, 2025-04-18 11:12:00
Abortion rates increased substantially from 2020 to 2023 in the United Kingdom and Europe, but not in Canada, a new study found.
“We are not seeing this kind of dramatic spike in abortion rates in Ontario, which has about 40% of the Canadian population,” lead author Laura Schummers, assistant professor of pharmaceutical sciences at The University of British Columbia in Vancouver, told Medscape Medical News.
The findings suggested that Ontario’s health services environment and Canada’s regulatory and policy approach to preserving reproductive health services may have helped stabilize abortion rates, the authors wrote.
The findings were published on April 11 in JAMA Network Open.
Longitudinal Data
The abortion drug mifepristone became available in Canada in November 2017. It had been widely used since 2000 in Europe and the United Kingdom, and its efficacy and safety profile were well-known. These circumstances enabled Canadian regulators to approve mifepristone’s use without many regulatory restrictions, allowing it to be prescribed by an authorized prescriber and dispensed by a community pharmacist, Schummers said.
“Before mifepristone, most abortions in Canada, about 96%, were performed surgically in special clinics in urban centers. A large proportion of the Canadian population did not live in those urban centers and would have to travel, sometimes very long distances, to reach an abortion service provider. But availability of mifepristone changed that and made abortion more accessible,” she said.
To study abortion trends in Ontario, the researchers examined all medication and surgical abortions that were provided from January 1, 2012, to December 31, 2022, to women of reproductive age who had provincial medical insurance coverage.
They identified 422,867 medication and procedural abortions performed during that period among 225,540 reproductive-aged women (mean age, 28.5 years).
The abortion rate declined steadily from 15.6 abortions per 1000 women per year in 2012 to 12.3 abortions per 1000 women per year in 2021, and then increased to 14.1 abortions per 1000 women per year in 2022.
The introduction of mifepristone in 2017 was not associated with an immediate change in the abortion rate, but there were an additional 1.5 abortions per 1000 women by the first quarter of 2020 compared with pre-mifepristone trends.
Abortion rates increased more among women aged 15-19 years, less among those aged 35-44 years, and not at all among those aged 25-29 years.
During the early part of the pandemic (March 2020 to December 2021), abortion rates decreased by 1.2 per 1000 women per year. This decrease was most pronounced among women aged 20-34 years.
In 2022, the abortion rate returned to what it was before the pandemic, with a greater increase among women aged 20-24 years but no change among women aged 25-29 years. This increased abortion rate was consistent with 5-year trends following the availability of mifepristone, the authors wrote.
Improved Access
“Canada was unique during COVID because within weeks of the pandemic being declared, Canadian ob/gyns stated that abortion care was an essential service and ensured that no service disruptions occurred,” said Schummers. “We were well-positioned to seamlessly continue abortion service delivery through the pandemic and have had policies in place to support primary care and telemedicine abortion care since 2017.”
Efforts to restrict abortion are not successful in reducing abortion rates, she added. “Making laws to restrict abortion care is not the most effective way to lower abortion rates. When we preserve access to reproductive health services, when we prioritize these to include contraceptive care and abortion care, and we meet people where they are to provide access to those services as needed, we see over time a decline in abortion rates. Any increases that may occur tend to be small and short-lived.”
The reproductive health policies enacted by the Ontario provincial government could be contributing to the relatively stable rates of abortion, suggested Amanda Black, MD, past president of the Society of Obstetricians and Gynaecologists of Canada and professor of obstetrics and gynecology at the University of Ottawa, both in Ottawa.
Ontario has made contraception free for patients younger than 25 years. In October 2017, it began to provide mifepristone free of charge, she noted.
“We have improved access, we’ve improved coverage, and this has probably improved the ability for people who live in communities that otherwise would not have access to abortion services. Perhaps we are not seeing the abortion rate go up a lot because we’re also trying to provide contraception for women under age 25 years,” Black said.
The study was funded by the Canadian Institutes of Health Research and Institute for Clinical Evaluative Sciences, which is funded by the Ontario Ministry of Health and the Ministry of Long-Term Care. Schummers and Black reported having no relevant financial relationships.