Abortion care in Alberta, Canada, from 2012 to 2023: a population-based, cross-sectional analysis of use and geographical access

Abstract

Background

Equitable access to abortion care remains a challenge in public health. Current Canadian abortion reporting overlooks modern practices such as mifepristone medication abortion and has no access and equity metrics. We aimed to comprehensively analyse abortion care provision in Alberta (the fourth largest province in Canada, home to more than 4 million people) focusing on temporal trends in annual abortion rates and access disparities.

Methods

In this population-based, repeated cross-sectional study using linked administrative databases (Practitioner Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, and Pharmaceutical Information Network) in Alberta, Canada, we examined abortion use across the province over a 10-year period. Our data included all females of reproductive age (12–49 years) who received abortion care from Jan 1, 2012, to June 30, 2023. The primary outcome was abortion rate, calculated as the annual number of abortions per 1000 females of reproductive age (15–49 years), trimming data for those younger than 15 years. We descriptively analysed abortions (procedural, medication, and induction of labour) using temporal and geospatial analysis by Alberta's five geographical zones and 35 subzones.

Findings

During the study period, 130 755 abortions occurred in Alberta, of which 120 326 (92·0%) were procedural (118 063 [98·1%] of 120 326 first trimester; 2263 [1·9%] second trimester), 7395 (5·7%) were medication abortions, and 3034 (2·3%) were induction of labour. Abortion declined steadily between 2012 and 2023, with a change of –0·42 abortions per 1000 reproductive-aged females per year (95% CI –0·49 to –0·36). Medication abortion increased following the introduction of mifepristone and comprised 1489 (13·8%) of 10 765 abortions by 2022. Nearly all (8440 [99·7%] of 8462) procedural abortions in 2022 were provided in Edmonton and Calgary. 14 882 (11·5%) of 129 527 individuals accessing abortion in Alberta travelled more than 3 h from home to receive care; 18 864 (14·6%) travelled more than 200 km.

Interpretation

Our findings suggest that annual rates of abortion in Alberta are declining; however, overall access to abortion care has minimally improved in the past decade. Abortion in Alberta remains highly procedural and concentrated in Alberta's two major cities, resulting in poor access outside metropolitan centres. Mismatch between use of abortion care and local provision of care results in substantial travel. Policy should focus on expansion of patient-preferred, evidence-based medication abortion services.

Funding

Canadian Institutes of Health Research; Women and Gender Equality Canada