Abortion rates remain stable in Ontario despite global spike

A new study finds that, unlike countries across the UK and Europe, abortion rates did not spike in Ontario, Canada from 2020-2022. 

Following decades-long declines in nearly all high-income settings, abortion rate trends reversed between 2020 and 2022 in many countries. For example, 2022 and 2023 saw the highest abortion rates on record in Scotland, England, and Wales. 

Researchers from the University of British Columbia and ICES found that, after accounting for changes in the abortion rate when the abortion medication mifepristone was introduced in 2017 and during the COVID-19 pandemic, abortion rates held fairly steady in Ontario through 2022. 

Canada was well-positioned to seamlessly continue abortion service delivery through the pandemic, with policies in place to support primary care and telemedicine abortion care since 2017."

Dr. Laura Schummers, lead author and Assistant Professor of Health Outcomes, Collaboration for Outcomes Research and Evaluation at UBC

Abortion trends from 2012 to 2022 

Long-standing abortion rate declines continued through 2016, and were steepest for those younger than 25 years, while rates for those aged 30 to 44 years remained stable. 

Rates then increased modestly between 2017 and 2020 when mifepristone became available, followed by a decline during the COVID-19 pandemic in 2020 and 2021. In 2022, the abortion rate returned to the pre-pandemic trend, continuing to increase gradually. 

The population-based cohort study examined all medication and procedural abortion provided to females (biological sex at birth) aged 15 to 44 years old from 2012 to 2022. Linked health data at ICES was used to examine patient use of primary care, inpatient and outpatient hospital services, same-day surgeries, and prescriptions from a pharmacy. 

This research found steady gains in the percentage of abortions provided by medication, accounting for more than 50% of abortions in Ontario by 2022. 

One limitation of the study is that "pregnancy intention"-a person's self-reported desire or plan to become pregnant-is not available in health administrative data, which means underlying trends in managing unintended pregnancy may not have been captured. 

Canadian policies may affect abortion rates 

The study notes that sharp increases in the abortion rate from 2020 to 2023 reported in some settings might be due to declining use of the most effective contraception methods. "If declining contraception use is due to misinformation or disinformation, like through social media, or concerns about cost-of-living, these may impact future rates in Canada" said Schummers. "On the other hand, if spiking rates elsewhere are due to decreased access to contraception or improved abortion access, Canada's unique policy and service environment mean we likely won't see similar trends in Canada." 

Policies to improve access to contraception are rolling out across Canada, including universal free contraception through the 2024 federal pharmacare legislation. Over time, this may mean we see declining abortion rates. 

However, the researchers note that it remains to be seen whether sociocultural forces impacting increased abortion rates in some countries may lead to abrupt increases in Canada in future years.