Part 2 - CIHI 2021 abortion data - still under-reported

Further to this post, it seems that CIHI is still under-reporting abortion stats, at least for Ontario.

Below I compare both stats. Since Ontario publishes numbers for fiscal years (2020/2021) and CIHI publishes for calendar years, I compare Ontario numbers to each of CIHI's fiscal years. You can see the differences below.

CIHI is under-reporting by either 5,998 or 5,185 abortions, depending on which of CIHI's years you look at. That's about 17% under reported. It could be even higher than that, since Ontario also has four other abortion codes it uses, that CIHI does not use. 

That would be 759 additional abortions, 126 of which are fetal reduction abortions, where one fetus is killed and the sister or brother is allowed to live. I wonder how the abortionist decides which fetus he will kill? I wonder if the mother will tell her surviving child when she grows up, that her twin brother or sister was killed so that she could live? 

Abortion is evil enough on its own; fetal reduction abortions just add another layer of evil on top of the first.

The abortions CIHI does not include, that Ontario does include:

• P001A MEDICAL MGMT FETAL DEMISE BETWEEN 14-20 WKS GESTATION (530 + 67 = 597 abortions)
• P054A FETAL MANAGEMENT-SGL/MULT-INTRACARDIAC KCL INJECTION (126 abortions)
• S770A CORPUS UTERI - HYSTEROTOMY. (30 abortions)
• S783A CORPUS UTERI - HYSTEROTOMY WITH TUBAL INTERRUPTION. (6 abortions)
• 

CIHI is still under-reporting abortion statistics

Abortion statistics are getting more confusing.

The Ministry of Health and Long-Term Care (MOHLTC) reported a total of 44,430 abortions for 2015/2016.

CIHI reported a total of 39,679 abortions for 2015.

That's a total difference of 4,751 abortions for one year.

To add to the confusion, MOHLTC reports using seven abortion codes (S752A, S785A, P054A, S770A, S783A, P001A, A920A), while CIHI reports using only two abortion codes (S752A and S785A):

"The enhanced methodology implemented in CIHI’s 2015 report for estimating the volume of induced abortions in Ontario incorporates NPDB (1) data selected using two fee codes for surgical abortions only. The report you shared includes seven fee codes and CIHI reports using two....the data sources for CIHI’s report are DAD, NACRS, and NPDB, while it appears that the Claims History Database was the source for the report you shared [from the MOHLTC]. (2)

If we only compare CIHI with MOHLTC for the same two codes that CIHI reports, we get CIHI at 39,679 abortions, and MOHLTC at 37,806 abortions. for a difference of 1,873 more than MOHLTC.

Neither CIHI nor MOHLTC could explain these differences.

Therefore CIHI reports 4,751 overall less than MOHLTC, but reports 1,873 more than MOHLTC if we only look at the same two codes.

Very confusing I know.

MOHLTC full fee code descriptions here.
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Additional Notes

Both CIHI and MOHLTC use these two codes:
S752A and S785A (surgical abortions)

The five codes not used by CIHI data, but are used in MOHLTC data are:
A920A (MEDICAL MANAGEMENT OF EARLY PREGNANCY - 5933)
P001A (MEDICAL MGMT FETAL DEMISE BETWEEN 14‐20 WKS GESTATION - 556)
P054A (fetal reductions - 115)
S770A CORPUS UTERI‐HYSTEROTOMY (16)
S783A CORPUS UTERI‐HYSTEROTOMY WITH TUBAL INTERRUPTION (4)

Those five additional codes used at MOHLTC add up to 6,624 abortions (115+16+4+556+5933). The Ministry also tells us that the S770A and S783A codes can be used for procedures other than abortions, but give me no indication as to which of these codes are not abortions. When I asked the Ministry to clarify medical abortions and identify which diagnostic codes are used for them, I was informed that:

"The OHIP claims system does require a physician to submit a fee code for payment however it is optional for a physician to submit a diagnostic code with the fee code and there is no rule that the diagnostic code needs to relate to the fee code."

Therefore it looks like the diagnostic codes are useless. So until the Ministry can tell me otherwise, I will assume that all of these additional procedures are also for abortions.

A920A and P001A codes are both used for medical abortions (556+5933=6,489 medical abortions), and CIHI isn't capturing these numbers. CIHI is also not capturing P054A for fetal reductions (115)

Note that CIHI doesn't report "medical" abortions or "fetal reduction" abortions.

That's 6,624 additional abortions being performed in Ontario for 2015/2016 (i.e. the five missing codes), than is officially being reported by CIHI.

(1) "The National Physician Database (NPDB) is a CIHI database that contains physician billings for publically funded insured medical services. Physicians do not report to it directly.  Physicians submit claims to the Provincial/Territorial medical care plans to be paid.  All provinces submit data from their claims systems to the National Physician Database." personal correspondence July 12, 217 with CIHI
(2) personal correspondence June 23, 217 with CIHI

Hiding abortion information = unaccountable government

This story is interesting. For a couple of reasons: Mount Sinai Hospital’s refusal to eliminate one fetus from twin pregnancy triggers human rights battle

First of all, the story is about a woman who was refused an abortion on one of the two unborn twins she was carrying. Also known as a fetal reduction. Because she was refused, she hired lawyer Amir Attaran to file a complaint to the Ontario Human Rights Tribunal, alleging discrimination on the basis of sex and family status. The woman wanted to see the policy of Mt. Sinai hospital:

"In an odd twist to the story, a recently prepared written policy on the issue — replacing the unwritten one followed at the time of the woman’s pregnancy last year — indicates the hospital has indeed reversed its position [on refusing the abortion].

"The policy — obtained by Attaran under Freedom of Information laws after hospital lawyers refused to divulge it — says elective fetal reduction is “ethically complex and divides many people,” but that patient autonomy should be given primacy in the area."

My radar immediately went up. How could Attaran obtain the policy from the hospital--a policy that is clearly about abortion--when all abortion related information in Ontario is excluded by the Freedom of Information and Privacy Act? So I checked with Mr. Attaran, and he confirmed for me that he did indeed obtain the information through an access to information request.

(As an aside, I contacted the hospital myself six days ago and asked them how this could happen. The hospital never responded to me.)

Second, so why was a lawyer able to get information, when I, a pro-life person, would not be able to get the same information? Because you may recall that I can no longer obtain access to abortion information from hospitals/government in Ontario. I don't know if Mr. Attaran is pro-choice or not, but I'm pretty sure the woman who hired him is pro-choice (clue: she had an abortion).

Third, this is a good example of pro-choice people also wanting to hold their hospitals/government to being open, transparent and accountable. Just like pro-life people want their hospitals/government to be open, transparent and accountable.

(Mind you if this woman and her lawyer were refused the information, I'm pretty sure the media would have been falling all over themselves with this story in a much broader way. After all, she was refused an abortion--the horror.)

Finally, guess how many fetal reductions there were in 2010? Seventy seven (77). Guess how many fetal reductions were done in 2011? We don't know. How many were done in 2012? We don't know. How many were done in 2013? We don't know. How many were done in 2014? We don't know. How many were done in 2015? We don't know.

Have fetal reductions gone up? Have they gone down? We have no idea. That's what happens when we allow our government to hide abortion information from us. Well, from some of us anyway.