be restricted.

Previous studies have shown there is rarely a solitary reason for termination; the decision making is often complex and the reasons interrelated.

This study appeared to highlight some opportunities where unintended pregnancies could have been avoided. Contraception failure (or failure to use contraception) was a common reason for requesting termination regardless of age, marital status and educational attainment.

This confirms the importance of offering women who are sexually active the opportunity to discuss reliable contraceptive methods that suit their needs; this could be condoms as well as hormonal contraception, long acting or otherwise.

Dr Richard Ma

• Wokoma TT, Jampala M, Bexhell H et al. Reasons provided for requesting a termination of pregnancy in the UK. J Fam Plann Reprod Health Care doi:10.1136/jfprhc-2013-100745 published online first 10/6/2014