Induced Abortion

Sex and Gender-based Analysis of this topic

Definition

Induced abortion is defined as the termination of pregnancy by medical or surgical means. Globally, countries are trending towards legalization of induced abortion. In Canada, induced abortion has been legal since 1969. The two primary measures used to measure induced abortions include: 1) induced abortion rate, which is the number of induced abortions per 1,000 women of childbearing age (15-44) and 2) induced abortion ratio, which is the number of induced abortions per 100 live births [1]. While the rate is the highest among women aged 20-24, the ratio is highest among teenagers [2]. For developing countries, the induced abortion rate in 2003 was estimated at 29 per 1,000 women aged 15-44 [3], while in Canada in 2005 the rate was 14 [4]. The total number of induced abortions in Canada has declined nearly 13% over the last decade [5], which parallels the global trend for the same period [6]. In Canada, the Canadian Institute for Health Information is responsible for collecting national data on induced abortions. The National Abortion Federation, of which many abortion providers are a part of, collects more detailed data through its members and is another valuable research source.

 
 
Sex Issues
Compared to other surgical procedures, surgically induced abortions are extremely safe with a less than 1% complication rate and do not pose long-term safety concerns [7]. The decision to use either medical (through use of drugs) or surgical means is based on gestational age, pre-existing conditions, and/or patient preferences. Surgical abortions are performed in clinics and hospitals, though the proportion of abortions in clinics has risen over the years [8]. Medical abortions are typically performed in doctor's offices or clinic settings.
 
 
Gender Issues

Induced abortion should be provided in the context of women-centred care, which should include supportive, confidential, and compassionate counseling on all available options according to the woman’s needs. There are many societal pressures on women concerning her choice to have an abortion, and for women who have experienced physical or emotional abuse, these issues are even more complex. It is important to place this medical issue within a larger, societal context to understand the full implications for women’s health.

 
 
Diversity

There are large disparities in induced abortions across Canada in terms of geography, age, and ethnicity. Across the provinces, the highest rate of induced abortions in 2005 per 100 live births was approximately 44 in the Yukon Territory, while the lowest rate was 14 in New Brunswick [9]. It should be noted that induced abortions are not available in Prince Edward Island, so this province is excluded in most reporting.  In terms of age, the highest rate of induced abortions per 1,000 females was for women aged 20-24, followed closely by women aged 18-19 [10]. Abortion rates are 30-50% higher for Status Indian women aged 18-29 and approximately double for Status Indian women 18 and younger compared to the rest of the BC population, respectively [11].

 
 
Critique

Though a 1988 law requires the provinces to pay for abortions at clinics and hospitals, access to abortion services still varies across Canada, causing a large inequity of care for Canadian women [12], which may explain the varying rates across Canada. Stronger federal involvement is needed to balance this disparity and provide service for all Canadian women. A lack of services can lead women to pursue abortions outside of the medical system, often with disastrous results [12]. Data should be generated on the related topic of emergency contraception use, which can reduce the rate of unwanted pregnancies and abortions. In British Columbia, emergency contraception first became available over the counter in 2000 making British Columbia the first province to dispense emergency contraception without a prescription. Other provinces have subsequently followed suit. Appropriate data will help determine if access and use of emergency contraception decreases the overall rate of abortion.

 
 
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