Therapeutic Abortion (TA) Data

Original source: Hospital TAs: Canadian Institute for Health Information (CIHI), Clinic and Private Physicians' Office (PPO) TAs: Ontario Ministry of Health and Long-Term Care
Distributed by: IntelliHEALTH Ontario, Ontario Ministry of Health and Long-Term Care
Suggested citation (see Data Citation Notes):
Ontario Therapeutic Abortion Database [years], IntelliHEALTH Ontario, Ministry of Health and Long-Term Care [extracted DATE]

Data Notes

• Therapeutic abortions (TAs) are also referred to as induced abortions. They are a major component needed for calculating the teen pregnancy rate since approximately 60% of teen pregnancies end in a TA and 40% a delivery (Ontario, 2009). This percentage breakdown varies considerably over time and place.
• TA data are accessed through IntelliHealth ONTARIO. Under the Ontario - Special Reports report folder, use the "Therapeutic Abortion Summary" predefined report. The predefined report uses a complex query that counts the number of TAs occurring in hospital from in-patient data, Day Procedures (up to March 2003) or the NACRS Ambulatory data (April 2003 onward), as well as in clinics and physician offices through OHIP medical services. Complete documentation is available through this report on intelliHEALTH ONTARIO.
• The adjusted number of TAs for Ontario residents should be used.
• TA data are based on the client's residence, not where the TA was performed.
• Individual-level data are not available (aggregate data only).
• Hospital TAs are captured through in-patient discharge and ambulatory care data sources, using the following ICD codes: ICD9 Codes (before April 2002) 6350, 6351, 6352, 6353, 6354, 6355, 6356, 6357; CCP Codes (before April 2002) 1056, 8193, 8641, 8642, 8700, 8710, 8720, 8721, 8729; ICD10-CA Codes (April 2002 onwards) O04 at the 3rd digit level, Diagnostic Type of M, 1, 2, W, X or Y; CCI Codes (April 2002 onwards) Intervention Codes to the 5th digit level: 5CA88, 5CA89, 5CA90.
• Clinic TAs occurring in five designated free-standing abortion clinics are captured using Medical Services data (OHIP approved claims paid) based on the following fee schedule codes: S752 Abortion: Induced - Curettage, Intra-amniotic injection (complete); S785 Abortion: Induced - Intra-amniotic injection (incomplete) followed by curretage, or by any technique after 16 weeks of gestation (only if length of gestation is confirmed by ultrasound). Note: Only codes with suffix "A" will be utilized. Suffix "A" indicates that a service was performed by a professional rather than by a technician e.g. S752A is billed by the physician while S752C is billed by the anaesthetist.
• Private Physicians' Offices (PPO) TAs are captured from Medical Services data in the same way as Clinic TAs but include private clinics, physicians' offices etc. and are not restricted to the five specific clinics.
• Exclusions: incomplete procedures, residents from other provinces/countries, pay direct patients, patients uninsured for any other reason, patients having an induced abortion outside of Ontario. As well, medically/pharmacologically-induced abortions (those induced by the emergency contraceptive pill, RU 486 or methotrexate which is usually reserved for ectopic pregnancies) are not captured in the hospital and clinic data.
• Data elements available are: total number of TAs; number of TAs within 40 days of a previous TA (likely complications of the first procedure); and the adjusted number of TAs (total # TA minus # TAs within 40 days).
• TA data are available by geography (public health unit, municipality, FSA or census tract), 5-year age group, and the location of the procedure (hospital, clinic, PPO).
• In 2011, the MOHLTC revised the methodology for identifying TAs to include those provided in PPOs and to exclude second abortions within 40 days of the first as this was likely a complication from the first procedure. These changes were based on work done by ICES with funding from an agency of the MOHLTC, Echo: Improving Women's Health in Ontario (1).
• Inclusion of PPO TAs represents a significant change and may increase teen pregnancy rates substantially in some jurisdictions. Since 2001, the numbers of hospital TAs in Ontario have decreased, clinic TAs have been steady, and PPO TAs have increased.
• Data for 2001 calendar year onwards are available from IntelliHealth ONTARIO. Earlier TA data (1992-2005) are available from HELPS (see HELPS Data Source) but does not include PPO TAs and has some other inconsistencies.
• The POWER Report, Reproductive and Gynaecological Health Chapter (2) provides extensive information about abortion in Ontario. The data provided in this report do not include PPO TAs.
• In Ontario, a TA performed due to detection of a congenital anomaly at ≥ 20 weeks gestation or where the product of conception is ≥ 500g should be registered as a stillbirth (3).
• Rates and proportions based on small counts must be suppressed to ensure that an individual cannot be identified. Given the sensitive nature of TA data, extra care should be given when presenting this information. Consider presenting pregnancy rates only to the public and providing specific TA information internally for public health staff.

Cited References:

1. Ferris LE, Croxford R & Salkeld E. "Induced Abortion in Ontario: Case Scenarios". ECHO Report 2011. Available at http://www.echo-ontario.ca/ for registered Health Professionals, under Resources, Studies on Access to Abortion Services, Case Scenarios.
2. Dunn S, Wise M, Johnson L, Anderson G, Ferris LE, Yeritsyan N, Croxford R, Fu L, Degani N, Bierman AS. Reproductive and Gynaecological Health. In: Bierman AS, editor. Project for an Ontario Women's Health Evidence-Based Report: Volume 2: Toronto; 2011. URL: http://www.powerstudy.ca/the-power-report/the-power-report-volume-2/reproductive-gynaecological-health.
3. Joseph KS, Allen A, Kramer MS, Cyr M, Fair M. Changes in the registration of stillbirths < 500g in Canada, 1985 - 95. Fetal-Infant Mortality Study Group of the Canadian Perinatal Surveillance System. Paediatr Perinat Epidemiol. 1999; 13:278 - 87.