Abortion: Why a Scottish city tops the European league table

With that rate above the rest of western Europe, Dundee has the unwanted distinction of topping the European abortion league table. Despite this, the figures for last year provide a chink of hope. The overall number of abortions in the Tayside health board area decreased from 2007 by just over 100 and the rate also dropped from 17.1 per 1000 women to 15.7.

Yet Dr Drew Walker, director of public health for NHS Tayside, warns against assuming that improvement would continue. "We must be very cautious about over-interpreting a small increase or decrease year on year. Both the overall numbers and the rates of terminations have gone down, but remain far higher than we would want them to be.

"The statistics on Tayside have been relatively stable over the last 10 years against the trend of an overall increase, but that was from a very high base."

With the objective of bringing the rates down, the health board involved members of the public, particularly young people, in developing a new sexual health strategy three years ago. One result of that has been an interactive website where people can ask questions about health worries anonymously and receive an answer within 24 hours. Sexual health is the most common category of question.

NHS Tayside has also been proactive in advertising the availability of emergency hormonal contraception, the "morning after pill," with information particularly targeted at the 16-25 age group.

Dr Walker attributes the success in holding down the rate of abortions to close working with the local authorities and voluntary organisations. In addition to health services, Dundee has pioneered a drop-in centre for young people offering confidential and professional advice on a range of health and social issues, funded and managed jointly by the health board and city council.

Theories have been advanced that the high rates of termination in Dundee are linked to a long tradition of powerful women workers who outnumbered men by three to one in the jute mills and were sexually bolder than their stay-at-home sisters.

That is difficult to substantiate, but Dundee has considerable poverty and the link between high rates of abortion and high levels of deprivation is incontrovertible. Women in the poorest fifth of the population have twice the number of abortions as women in the most affluent band.

In Tayside the rate for all women in the most deprived section of the population is 25 per 1000. In that particular group, however, it is fourth after Grampian, Fife and Lothian, suggesting that the targeting of services might be having an impact.

Scotland's Public Health Minister, Shona Robison, the MSP for Dundee East, said it was "disappointing" that the overall number of abortions had risen but added: "Education has a key role to play, which is why we are working with parents, schools and NHS Health Scotland to provide additional support and information around relationships and sexual health.

"Nationally we're developing a marketing campaign, supported by a website, for the adult population which will focus on encouraging people to talk to their partner about their sexual health."

She added: "NHS Tayside is working to increase the number of women using long acting reversible contraception and I hope all these measures, taken together, will help to reduce the number of terminations and unintended pregnancies in the Tayside area."

However, Cardinal Keith O'Brien said the figures "represent a human rights violation, in our midst, on a massive scale".

He said: "We destroy 53 unborn children each day in Scotland. Were this carnage to take place among children lucky enough to have been born our outrage would be boundless.

"These statistics shame and debase us all."

The latest information is published less than a week after figures released for England and Wales showed that the number of abortions carried out south of the border had fallen from 198,499 in 2007 to 195,296 last year.

Natika Halil, of the Family Planning Association, said that the Scottish statistics showed the need for greater accessibility to contraceptive services throughout the country. "It is important that targeted contraceptive services reach rural areas, deprived areas and young people, not just those living in urban areas," she said.

Lynn Wheeler, of the British Pregnancy Advisory Service in Scotland, welcomed the figure showing that 70.3% of terminations were carried out before 10 weeks' gestation. The number of terminations which are carried out during the first 10 weeks of pregnancy increased from 9494 in 2007 to 9711 in 2008.

But Ms Wheeler raised concern about a small number of women seeking late abortions who travel to England because they have difficulty accessing a termination in their local area.

"The 2008 abortion statistics for England and Wales show that after the Republic of Ireland and Northern Ireland, where access to abortion is restricted by law, the third largest group of non-resident women coming for treatment had come from Scotland," she said.

Cardinal Keith O'Brien said the statistics "confirm the abject failure of the so-called sexual health strategy of recent years".

He added: "They represent a human rights violation, in our midst, on a massive scale. We destroy 53 unborn children each day in Scotland. Were this carnage to take place among children lucky enough to have been born our outrage would be boundless. The victims of this inhuman and degrading violence are firstly the 13,817 Scottish children killed before they have been born and then the thousands of women who agree to their own offspring being aborted.

These statistics shame and debase us all."

Ms Robison said it was "disappointing" that the overall number of abortions had risen but said work was under way to educate people about sexual health and a marketing campaign was being designed to encourage adults to discuss issues with their partners.

She added: "Education has a key role to play, which is why we are working with parents, schools and NHS Health Scotland to provide additional support and information around relationships and sexual health.

"As part of this, we're developing a marketing campaign, supported by a national website, for the adult population which will focus on encouraging people to talk to their partner about their sexual health. "We're also committed to reducing the number of repeated unintended pregnancies. The sexual health standards for boards, produced by NHS Quality Improvement Scotland, are designed to ensure women receive a safe termination, followed by a contraceptive review and counselling.

"They also contain a target to increase the use of Long Acting Reversible Contraception. A forthcoming NHS Health Scotland campaign will inform and encourage women to use these methods.

"We also strongly encourage the use of condoms to help protect against sexually transmitted infections, as well as preventing unintended pregnancies."