Abortion care in Alberta, Canada, from 2012 to 2023: a population-based, cross-sectional analysis of use and geographical access
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".