The Therapeutic Abortion Statistics Survey as published for 2001 and in The Daily on February 11, 2005 for the year 2002 is a recitation of mea culpa excuses for the obvious failure of both The Canadian Institute for Health Information (CIHI) and Statistics Canada to provide accurate and comprehensive data about the induced abortions being performed in our Canadian hospitals and clinics.

The Therapeutic Abortion Survey was designed originally in 1970 to account for all
legally induced abortions performed in Canada and hopefully those numbers would also include a count for Canadian women who went to the U.S. for terminations. More importantly, demographic and medical case details would accompany these counts. Statistics Canada was responsible for this survey of hospital and clinic abortions.

Perhaps you will recall that in the 2001 survey, Statistics Canada defended their former historical accuracy by saying that for “the data years 1970 to 1987, the coverage of the survey was considered to be 100% of all induced abortions performed in Canada.”

In 1986 it became apparent that there was a determined effort afoot to eliminate the abortion statistics. Dr. Ivan Fellegi, the newly appointed Chief Statistician of Statistics Canada, advised the Minister of Supply and Services, Stewart McInnes to cease compiling figures for the induced abortions because “they did not give a precise and worthwhile picture of the therapeutic abortions done in Canada”. The Director of Health Services, Statistics Canada, David Bray, was quoted in the Ottawa Citizen on October 8, 1986 as saying that he issued his August directive to hospital administrators requesting them to discontinue sending the annual Therapeutic Abortion form to Statistics Canada as a “cost cutting measure” and also that “the figures weren’t relevant to most Canadians.” (69,572 abortions in 1986). He also thanked them for their cooperation over the years.

There was such an outcry from all groups interested in the impact of abortion on Canadian society that the new minister responsible for Statistics Canada, the Honourable Monique Vezina reversed the decision with this promise, “the method of compiling the (abortion) figures will be changed to provide a more precise picture of therapeutic abortions performed in Canada”. The Chief Statistician of Canada, Dr. Ivan Fellegi was advised to continue the annual compilation of abortion statistics.

In the year 1994, however, The Canadian Institute for Health Information (CIHI) was formed. When CIHI was created their mandate was established jointly by federal and provincial/territorial ministers of health: to improve the health of Canadians and the health care system by providing quality, reliable and timely health information as well as by developing and managing databases and registries. (www.cihi.ca) CIHI assumed responsibility for data collection, compilation and processing. Statistics Canada remains
involved in the approval of the final annual file and plays a major role in the dissemination of data from the survey. Dr. Ivan Fellegi has served on the Board of Directors since its inception. After CIHI took over the role of collecting the abortion statistics the decline in the quality of the data was very noticeable. Even the late Dr. Marion Powell, a strong abortion advocate who served on the Privy Council of Canada and worked on the federal committee reviewing the abortion law commented that “because of a lack of consistency in reporting abortion statistics, the actual number of abortions performed in clinics can only be estimated” [Canadian Med. Assoc. J. 1st. June, 1997; 156 (11)].

As of 2000 CIHI estimated that the CIHI Therapeutic Abortion Database represented approximately 90% of all abortions performed in Canada involving Canadian residents, although many of these abortions are now recorded as aggregate counts only.

Ontario continues to have the highest number of abortions of any province (38,109). Despite this fact, The Ontario Ministry of Health and Long-term care announced in 2000 that they no longer maintain a system for the collection of detailed information about the abortions performed in Ontario clinics. It is of interest that the Deputy Minister of Health of Health for Ontario is a member of the Conference of Deputy Ministers of Health which maintains “strong links” with the Board of CIHI
There were 18,483 clinic abortions in Ontario in 2002; this represents 48.5% of all the Ontario abortions. Ontario now uses the OHIP billing system only for an aggregate count of the clinic abortions. Information is no longer available for non-residents of Ontario or for Ontario residents who do not submit an OHIP claim for their abortion. Statistics Canada notes that caution should be taken in comparing Ontario clinic data after 1999 with that for 1998 and earlier. At present only the province of Alberta provides detailed information for their clinic abortions (5,567 in 2002).

The abortion law was amended in 1969 to allow abortion in cases where “the continuation of the pregnancy…would be likely to endanger the life or health of the mother” (the word health was not defined). The number of abortions recorded in the 1970 survey was 11,152. In 1987 there were 70,023 induced abortions. The law was struck down in 1988 and in 2002 the number of reported abortions has risen to 105,383. This number does not include the 152 women who were reported to have obtained abortions in the U.S. border states. It should be noted that in 2002 Nunavut sent a count for only 3 months so that Nunavut is not included in the current 2002 provincial and territorial count.

The national rate of abortions per 100 live births in 1970 was 3.0. In 2002 the national rate is 32.1. This means that for every 100 babies born alive, 32.1 were killed by abortion. Despite the swelling numbers of abortions during the ensuing 32 years, the detailed records available in the data base for hospital and clinic abortions combined have
dwindled once again from 69% in 1995 to 54% in 2001 (some data elements were assigned values of ‘unknown’ or ‘not available’) to 47% of the available demographic
and medical case items in 2002 (the age group of the mother, marital status at the time of the abortion, gestational age of the child, any immediate complications, nature of the procedure, previous deliveries and the number of previous abortions).

In 2000 the records showed that only 13.3% of the abortions were carried out on married women In 2001 the marital status category was eliminated from the detailed database tables of CIHI.

Statistics Canada stated in 2001 that “The title of the survey retains the word ‘therapeutic’ for the sake of ‘historical continuity’. When the survey began in late 1969
a woman could only obtain an abortion for health reasons. In 1988, with the removal of abortion from the Criminal Code, a reason for obtaining an abortion was no longer required.” (emphasis mine). In other words, as we have always said, abortion on demand!

To compound the problem for anyone attempting to obtain an accurate profile of a woman seeking an abortion, Statistics Canada now says the Survey is no longer treated as mandatory.* I quote: “Coverage of abortions performed in Canada was considered to be 100% prior to 1988. In January 1988 the Supreme Court of Canada struck down the 1969 abortion law and some hospital and provincial ministry respondents interpreted this action as the basis for no longer having to report to the Therapeutic Abortion Survey. The law had included a provision enabling provincial ministries of health to obtain abortion data from hospitals. At the federal level, however, Statistics Canada surveys (including the Therapeutic Abortion Survey) are mandatory unless otherwise specified, but Statistics Canada chose to treat the Therapeutic Abortion Survey as ‘voluntary’ but encouraged respondents to continue to supply data for health-related purposes.” (emphasis mine) It is perfectly reasonable to conclude that this decision to treat the survey as voluntary rather than mandatory has caused a serious decline in the quality of abortion related data. Statistics Canada must accept some responsibility for the drastically diminished abortion statistics since 1988. * [Data Quality in the Therapeutic Abortion Survey – Survey #3209 Stats Canada 2000 in the document section]

SO WHAT CAN WE GLEAN FROM THE EXISTING ABORTION STATISTICS?

In 2002 there were 105,383 reported abortions in Canada: 58,536 were in hospitals and 46,847 were in clinics. The clinic abortions now account for 44.5% of the total abortions.

Ontario leads the way with 38,109 abortions, followed by Quebec reporting 30,841 and British Columbia 16,076. The overall rate of abortion per 100 live births is 32.1 but the rate for Quebec is 42.6, British Columbia is 39.9 and the Yukon Territory is 36.9.

We have detailed records for 71.7% of the hospital abortions, 16.2% of the clinic abortions and for the combined hospital and clinic abortions we have detailed records for only 47% of the 2002 abortions. .

Statistics Canada reports that 52 % of the abortions were done on women in their twenties; however, 337 abortions were reported for girls under 15 and 19,007 were done on girls from 15-19 years of age (CANSIM table 106-9024).

From the incomplete detailed records we can determine that 35.2% of the women had one or more previous abortions (repeat abortions) and 48.7% aborted their first pregnancy.

There can be up to 3 immediate complications reported for the abortion procedure: hemorrhage, infection, pelvic damage, retained products of conception (most frequent complication) death and “other’. From the combined detailed records (47,559) we note that 304 women had one complication and 44 women incurred a second complication at the time of the abortion.

Gestation Period: 41.7% were induced on babies under 9 weeks and 47.8% on babies 9-12 weeks (combined figures for hospitals and clinics). In the complications by age group
table there were complications listed as 19.5% for babies over 20 weeks.

For 2001 and 2002 under the category of “initial procedure” there is a new entry: Medical (pharmaceutical) abortions listed as antacid and antimetabolite (Methotrexate)
both for hospital and clinical procedures. The most common form of abortion is suction abortion; however for the 7,574 abortions in the data base detailed records which include
Alberta clinic abortions and some clinic abortions in British Columbia (which did report, along with their count, the initial abortion procedure) they indicate that 21% were antacid abortions and 2.9% were methotrexate abortions (1811 in total).

The most common form of abortion used in the first 12 weeks of pregnancy is Suction D&C (93%)– a surgical procedure which uses a mechanical suction machine to remove the fetus and placenta sometimes under general anaesthetic and some times with a local anaesthetic (an intravenous injection is used to freeze the cervix). The cervical opening is dilated and the doctor inserts a hollow tube into the uterus which is attached by a transparent tube to a vacuum machine. The fetus and placenta are broken up and the pieces are sucked into a bottle and discarded. The walls of the uterus are sometimes scraped with a loop-shaped knife called a curette to make sure no “tissue” remains.

The Women’s Health Matters Network website says a medical abortion uses drugs to “empty the contents of the uterus” in early pregnancy with the drug combination methotrexate and misoprostol. RU486 is not currently approved for sale in Canada (3/18/2005). Misoprostol is a drug used to treat stomach ulcers and it causes the muscles of the uterus to contract, pushing out its “contents”. Methotrexate is used to treat
psoriasis and cancer and it stops the growth of a pregnancy if given early enough by injection. Tablets of misoprostol are placed in the vagina 5 to 7 days after the methotrexate injection; in most cases “the uterus will be emptied within 24 hours, but in 35 percent of cases, it can take several days or weeks. Pain medication is used to ease the pain of the cramps, which occur when the pregnancy tissue comes out of the uterus”. They go on to say, “the drugs that induce medical abortions cause birth defects. A woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful”. They say that there is a 10% risk of an incomplete abortion and that there is often nausea, diarrhea, abdominal cramping or pain, vomiting and hot flashes (last update is May 9, 2002).

Stats Canada claim this new use of medical abortions is creating difficulties in collecting comprehensive data on all induced abortions because it is not known if medical abortions
are being initiated in physicians’ offices as well as in the usual hospital and clinic sites.

It is obvious that many groups beside pro-life groups have been asking the same question which we have posed for years: why are there not more details rather than diminishing details about women seeking abortion? To quote Statistics Canada, “The current challenge is to provide at least a minimal data set at the national level. Beyond this goal, there are many client requests that the survey cannot meet. For example, the survey does not collect data elements such as education or income level of (the) mother, reason for the abortion and any complications arising after discharge” (italics mine).

Why should this be? Comprehensive, accurate abortion statistics are vital for demographic, economic and population decisions; for good medical research on such matters as infertility, post abortion trauma and the long term effects on women of physical and psychological complications. They provide insight into the relationship of abortion and marital/non-marital status.

It is absolutely outrageous that the abortion facts are being buried when Statistics Canada estimated in 1992 that 1 Canadian woman in 3 would have at least one abortion in her life time! [Family Planning Perspectives, Millar, Henshaw, and Wadhera, Jan/Feb 1997, vol., 29, No. 1] Abetted by Statistics Canada, The Canadian Institute for Health Information has failed its mandate.

Lyn Smith, formerly of Action Life (Ottawa), has done extensive investigation into abortion statistics. She lives in Cobourg, Ontario.