Should Abortion Reporting Continue in Canada?
Fowler, Dawn, Trouton, Konia J, Canadian Journal of Public Health
Surgical abortion in Canada has been a recognized medical procedure since removing it from the criminal code in1969.' From 1969 through 1988, Therapeutic Abortion Committees (TAC) were established at each hospital where abortions were performed, and women needed to apply to the TAC in order to have an abortion. In addition to monitoring the decriminalization of abortion, a database was established for annual reporting. In 1988, the Supreme Court decision ruled in favour of abolishing the TACs.2 However, the database has not been reviewed and the purpose of abortion monitoring and surveillance today is not clear.
The presumption is that all women in Canada who want an abortion have ease of access to services. In reality, women do not have equal access to abortion services. The purpose of this commentary is to argue for routine, publicly funded monitoring of abortion services, but with the purpose of reporting on compliance with the Canada Health Act (CHA).
Gaps in access
The need for abortion services is high; available statistics show that over one in four pregnancies are resulting in an abortion. If the demand is this high (about 110,000 abortions in Canada per year3), then the question is: "How many women are not able to obtain an abortion?" Today, we cannot answer this question.
A review of how each provincial and territorial government provides for abortion services shows that the principles of the CHA are being violated. Prince Edward Island provides no abortion services, and does not allow for reciprocal billing for abortion. Abortions are not available before 7 weeks or after 14 weeks in Nunavut, the Northwest Territories or the Yukon because of a lack of trained providers. In northern and remote parts of Newfoundland, Ontario, Quebec, Manitoba, Saskatchewan, Alberta and BC, there are similar problems of lack of service. The need to obtain travel authority in some remote locations leads to unnecessary and dangerous delays. Many women are left to shop around by themselves for services this compounds the problem, the number of weeks of gestation being a critical factor in having the procedure performed.
Many jurisdictions do not cover the entire cost of abortion services, even though these are available within the jurisdiction. For example, the costs of abortions in hospitals are entirely covered, but those in clinics are incompletely subsidized. In New Brunswick, Nova Scotia and Quebec, there are clinics where neither the physician billings nor the clinic costs are borne by the provincial billing system. In British Columbia and Ontario, there are clinics where only the physician fee is covered.
There is a cap for abortion services in clinics in Alberta, BC and Ontario. This limits the number of abortions per month that can occur at a particular facility, or the number per year that a single provider can perform. Therefore, this creates a bias for women who get pregnant at the beginning of the month, or early in the year.
There are a limited number of trained providers in Canada. Training in abortion is not a mandatory part of family practice or gynecological training. With the other factors that create gaps in access, we cannot understand how this is justifiable.
Gaps in monitoring and reporting
Since 1995, the Canadian Institute for Health Information (CIHI) has collected information on abortions. These data are then sent to Statistics Canada for analysis and publication. Data from 1996 have just recently been published electronically.
The Statistics Canada publication "Therapeutic Abortions 1995" acknowledges that there are inconsistencies in the data.' Since 1988, a number of hospitals in Quebec and all facilities in BC stopped filling out the therapeutic abortion individual case report form prescribed by Statistics Canada. Currently, some provinces only provide counts, and no information on the medical and demographic items listed. …