Abortion
Women need to be informed that abortion is an option. It is available to women up to about twenty weeks gestation but varies between provinces and clinics. Approximately half of women facing an unintended pregnancy in Canada choose to have an abortion [4]. Those women most likely to have a therapeutic abortion are those aged 20-24, and living in the Northwest Territories, Quebec, Yukon, and British Columbia, whereas the abortion rate is very low in New Brunswick and P.E.I. [8]. The differences in rates between provinces may be attributable to cultural differences as well as ease of access given the shortage of abortion providers, particularly in rural areas of Canada. The abortion rate has remained relatively constant at about 15 per 1,000 women in Canada from 2000 to 2004 [8].
When a woman is considering an abortion, it is important to explore her feelings about abortion and the social support she has. Furthermore, she should be informed of the risks, benefits, and different methods available [5].
The benefits:
Allows patients to delay or avoid parenting when the timing is not appropriate
Safe – less than 1% complication rate when performed in hospitals
The risks:
Failure of procedure
Hemorrhage, infection, uterine perforation
The methods:
Medical – methotrexate and misoprostol (up to 7 weeks GA)
Dilation and Currettage (6-14 weeks GA)
Dilation and Evacuation (12-24 weeks GA)
Access to, and specific methods of, pregnancy termination available to patients will vary by region. Physicians have a responsibility to ensure that the interval between pregnancy diagnosis and termination, if this is the desired outcome, is minimized. One way to do this is to be aware of the location of and referral process of the nearest abortion provider. Referring physicians may be able to facilitate the process by ordering blood work and imaging, too, if these are required by the clinic or hospital.
It is also important to consider and ask about sexual, physical, and emotional abuse in women considering abortion. In particular, women with recurrent abortions are at increased risk for being the victim of abuse.
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4. Canadians For Choice. Abortion [homepage on the internet] Ottawa. Canadians For Choice; [Cited 2007 April 24]. Available from: http://www.canadiansforchoice.ca/options.html
5. Planned Parenthood. Abortion [homepage on the internet] Planned Parenthood Federation of America, Inc. [Cited 2007 April 24] Available from: http://www.plannedparenthood.org/index.htm
8. Statistics Canada, Canadian Vital Statistics, Birth Database and Stillbirth Database. Reproductive Health: Pregnancies and Rates, Canada, 1974-1993. Updated Oct. 2007. Catalogue no. 82-568-XPB.
