Breakdown of Quebec abortions by type of abortion 2023/2024

Further to 2023/2024 Quebec abortions. Below is the breakdown by abortion code. I include the English translation in bold. 

Note: the codes for abortions done > 14 weeks (6941, 6948, 6949) and > than 20 weeks (6137)

Note: Nombre d'avortement distinct (plus d'un code peut être utilisé pour un même avortement) - Number of distinct abortions (more than one code can be used for the same abortion)

06137 - Gynécologie / Utérus et col utérin / Manipulation / Avortement par dilatation et extraction à partir de 20 semaines de grossesse, incluant la dilatation du col et l'insertion de tiges laminaires (PG-28) - Uterus and cervix / Manipulation / Abortion by dilation and extraction from 20 weeks of pregnancy, including cervical dilation and insertion of laminar rods

06451 - Gynécologie / Trompes / Suture / Stérilisation, toute méthode, toute voie d'approche, unilatérale ou bilatérale, post-partum ou élective, avec ou sans curetage / avec avortement thérapeutique - Tubes / Suture / Sterilization, any method, any approach, unilateral or bilateral, postpartum or elective, with or without curettage / with therapeutic abortion

06906 - Gynécologie / Utérus et col utérin / Manipulation / Avortement incomplet / par curetage - Gynecology / Uterus and cervix / Manipulation / Incomplete abortion / curettage

06908 - Gynécologie / Utérus et col utérin / Manipulation / Avortement / par extraction menstruelle (incluant la dilatation du col, l'insertion de tiges laminaires) - Gynecology / Uterus and cervix / Manipulation / Abortion / by menstrual extraction (including cervical dilation, insertion of laminar rods)

06909 - Gynécologie / Utérus et col utérin / Manipulation / Avortement / par curetage (incluant la dilatation du col, l'insertion de tiges laminaires) (PG-28) - Gynecology / Uterus and cervix / Manipulation / Abortion / curettage (including cervical dilation, insertion of laminar rods) (PG-28)

06941 - Gynécologie / Utérus et col utérin / Manipulation / Avortement thérapeutique à partir de 14 semaines / Un temps : (incluant le bloc paracervical, la dilatation du col, l'insertion de tiges laminaires) / aspiration, curetage et évacuation du foetus (P.G. 7.7 C) (P.C. 13) - Gynecology / Uterus and cervix / Manipulation / Therapeutic abortion from 14 weeks / One-stage: (including paracervical block, cervical dilation, insertion of laminar rods) / aspiration, curettage and evacuation of the fetus

06948 - Gynécologie / Utérus et col utérin / Manipulation / Avortement à partir de 14 semaines / Deux temps : / 1er temps : induction, toutes méthodes incluant, le cas échéant, l'évacuation du foetus (P.G. 7.7 C) - Gynecology / Uterus and cervix / Manipulation / Abortion from 14 weeks / Two stages: / 1st stage: induction, all methods including, where applicable, evacuation of the fetus (P.G. 7.7 C) 

06949 - Gynécologie / Utérus et col utérin / Manipulation / Avortement de la 14e à la 19e semaine de grossesse inclusivement / 2e temps : curetage ou expulsion spontanée - Gynecology / Uterus and cervix / Manipulation / Abortion from the 14th to the 19th week of pregnancy inclusive / 2nd stage: curettage or spontaneous expulsion

Quebec abortions performed in Quebec

Certains avortements rendus le même jour peuvent être rémunérés selon 2 codes d'acte différents, expliquant que le nombre d'avortements (distinct) peut être inférieur à la somme par code d'acte. * Valeurs inférieures aux règles de diffusion de l'information et de protection des renseignements personnels. - Some abortions performed on the same day may be paid for according to 2 different procedure codes, explaining that the number of abortions (distinct) may be less than the amount per procedure code. * Values ​​lower than the rules for dissemination of information and protection of personal information.

Quebec abortions performed in other provinces

Why low numbers for medical abortions in Quebec

The medical abortion numbers in Quebec I reported last time appeared to too low, so I asked RAMQ:

"The numbers of medical abortions seem to be very low. Can you check for me and see if there is a mistake in the medical abortion numbers? Also, the cost per abortion seems very low. Can you check on those costs as well?"

The response I received:

"Les tableaux disponibles en ligne concernant les remboursements accordés dans le cadre du Programme d’accès universel gratuit à l’interruption volontaire de grossesse médicamen­teuse fournissent des données concernant le MifégymisoMC (pilule abortive) remis en pharmacien communautaire à la suite d’une consultation en clinique médicale à une personne assurée au régime public d’assurance médicaments. La Régie ne détient pas de donnée concernant le MifégymisoMC reçu dans un établissement de santé . Nous constatons que peu de personnes assurées vont en clinique médicale lorsqu’elles envisagent un avortement médicamenteux. En effet, elles semblent privilégier les services en établissement. Le nombre peu élevé de remboursements du MifégymisoMC dans les pharmacies communautaires s’explique probablement ainsi."

I don't speak French, so according to Google translate:

"The tables available online regarding reimbursements granted under the Free Universal Access to The Voluntary Termination of Pregnancy Drug Program provide data on Mifegymiso™ (abortion pill) given to a community pharmacist following a consultation in a medical clinic to a person insured under the public drug insurance plan. The Régie does not hold any data concerning Mifégymiso™ received in a health facility. We find that few insured people go to medical clinics when they are considering a medical abortion. Indeed, they seem to favour institutional services. This is likely due to the low number of reimbursements for Mifegymiso™ in community pharmacies."

I will attempt to find out what the numbers are for health facilities. 

Quebec (gestational age and medical) abortions

In 2019 there were 538 medical abortions in Quebec. We also now have some gestational ages for Quebec abortions. 

CIHI doesn't report medical abortions, or gestational age abortions for Quebec.

Here is the complete list of Quebec abortion facilities.

Below is a breakdown of the types of abortions. My last Quebec stats.

Translation of codes below.

Gestational ages of Quebec abortions compared to the rest of Canada's (according to CIHI):

Information on medical abortions in Quebec. 538 in 2019

(English translation of abortion codes)

06137 - Gynecology / Uterus and cervix / Manipulation / Abortion by dilation and extraction from 20 weeks of pregnancy, including cervical expansion and laminar rod insertion (PG-28)

06451 - Gynecology / Tubes / Suture / Sterilization, any method, any route of approach, unilateral or bilateral, postpartum or elective, with or without curettage / with therapeutic abortion

06906 - Gynecology / Uterus and cervix / Manipulation / Incomplete abortion / by curettage

06908 - Gynecology / Uterus and cervix / Manipulation / Abortion / by menstrual extraction (including cervical dilation, insertion of laminar rods)

06909 - Gynecology / Uterus and cervix / Manipulation / Abortion / curettage (including cervical dilation, laminar rod insertion) (PG-28)

06941 - Gynecology / Uterus and cervix / Manipulation / Therapeutic abortion from 14 weeks / One time: (including the block paracervical, cervical dilation, insertion of laminar rods) / aspiration, curettage and evacuation of the fetus (P.G. 2.4.7.7 C) (P.C. 13)

06948 - Gynecology / Uterus and cervix / Manipulation / Abortion from 14 weeks / Two times: / 1st time: induction, all methods including, if necessary, the evacuation of the fetus (P.G. 2.4.7.7 C)

06949 - Gynecology / Uterus and cervix / Manipulation / Abortion from the 14th to the 19th week of pregnancy inclusively / 2nd time: curettage or spontaneous expulsion (PG-28)

Canadian abortion statistics: who does, and who does not, report medical abortions

This is an update of all the different kinds of abortions reported by CIHI, vs the provinces. (Further to this post which is starting to confuse even me.)

CIHI only reports these abortions: S752 - induced - by any surgical technique up to and including 14 weeks gestation, S785 - induced - by any surgical technique after 14 weeks of gestation (CIHI does not report medical abortions)

Quebec Health has confirmed that their abortion numbers do not include medical abortions.

Alberta Health has confirmed that their abortion numbers do not include medical abortions.

Ontario Ministry of Health and Long Term Care does report medical abortions:

MOHLTC reports all these types of abortions (at this point Ontario has the most comprehensive reporting of abortion numbers in Canada):
A920A - MEDICAL MANAGEMENT OF EARLY PREGNANCY - INITIAL VISIT (medical abortions)
P001A MEDICAL MGMT FETAL DEMISE BETWEEN 14-20 WKS GESTATION
P054A FETAL MANAGEMENT-SGL/MULT-INTRACARDIAC KCL INJECTION
S752A FEM.GENITAL SYST.-INDUCED-CURRETINTRA-AMNIOTIC INJ.
S770A CORPUS UTERI - HYSTEROTOMY.
S783A CORPUS UTERI - HYSTEROTOMY WITH TUBAL INTERRUPTION.
S785A FEM.GENITAL SYST.-INDUCED-INTRA-AMNIOTIC INJ. (INCOMP.)

BC does report medical abortions

The never ending story of abortion statistics in Canada

Further to my post on Canada's abortion statistics, I have done a four year comparison between CIHI's and Ontario's abortion numbers. As you can see the spread between CIHI's and MOHLTC's numbers increase every year between (2014 and 2014/2015), to (2017 and 2017/2018). So while overall the numbers are decreasing, the spread is getting larger. In 2014 and 2014/2015, the difference was 8.4%. In 2017 and 2017/2018 the difference was 20.42%. 

Adding 20.42% (to CIHI's reported 85,195 in 2018 for all of Canada) would mean a total of at least 102,592 abortions for all of Canada. 

See above link for my notes from CIHI and MOHLTC.

UPDATE The facts about abortions statistics in Canada

(UPDATE March 22, 2010. Quebec Health (RAMQ) has confirmed that their abortion numbers do not include medical abortions.)

The media has it wrong: New data suggests Canadian clinics and hospitals performing fewer abortions. So does Joyce Arthur.

Why? Because what people always report are CIHI's numbers. And CIHI is missing a lot of data based on freedom of information requests I've done.

It is a well known fact CIHI under reports abortion numbers because they do not collect data based on fee for service records (i.e. OHIP billings in Ontario).

"CIHI captures administrative, clinical and demographic data on induced abortions performed in Canadian hospitals. Data is supplied by provincial and territorial ministries of health, hospitals and independent abortion clinics in Canada. Clinic data is submitted voluntarily to CIHI. Counts in the following tables include induced abortions performed in a hospital or clinic setting in Canada. Due to variations in use of fee-for-service (FFS) payments for induced abortions across the country, these figures are not based on pan-Canadian FFS data."

What we do know about CIHI's data:

• abortions performed in physician's office are not reported (only hospitals and clinics are reported). (UPDATE March 2, 2020 Correction: CIHI apparently does a calculation to increase their accuracy  *** However they are still under reporting see below)
• clinic abortion data is under reported because of its voluntary nature
• medical abortions (the abortion pill RU-486) are not reported (for the most part they are prescribed through physician offices)
• CIHI hospital abortion data is accurate
• the only accurate data available for all abortions comes from FFS or doctor's billing records (OHIP in Ontario RAMQ in Quebec)

I have received data from Ontario billing records over the years. Recently I received Quebec billing records. Both of these sources are fairly accurate because they are based on FFS records.

Ontario: In 2017/2018 MOHLTC reported 42,853 abortions compared to 2018 CIHI reported 29,513 abortions in Ontario. A difference of 13,340 unreported abortions.

(UPDATE March 2, 2020): in 2017/2018 MOHLTC reported 42,853 and in 2017 CIHI reported 35,587. In the calculation above I used CIHI's 2018 numbers instead of 2017 numbers. The confusion comes from the fact that CIHI reports a calendar year, and MOHLTC reports a fiscal year of April 1, 2017- March 31, 2018. So it makes more sense to compare MOHLTC numbers to CIHI's calendar year. Therefore Ontario: In 2017/2018 MOHLTC reported 42,853 abortions compared to 2017 CIHI who reported 35,587 abortions in Ontario. A difference of 7,266 unreported abortions. This means CIHI under reported Ontario's abortions by 20.42%. I will be doing more comparisons in a later post.)

Quebec: Recently I reported numbers for the first time from Quebec: 

In 2018 RAMQ reported 26,979 compared to 22,093 from CIHI = 4,886 unreported abortions

This means CIHI under reported Quebec's abortions by 22%.

Quebec and Ontario are the largest provinces in Canada. Therefore they perform the most abortions. So total numbers of abortions reported by CIHI are probably somewhere between 22% and 45% lower than the actual totals.

CIHI reported 85,195 in 2018 for all of Canada. Quebec and Ontario abortions make up 65% of that number. If we assume all provinces have similar under reported abortion numbers, it's fair to say that the percentages would be somewhere between 22% or 45% higher than CIHI reports.

This means the total number of abortions done in Canada in 2018 can reasonably be expected to be somewhere between 103,937 to 123,532. Not 85,195.

UPDATE March 2, 2020 from CIHI: "The report you shared (42,853) includes seven fee codes, however CIHI reports only using two fee codes. If you limit your comparison to the 2 surgical fee codes (S752 and S785), the total numbers presented in the MOH report are very close to CIHI’s reported numbers (32,795 vs 29,513 respectively). In addition, CIHI reported for calendar year 2018 while the other report appears to be based on fiscal year 2017/18 data."

To which I responded: "So why doesn't CIHI use all the fee codes used by Ontario, since those are abortions as well? There is a big 45% difference between CIHI's numbers and Ontario's numbers. Ontario reported 42,853 and CIHI only reported 29,513. I realize there is a difference in the two reporting periods, because MOHLTC reports using a fiscal year, CIHI uses a calendar year, but there is no way to get a completely equivalent time frame, so I must compare the two years in this manner."

*** This is included on CIHI's annual reports on abortion ***
The methodology to estimate induced abortion volumes for Ontario is consistent with the enhanced methodology that was introduced in the 2015 report. Total volumes were derived by using the total abortion volumes reported to the National Physician Database (NPDB) at CIHI and adding both hospital-based abortions for non-Ontario residents and hospital-based medical-method-only abortions for Ontario residents (as reported to the Discharge Abstract Database and the National Ambulatory Care Reporting System). For Ontario, volumes reported in the column Number of induced abortions reported by clinics include services from non-hospital settings. Volumes for non-hospital settings (clinics/surgical facilities/physician offices) were estimated using the total abortion volumes as described above and subtracting hospital-based abortions. This methodology results in induced abortions occurring in physician offices and in clinics being included in non-hospital settings volumes. 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.

Update March 3, 2020 from OMHLTC: 
"Health Services Branch has confirmed that medical abortions would be captured under A920A." This means that medical abortions are being captured under A920. But so are missed abortions. As well, there are other methods to deal with missed abortions which do not include RU486. What a dog's breakfast abortion statistics are.

UPDATE March 4, 2020, comparison of Ontario and CIHI's data for the past four years.

Quebec abortions at least 20% higher than reported by CIHI

I have good news and I have bad news.

The good news is that Quebec's abortion rates appear to be decreasing. The bad news is that what CIHI reports for Quebec abortions is under reported by at least 20%.

I did a freedom of information request of Quebec Health RAMQ. This is what I asked for:

1. The number of abortions done in a Canadian province, other than Quebec, reimbursed by RAMQ, as well as the total cost, for each of the last five years, broken down by hospital, by clinic, and by physician's office. 

2. The number abortions done in Quebec, reimbursed by RAMQ, as well as the total cost, for each of the last five years, broken down by hospital, by clinic, and by physician's office. 

3. The number abortions done in the United States, reimbursed by RAMQ, as well as the total cost, for each of the last five years.

Below are scans of what I received back. Sorry for the poor quality.

The first three scans are the numbers of abortions done in Quebec, and the last scan is of the abortions done in a province outside of Quebec.

Ignoring the 2019 stats (the year isn't finished yet) and the 2014 stats (doesn't seem to be online anymore at CIHI's site), I looked at 2015, 2016 and 2017 and compared them to CIHI's numbers.

Here they are (and for this calculation I ignored the out of province abortions so the actual abortions are even higher than this):

2015 RAMQ/CIHI 29,036/24,193 (difference of 4,843)
2016 RAMQ/CIHI 28,086/23,393 (difference of 4,693)
2017 RAMQ/CIHI 27,621/22,966 (difference of 4,655)

For the abortions done out of province, I noticed something interesting. For those done under "Services professionels" (380 of them), the average cost was about $308. For those done under "Services hospitaliers" the average cost was about $1,580. It seems probable that these are late-term abortions because of the much higher cost.

Regarding abortions done if the US, I was told:

"Furthermore, we wish to inform you that we have not reimbursed any abortion performed in the US." [sic]