Canada's 2023 abortion numbers increase - again

Once again Canada's abortion numbers are up for 2023. I've included 2022 and 2021 below for comparison purposes. Lots of caveats emphasized below in bold. So as usual, the numbers are underreported. 

As well we used to get gestational ages of abortions. Not anymore. CIHI stopped reporting them in 2021.

2023 total abortions = 101,553

2022 total abortions = 97,211

2021 total abortions = 87,485

So Mr. Mark Carney, how do you reconcile the slaughter of 101,553 children in the womb and your Catholic faith? I'm having a wee bit of a problem with that Mr. Carney.

(PS, I couldn't find Mark Carney's email address. He's our Prime Minister but there doesn't seem to be an email address for him posted. Why is that?)

n/a: Not applicable because data from other non-hospital settings is not available.Table 1 Number of induced abortions reported in Canada in 2023, by province/territory of hospital or other non-hospital setting*Induced abortion is defined as the medical termination of pregnancy. Equivalent terms include artificial abortion, therapeutic abortion, voluntary termination of pregnancy, elective termination of pregnancy and active termination of pregnancy.† The methodology to report induced abortion volumes is consistent with the enhanced methodology that was introduced in the 2021 report. For 5 provinces — Newfoundland and Labrador, Nova Scotia, Ontario, Manitoba and British Columbia — total induced abortion volumes were derived by using the total abortion volumes reported to the National Physician Database (NPDB) at CIHI. Volumes for non-hospital settings (e.g., clinics, physician offices) were estimated using the total abortion volumes as described above and subtracting hospital-based abortions (as reported to the Discharge Abstract Database and National Ambulatory Care Reporting System [NACRS]). This estimation approach for non-hospital volumes was required because information on the location where the service is rendered (e.g., clinic, hospital, physician’s office) may not be included in the NPDB data.Table 1 includes induced abortions performed in a hospital or in a non-hospital setting in Canada (numbers are presented by the province/territory in which the abortion was performed). For Quebec, induced abortions with an unknown location or cases outside of Quebec (0.1% of Quebec cases) are grouped under “non-hospital setting.” Induced abortions are not performed in clinics in Nova Scotia, the Yukon, the Northwest Territories or Nunavut; clinic volumes for Prince Edward Island are reported together with hospital-based abortions.

Hospitals are mandated by their provincial/territorial ministry of health to report all hospital activity (not limited to abortions); therefore, coverage of abortions performed in Canadian hospitals can be considered complete. However, there is no such legislative requirement for clinics providing abortion services to report their activity (reporting is voluntary). Physician billing data captures clinical activity for publicly insured medical services funded through the provincial/territorial medical care plans. For 2023, clinic data for New Brunswick and Saskatchewan is incomplete. For Quebec’s hospital and non-hospital data, only induced abortions covered by the provincial health insurance plan are included. Hospital data from all other provinces/territories includes all induced abortions performed within their respective jurisdictions. For example, patients with coverage under Quebec’s health insurance plan receiving care in Alberta are reported by Alberta. However, patients with coverage under Alberta’s health insurance plan receiving care in Quebec are not reported (by either Quebec or Alberta).

As a result of the implementation of a new province-wide electronic health record system in Alberta (i.e., Connect Care), the regular data flows for day surgery, clinic, diagnostic imaging and other ambulatory care (excluding emergency department) data to NACRS have been disrupted, resulting in a decrease in overall volumes. Caution is warranted when interpreting the percentage change in volume.

Part 1 - CIHI 2021 abortion data

CIHI is out with their 2021 abortion numbers. They are now adjusting their numbers to use doctor's billing codes. That is good. But what is bad is that they are not including all of their previous stats.

"March 23, 2023 — Provision of abortion services in Canada has evolved in recent years. Since the medical abortion medication Mifegymiso became available in Canada in 2017, medical abortions have become increasingly accessible in non-hospital settings (e.g., nurse practitioner and physician offices, community and public health clinics). In addition, the ongoing COVID-19 pandemic may have further shifted abortion services to non-hospital settings. As a result, reporting from traditional hospital data sources has led to an underestimation of the true number of induced abortions in Canada."

There are a lot of caveats to the 2021 data:

"Reporting enhancements

As part of CIHI’s ongoing improvement efforts, we explored opportunities to address data gaps, resulting in a revised methodology for reporting induced abortions for some jurisdictions in Canada. The methodology now includes physician billing data as the source of total abortion volumes and method of abortion for some provinces. 

Because of the revised methodology, 2021 results are not comparable with historical data results. Restated 2020 abortion volumes using the revised methodology can be found in the notes to Table 1. The tables also contain information regarding data sources and coding methodology.

Frequently asked questions

Why is the total number of reported induced abortions larger than in previous years?

The number has increased due to changes in reporting methodology. More complete reporting for 5 provinces (Newfoundland and Labrador, Nova Scotia, Ontario, Manitoba and British Columbia) is now sourced from physician billing data. Restated 2020 abortion volumes using the revised methodology can be found in the notes to Table 1.

Why were the reporting changes made now?

We enhanced the methodology as part of our ongoing efforts to improve completeness of reporting. The revised methodology better captures induced abortions, which are increasingly occurring in non-hospital settings (e.g., nurse practitioner and physician offices, community and public health clinics).

Why is the revised methodology used for some provinces only?

Due to variations in physician billing data capture and completeness across the country, it was not feasible to use the revised methodology for all jurisdictions; this has resulted in some ongoing underestimation of total abortion volumes. More comprehensive reporting may be available in future CIHI releases.

Do the results include the number of induced abortions from RU-486/mifepristone/Mifegymiso? 

Reported volumes include abortions induced by Mifegymiso that occurred in a hospital, that were reported voluntarily by clinics or that were captured in the medical abortion physician billing codes. The data does not permit us to report these volumes separately because there is no unique code to identify Mifegymiso in the data sources. A high-level breakdown by method of abortion can be found in Table 3.

Why are there fewer data tables in the 2021 data release compared with previous years?

Breakdowns derived from hospitalization data only are no longer included since they are not representative of all abortions across all settings and represent only a small proportion of the total number of abortions."

So you can see that there is a lot of missing information from previous years:

• By Gestational age
• By number of previous deliveries
• By Number of previous abortions
• By complications

I had to do a fair amount of diddling with the report to get it to print properly, (formatting, etc) and haven't had time yet to review the actual data yet. 

Ontario farms out 44 plus abortions to other provinces

In 2021, Ontario farmed out between 44 and 54 of its abortions to other provinces (Quebec, Alberta and British Columbia.