Get the facts: how many abortions take place in Queensland?

The facts on abortion rates in Australia are hard to come by, because there’s no national data collection on abortion, and different states have different laws and regulations – and therefore different reporting mechanisms – regarding numbers of abortion procedures. Queensland has no such reporting mechanism, so it is impossible to know exactly how many abortions occur each year in Queensland.

Because there are no national or Queensland abortion statistics, most of what  is available relies on estimates – so if someone tells you they know exactly how many abortions take place here each year, or at exactly what gestation or for what reason, they’re making it up. This data doesn’t exist [1].

It is estimated that half of all pregnancies in Australia are unplanned and that half of those are terminated[2]; also that between one quarter and one third of Australian women will experience an abortion in their lifetime.

The figure of one quarter to one third of Australian women having an abortion is from South Australia, which is the only jurisdiction with mandatory abortion notification where reports are made publicly available, through their Pregnancy Outcome Unit in the Department of Health. The most recent report available is for 2014 (they lag a couple of years behind) which states on p.57 that:

This suggests that 26.3% of women would have at least one termination of pregnancy in their lifetime if they experienced the termination of pregnancy rates of the different age groups for 2014 [3].

This figure has fallen in the past twenty years, from one in three women in the 1997 report [4] to just over one in four in the most recent one. This data is extrapolated from South Australia to give a national estimate, and is where the broadly used ‘one in three’ estimate originates.

In 2016 Queensland Health provided evidence to the Parliamentary Health Committee on abortion numbers in Queensland. They reported that in 2015 there were 10,403 abortions provided in the private sector and 295 in the public sector. The public sector numbers include 120 at 20 weeks gestation or above; these are all the procedures at that gestation performed in Queensland, and all were performed in hospitals. The 10,403 in the private sector does not, to our understanding, include medication abortion, including those provided by GPs or sexual health clinics[5].

Given the data shortcomings, it’s estimated that between 10,000 and 14,000 abortions occur in Queensland each year.

Why can’t we use Medicare data?

The short answer is that the Medicare data counts some procedures that aren’t abortions, and doesn’t count some that are, for a few different reasons.

Surgical abortion is a rebatable procedure under Medicare[6]. However, the Medicare item numbers used to process abortions are not exclusively used for abortive procedures; they are also used for procedures to treat miscarriage, as well as some other gynaecological procedures [6] . Because there are no explanatory notes or subcategories assigned to these item numbers for the purposes of data collection, there is no way of knowing how many of these procedures are terminations and how many are not [6]. 

In addition, public hospital procedures are not processed using Medicare item numbers [6]  – not a large problem statistically in Queensland as the state health department estimates that only around 1-2% of our terminations are performed in public hospitals [5], but a bigger issue when looking at nation-wide abortion data for Australia.

Medication abortion is not covered by Medicare, although the medications are listed on the Pharmaceutical Benefits Scheme therefore some information about dispensed doses is available at a national level. There are however limitations with this data when looking at the state-based distribution statistics; in Queensland, for example, the data is artificially inflated because one large pharmacy group supplies prescription medicines used for medical abortion to service providers in other states, whilst processing the PBS prescriptions in Queensland.[7]

Given these shortcomings, using Medicare data alone can be very misleading. Public hospital abortion figures can be estimated using public hospital morbidity data, although one study found this over-estimated the number of publicly provided abortions [6]. 

How are estimates calculated?

Because of these data limitations, national estimates are difficult to compile and must be academically calculated. This is most often done using a combination of Medicare data, public hospital morbidity data, and private health insurance claims. The most recent estimate was calculated in 2005, before medication abortion was available in Australia [6].

The 2005 estimate found that 83 210 induced abortions were performed in a year, with women aged 20-29 years the most likely to present for abortion [6]. The resulting estimated abortion rate in Australia was about 19.7 per 1000 women aged 15-44 [6], which is relatively high when compared with other countries where abortion is legal and easier to access. For example, in 2005 Germany and the Netherlands both had abortion rates less than half that of Australia’s [6]  and both countries have easily accessible contraception and abortion services as well as comprehensive sex education.

While this estimate is widely used, however, the abortion rate could have altered considerably in ten years (as it has in South Australia); additionally, the ability to calculate this using the methods in that report has changed with the increasing availability of mifepristone (medication abortion).

How many abortions take place in Queensland each year?

It is generally accepted that somewhere between 10,000 and 14,000 abortions take place each year in Queensland, but without standardised data collection and reporting it is impossible to narrow that broad estimate down any further.

We note that in June 2016 an answer to a Question on Notice to Health Minister Cameron Dick was tabled in parliament, outlining the numbers of terminations which take place in private clinics across Queensland each year as follows:[8]

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
12,387 13,232 13,996 14,302 14,330 12,744 11,432 11,630 11,756 10,963 10,403

 

While these figures do not represent all terminations performed in Queensland (as they exclude public hospital procedures, and medical abortion provided by GPs and sexual health clinics), it seems possible that the numbers of abortions performed each year are falling, given the data from South Australia which shows a gradual decline. However we can’t state this with authority give the lack of specific data.

The lack of accurate information about abortion rates also makes it difficult to plan for service delivery and to monitor whether public health interventions are successful in reducing the unplanned pregnancy and abortion rates, at both state and national levels.

 

References:

[1] See for example, M Shankar, K Black, P Goldstone, S Hussainy, D Mazza, K Petersen, J Lucke, A Taft, ‘Access, equity and costs of induced abortion services in Australia: a cross-sectional study’, Australian and New Zealand Journal of Public Health, vol. 41, no. 3, Janurary 2017, pp. 309-304.

[2] C Rissel, J Richters, AE Grulich, RO de Visser, & A Smith, ‘Sex in Australia: attitudes towards sex in a representative sample of adults’, Australian and New Zealand Journal of Public Health, vol. 27, no. 2, April 2003, pp.118–123.

[3] W Scheil, K Jolly, J Scott, B Catcheside, L Sage, R Kennare Pregnancy Outcome in South Australia 2014. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2016. Online at http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/health+statistics/pregnancy+outcome+statistics

[4] A Chan, J Scott, K McCaul, R Keane Pregnancy Outcome in South Australia 1997. Adelaide: Pregnancy Outcome Unit, Epidemiology Branch, South Australian Health Commission 1999, p47.

[5] Evidence provided to a public hearing of the Health, Communities, Disability Services, and Domestic and Family Violence Prevention Committee of the Queensland Parliament on 12 July 2016. A transcript is available online at http://www.parliament.qld.gov.au/documents/committees/HCDSDFVPC/2016/AbortionLR-WRC-AB2016/14-trns-12July2016.pdf.

[6] A Chan, L Sage ‘Estimating Australia’s abortion rates 1985-2003’ Medical Journal of Australia 2005; 182 (9): 447-452. Online at https://www.mja.com.au/journal/2005/182/9/estimating-australia-s-abortion-rates-1985-2003.

[7] Information supplied to Children by Choice on request from distributor, 2015.

[8] Question on Notice No 883, asked on 24 May 2016. Answer tabled on 10 June 2016. Online at https://www.parliament.qld.gov.au/documents/tableOffice/questionsAnswers/2016/883-2016.pdf.

Advertisements