|Facts and Figures on Abortion in Canada||Return to Gender & Health theme page|
1. Core Knowledge
A major clinical challenge is to provide appropriate, patient-centered and sensitive support for a woman who experiences an unwanted pregnancy. It can be very difficult to balance an understanding of her preferences, which may be clouded by the stress she is currently experiencing, and your own perspectives. Not least, the time pressure works against making a fully balanced decision. Here is a link to a poignant story on an abortion in Quebec by Margaret Somerville, Director of the McGill Centre for Medicine, Ethics and Law, that raises some of the ethical issues involved.
There are various resources to assist a woman in making the supremely difficult choice between continuing with the pregnancy, terminating the pregnancy or seeking an adoption. Here is a useful decision aid: Decision-making for an unplanned pregnancy from the Alberta Options group. Other materials from a pro-life perspective are available through the Canadian Association of Pregnancy Support Services.
Spontaneous and Induced Abortions
Spontaneous abortions (or miscarriages) refer to the loss of a fetus due to natural causes before 20 weeks of pregnancy (not due to human intervention). Miscarriages are common, and are strongly related to the mother’s age:
2. Nice to Know
- About 80% of Canadian women use some form of contraception, compared to 64% of American women.
- Nonetheless, a substantial proportion of pregnancies are unplanned. Such information is not routinely collected, so it is hard to obtain estimates, but it seems likely that perhaps 40% of all pregnancies in Canada are unplanned. Of these, about half are carried to term; the other half are terminated.
- There are about 31 abortions per 100 live births: roughly 330,000 live births and 100,000 abortions each year. About half of the abortions are performed in hospitals, half in clinics.
- In 2003, 103,768 abortions were recorded in Canada, about 15.2 per thousand women. The number appears to be declining by about 1% per year. There are about 39,000 abortions each year in Ontario, delivered in 76 hospitals and 6 clinics.
- An exception is Quebec, where abortion rates are among the highest in the Western world. From 17,000 abortions per annum in 1978, they rose to 29,000 in 1998, and 31,000 in 2002, or a rate of 38 per 100 births. School sex education programs are not universal in Quebec.
- Abortion rates are usually calculated as the number of abortions per 1000 women of reproductive age (usually ages 15 - 44). Figures vary (and are difficult to estimate accurately), but our overall abortion rate lies somewhere between 12 and 16 per 1000 women of child-bearing age per year; this is fairly low compared to other developed countries.
- A wide range of women undergo abortions. About 50% are under 25; 64% are single, and 45% have children.
- Over 90% of abortions in Canada are done in the first trimester; only 2-3% are done after 16 weeks, and no doctor performs abortions past 20 or 21 weeks unless there are compelling health or genetic reasons. The risk of maternal mortality is probably greater in carrying a pregnancy to term (7.06 per 100 000 live births) than the risk associated with abortion (0.56 per 100 000 terminations) (Grimes D. Am J Obstet Gynecol 2006; 194: 92-94).
- Abortion services are fully covered in Ontario, but wait times are long (up to 6 weeks in Ottawa). Only one in six hospitals in Canada offers abortions. There is a looming shortage of doctors willing to provide the service; many are approaching retirement and younger MDs are not replacing them, some out of fear of harassment and others because they have not witnessed the dangers of unsafe abortions. Hence, therapeutic abortion services may in theory be available, but they may not be accessible.
3. Additional Information
Safety of Abortions
Obviously, concern over the safety of abortions is paramount. The risk of death from induced abortions in the U.S. has been put at 1 in 160,000 – lower than the mortality risk from childbirth. (Source: JAMA 1992; 268: 3231-9).
Psychological trauma following induced abortion may occur: it is logical that a woman will feel sadness or regret. The strongest predictor of a more extreme reaction is the woman's mental health before the abortion. However, the mental well-being of most women improves following the abortion (Robinson GE et al. Harvard Review of Psychiatry 2009; 17(4):268-290).
The quality of research on the existence of a 'post-abortion syndrome' varies widely and is clouded by partisan stances on both sides of the debate. You should carefully examine the quality of studies on the topic: How representative was the sample studied? What was the comparison group? How was mental distress measured? Was the wantedness of the pregnancy controlled for? How were pre-existing mental conditions handled in the analyses? What other stressful circumstances did the women experience?
Here is a perspective from Canadian novelist Margaret Laurence:
“I don’t believe anyone, including myself, is pro-abortion. I am pro-choice because there are times when abortion is the least damaging course. Those who would give the fertilized egg the same rights as a born child seem to me to have precious little regard for those children once they are born. Nor do the anti-abortionists show much concern over the rights and life of the mother. I have never met a woman who has had an abortion flippantly or easily or without searching her heart and her soul. No doubt such women do exist, but I believe they are in a small minority, and should be cared for, for their shadowed pain. As for the young girls-terrified children, really-who have been molested, subject to rape or incest, or simply, out of desperate need, have sought what they mistakenly believed to be love and caring, I think it is wicked to force them to bear the children of such frightening unions, of such traumatizing and wounding encounters… The fires at the Morgentaler Clinic in Toronto, the bombing of various abortion clinics in America, the harassment of women entering these clinics – all these demonstrate to me not a concern over the sanctity of human life but, on the contrary, a deeply aggressive and punitive attitude towards women on the part of a basically male establishment.”
We have some estimates of the prevalence of unsafe abortions in the world (figures per 1000 women aged 15-49):See Grimes DA, et al. Unsafe abortions: the preventable pandemic. WHO, 2006.
World Figures on Abortions
The UN Population Division offers international information on abortions by country. The report illustrates the legal status of abortion in each country and reports rates for many of them (the document is from 2002; statistics are from a variety of previous years).
Abortion rates vary from a high of 53.7 per thousand women aged 15-44 in Russia, through 38 per thousand in China, 35 (Viet Nam and Kazakhstan); 33 (Estonia); 32 (Belarus); 27 (Ukraine and the USA); 20.2 (USA); 19.7 (Australia and New Zealand); 16.9 (France); 15.2 (Canada); 10.6 in Italy; 10.4 (Netherlands); to 0.2 (Portugal). Reassuringly, no abortions were reported from the Vatican City.
Doctors Talk about Conscience in Medicine
The Medical Post reported comments by clinicians on how they balance their personal beliefs with their obligations to patient care, including abortions (September 23, 2014, page 5). Here are the quotations:
- “Everything should be founded on the doctor-patient relationship… I think conscience is one of the things that should be taken into account when fulfilling our obligations, but it doesn’t excuse us from them.”
- “Always give the patient access to all different types of care. If one doctor is not willing to offer contraception, for instance, it’s important he refers the patient. To not deprive the patient but to respect one’s conscience is the key.”
- The physician has a fiduciary responsibility. But I think it depends on the details. I don’t see my colleagues going around denying care. I think the cases where that happens are rare. And that’s a good thing.”
- “I think there are grey areas where personal beliefs start to infringe on what society expects… But we are essentially trained by society, so we have a duty.”
Law on abortion in Canada
Planned Parenthood provides resources to help women choose between parenthood, adoption or abortion.
First Place Options similarly provides women with counseling; they use a decision aid to assist women in reaching a decision over an unplanned pregnancy.
The Society of Obstetricians & Gynecologists of Canada provides clinical guidelines
The Pro-Choice group offers a history of abortion in Canada
The Medical students for choice site contains a wide variety of information, as does the Medical Students for Life
Canadians for choice has some useful information, while the Canadians for Life site covers a wide range of pro-life topics, not just pregnancy, but also including palliative care.
The de Veber Institute produces literature reviews concerning health problems associated with abortions.
Updated July 24, 2015