Even fewer abortions in Quebec in 2021

The number of abortions in Quebec continued to fall in 2021, reaching a historic low… except among women aged 40 and over. A reality that could hide a darker facet of the difficulty of access to care, in the midst of a pandemic.

Lila Dussault
The Press

In 2021, 20,803 women chose to terminate their pregnancies, according to data from the Régie de l’assurance maladie du Québec (RAMQ) obtained by The Press*. This is just over 2,000 fewer abortions than in 2020, a year when a sharp drop had already been observed.

It should be noted that these data only include abortions by instrument billed by physicians to the RAMQ. Medical abortions are not included, nor are abortions for women without health insurance cards.

“With us, in 2020, [le nombre d’interventions] dropped by a hundred, and in 2021, another hundred,” confirms Patricia Larue, executive director of the Clinique des femmes de l’Outaouais.

But while fewer women sought the clinic’s services, those who did suffered more, notes Ms.^me The street. “We noticed a lot more anxiety, distress, domestic violence, problems of lack of housing, substance use,” laments the director.

A reality also observed on the Mauricie side. “The state in which some women arrived was different from before the pandemic,” says Pascale Dupuis, director general of the Trois-Rivières Women’s Health Center. The workers felt more stress, anxiety, distress, isolation [chez les patientes]. »

Service disruptions?

The drop in the number of abortions performed in Quebec in 2021 may be explained by the confinement and the curfew imposed by the Quebec government – ​​and their consequences on the sex life of Quebec women, according to several stakeholders consulted by The Press.

“The first months of 2021, we saw a great decrease in demand, remembers Patricia Larue. The clinic even had to cancel opening days. Afterwards, it picked up and stabilized. »

Access to contraception also continues to improve in the province. “In recent years, we have seen a major movement to promote, as a first choice, the use of long-acting methods of contraception, such as the IUD or the implant, which previously were reserved for women who had already had a pregnancy. “, explains the D^D Geneviève Bois, assistant clinical professor at the University of Montreal, who also performs voluntary terminations of pregnancy. However, these methods are much more effective in preventing unwanted pregnancies.

“But it’s not as if we had a big change in access to contraception between 2019 and 2020 [ou 2021] », Notes Jess Legault, co-coordinator of the Quebec Federation for birth planning.

A question that also worries Louise Langevin, specialist in the right to reproductive autonomy and professor at Laval University. ” Maybe [ces données] are a sign that women who would normally have requested an abortion have not had access to it”, she underlines.

A real risk in situations of domestic violence, for example. “Let’s admit that you are confined with the person who makes you live with it, how do you manage to telephone discreetly, without it being known, to obtain an abortion? asks Pascale Dupuis.

Women aged 40 and over, an exception

Women aged 40 and over are the only age group that has not seen a decrease in the number of abortions between 2020 and 2021. Interventions even increased slightly, from 1,656 to 1,701, according to data from the RAMQ.

“We know that access to contraception has improved for young people, but not for 40 year olds,” says Pascale Dupuis. What you need at this age is a family doctor. And sometimes, access to a family doctor is complicated. »

Another hypothesis: women in this age group, on the contrary, already have good access to contraception, which would explain a lesser variation in their statistics, notes the D^D Drink. “Generally, women in their thirties or forties are more likely to have access to a family doctor or a gynecologist,” she explains. Not to mention that it may be more difficult to assert yourself when you are 17 than when you are 40. »

One thing is certain, the pandemic has not affected everyone in the same way: “We know that the pandemic has affected women disproportionately compared to men, on all fronts, recalls Jess Legault. We ended up with women who took care of parents, children, in addition to working. I wonder if that wouldn’t be it. »

* During the health emergency period, doctors had 120 days to bill their medical act to the RAMQ. The Press received these statistics on April 29, 119 days after the start of the year. “The data provided is therefore incomplete and will continue to fluctuate as we receive the bills,” said Caroline Dupont, media spokesperson for the RAMQ.