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Fertility and induced abortions

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Fertility
Induced abortions

Fertility

Births

Following a period of declining births in Canada throughout the 1990s, there has been a small upturn in recent years although the number of births is still below the level of the early 1990s. In fact, 2005 marked the third consecutive year of increase in the number of babies born, and the highest number of births since 1998 (figure 2.1). In total, nearly 342,200 babies were born in 2005, roughly 5,100 more than the previous year. This increase can at least partially be explained by higher fertility for women in their thirties, as well as a greater number of women in their prime reproductive years, particularly their twenties, in recent years.

Figure 2.1
Births in Canada, 1926 to 2005.

Figure 2.1
Births in Canada, 1926 to 2005

Trends in the number of births are a reflection of both population structure and fertility rates, or the number of children born per woman. Birth patterns over the past six decades in Canada can be traced back to the post-World War II era known as the baby-boom. The years between 1946 and 1965 were a period when fertility rates were particularly high. During the height of the baby-boom in 1959 there were 479,300 births and the total fertility rate was close to four children per woman. The following period, the baby bust, occurred roughly from 1966 to 1974 and was marked by a rapid decline of fertility rates and fewer births. However, when baby boomers reached childbearing age, the sheer size of this cohort contributed to a higher number of births, creating what has been termed an echo effect, beginning in the late 1970s. This increase was particularly noticeable in the late 1980s and early 1990s, a time when fertility rates also rose, and resulted in a recent historical peak of 404,700 births in 1990. The subsequent decrease of fertility rates throughout the 1990s, combined with the smaller cohort of baby bust women reaching their reproductive ages, again produced fewer births and in the year 2000 only 327,900 babies were born. Currently, many women from the echo generation have entered their childbearing years, and fertility rates have edged up slightly which could account for the higher number of babies born in 2005.

Total fertility rate

The total fertility rate refers to the number of children that a woman would have over the course of her reproductive life (age 15 to 49) if she experienced the age-specific fertility rates observed in a given calendar year. It is a cross-sectional or “synthetic” measure as it is actually a compilation of the fertility experiences of many different cohorts of women. The total fertility rate is not affected by variations due to population size or age structure, allowing for comparison from year to year.

In 2005, the total fertility rate was 1.54 children per woman in Canada, the same rate as in 1999. The total fertility rate was up only marginally from the previous year (1.53) and since the late 1990s, it has fluctuated between 1.51 and 1.54. These patterns are indicative of a continued trend in this country to have small families. A total fertility rate of approximately 2.1 children per woman is known as replacement level fertility, which is the level that needs to be maintained in order to replace the population in the absence of migration. The last year that the total fertility rate in Canada reached the replacement level was 1971.

The low fertility rate in Canada is a pattern shared with many other countries. In fact, in 2005 the number of children per woman was at an even lower level in countries such as Japan (1.3), Italy (1.3), Greece (1.3) and Germany (1.4). Although still below replacement level, the fertility rate in a number of European countries was higher than that of Canada: France (1.9), Norway (1.8), Denmark (1.8), United Kingdom (1.8), Sweden (1.8) and Belgium (1.7).1 In the United States, the total fertility rate was 2.05 in 2005 and a preliminary estimate for 2006 indicates it is at replacement level (2.10) for the first time since 1971.2

Many low fertility countries have experienced an increase in fertility rates in recent years. It is too soon to indicate whether this is a new trend or simply a fluctuation, but it could be related to a change in childbearing behaviour. Countries, such as Canada, which have higher fertility levels among women in their thirties than in the past, could be offsetting, to some extent, fertility declines among younger women in their twenties. In contrast, in the United States there have been gains in the fertility rates of women in almost all age groups over the age of 15 in recent years.3

Birth order and age at maternity

Close to half (45.0%) of the 342,200 births in Canada in 2005 were first births. More than one-third (35.1%) of babies born were second order births, and about one-fifth (19.9%) were third or higher order. This pattern in birth parity is similar to that observed about 25 years earlier; however, there are some important differences. First, more births, particularly first births are occurring for women aged 30 and over. In 2005, 16.5% of all births were first births to women in this age group, close to a three-fold increase from that observed less than 25 years earlier (5.6% in 1981). Another way to look at the phenomenon is to consider the proportion of all births to women aged 30 years and older which were first births. In 2005, more than one-third (33.8%) of all births to women in their thirties or forties were first births compared to 23.7% in 1981 (table 2.1).

Table 2.1
Births among women aged 30 and over, by birth order, Canada, 1981 to 2005.

Table 2.1
Births among women aged 30 and over, by birth order, Canada, 1981 to 2005

Considering that nearly half of all births in 2005 were to women aged 30 and older (48.9%), more than doubling from 1981 (23.6%), this inevitably has affected the average age at motherhood.The transition of childbearing to older ages that started in the mid 1970s has continued into the new millennium. In 2005, the average age of mothers at birth of their children was 29.6 years. This compares to an average age of 29.3 years in 1945. Since 1945, the average age of motherhood declined to reach a low of 26.7 years in 1975, before continuing an upward trend (figure 2.2).

Figure 2.2
Average age at maternity by birth order, Canada, 1945 to 2005.

Figure 2.2
Average age at maternity by birth order, Canada, 1945 to 2005

Indeed, the average age of women at their first birth was 28.0 years in 2005. The rise in age at first motherhood began in 1966 when it was 23.5 years, and has been increasing for nearly 40 years. Contributing factors to the later age of motherhood include pursuit of higher levels of education and women’s participation to the labour force.

Fertility by age of mother

The tendency of women to delay childbearing is evident when analyzing the age-specific fertility rates (figure 2.3). For the first time among the data collected since 1926, the fertility level of 30 to 34 year old women in 2005 was the highest of all specific age groups, slightly exceeding that of women aged 25 to 29, who in the past several decades, had usually the highest fertility rates. There were 97.4 births per 1,000 women in their early thirties in 2005 while for women in their late twenties it was 97.3 births per 1,000 women. The fertility rates between these two age groups have been converging for several decades reflecting the greater tendency for women to postpone childbearing to older ages.

Figure 2.3
Fertility rate by age group, Canada, 1926 to 2005.

Figure 2.3
Fertility rate by age group, Canada, 1926 to 2005

The gap in the fertility levels at the extremes of childbearing ages, that is, for 15 to 19 year olds and 40 to 44 year olds is also starting to narrow.4 Early in the 20th century, fertility was higher for women in their early forties than for those in their late teens. Reasons for the higher fertility for the older age group include the fact that during this time, the average age of first marriage for women was about 24 years5 and most fertility took place within marriage. Contraception was less effective in the early 1900s so it was more difficult to control the timing and number of subsequent births following the birth of a first child. Beginning in 1946, the first year of the baby boom, the fertility level of 15 to 19 year olds exceeded that of women in their early forties as marriage and childbearing began at younger ages than had been the case earlier in the century. Over the past decades there has been increasing convergence in the fertility rates of these two age groups as fewer women have children during their teenage years and more women bear children in their early forties. In 2005, the fertility rate of 15 to 19 year olds was 13.3 births per 1,000 women compared to 7.1 births per 1,000 women aged 40 to 44 years. In 1981, the corresponding age-specific rates were 25.8 and 3.2 births per 1,000 women, respectively.

The gap in the fertility levels of two other age groups has also narrowed dramatically in recent years, those of 20 to 24 year olds and 35 to 39 year olds. In 2005, the fertility rate of women in their early twenties was 50.4 births per 1,000 women and that of women in their late thirties was 42.1 births per 1,000 women. In 1981, the fertility rate of 20 to 24 year olds was much higher at 92.2 births per 1,000 women while it was only 19.2 births per 1,000 women aged 35 to 39 years. If current trends continue, it is possible that fertility of women in their late thirties will surpass fertility of women in their early twenties.

Completed fertility rate of recent cohorts

While the total fertility rate can be influenced by fluctuations over the course of a given calendar year, the completed fertility rate shows the fertility of actual cohorts of women who have passed through their reproductive years. The disadvantage is that it takes many years to obtain the necessary data to calculate this indicator for a given cohort. Given that very little childbearing takes place for women after age 45, the completed fertility rate for women born up to 1960 can be calculated in 2005. It is also possible to estimate the completed fertility rate of the 1970 birth cohort, who were aged 35 in 2005 and have likely completed the majority of their childbearing. The estimated completed fertility rate for more recent cohorts introduces a higher degree of uncertainty as more of their childbearing years are based on extrapolation of the trend from the past ten years. Therefore, the completed fertility rate for cohorts born after 1970 should be interpreted with caution.

The cohort of women born in 1946 (first cohort of the baby-boomers) was the last generation to have achieved replacement level fertility (2.1), therefore, this cohort is often taken as a reference group for subsequent generations. As shown in figure 2.4 this cohort of baby-boom women had much higher levels of fertility throughout their late teens and early twenties compared to more recent generations, but this level fell fairly rapidly by their early thirties and is actually lower than the succeeding cohorts of women. Indeed, the fertility of these more recent cohorts (born from 1970 onward), while lower than the 1946 cohort until age 28 (there is some fluctuation around age 29 and 30) has surpassed that of all previous cohorts of women at age 31 and older. For example, the fertility level of the cohort born in 1970, and who have therefore not yet completed their reproductive years, was 66.6 births per 1,000 women aged 35 years in 2005, which is higher than earlier cohorts when they were 35 years old. This rate is more than double that of the 1946 cohort (31.5 births per 1,000 women), an important change given that the difference between the generations is less than 25 years.

Figure 2.4
Fertility rate by age for selected cohorts, Canada.

Figure 2.4
Fertility rate by age for selected cohorts, Canada

The lower height of the curves for more recent cohorts combined with the peaking of the curve at older ages indicates both the fact that women have fewer children and the shifting ages of motherhood.Overall, completed fertility is lower for more recent cohorts because despite the fact that they have a higher fertility in their thirties, it is not sufficient to offset the lower fertility during their twenties. Consequently, it seems that the more women delay their childbearing to older ages the lower will be their completed fertility as they cannot “catch up” or compensate with higher fertility rates during their thirties. The age-specific fertility rates of the most recent cohorts, women born in 1975 and 1980, are still continuing to ascend despite the fact that they were the lowest so far for a given age. This is an important trend to follow in future years as the fertility of these younger cohorts is not only moving to increasingly older ages, it has also not yet peaked.

The evolution of the total fertility rate and the completed fertility rate shows the same general tendency of higher fertility during the baby boom and lower fertility in recent years (figure 2.5). However, there are also some important divergences between the two fertility measures, primarily related to the tempo of fertility as women delay childbearing until increasingly older ages. Consequently, in recent years, the completed fertility has been higher than the total fertility rate. Following a period of steady decline the completed fertility has been fairly stable ranging from 1.74 to 1.76 children per woman since 1993.

Figure 2.5
Total fertility rate, 1926 to 2005 and completed fertility, 1906 to 1976.

Figure 2.5
Total fertility rate, 1926 to 2005 and completed fertility, 1906 to 1976

Single and multiple births

As shown in table 2.2, the vast majority of births in 2005 were single births (97.0%), but about 10,400 births consisted of twins (2.9% of all births) and triplets or more (0.1% of all births).6 In 1981, 1.8% of all births were twins or more. This increase could be observed for all age groups of mothers. For example, among women aged 25 to 29, 2.7% of all births in 2005 were multiple births up from 1.9% observed in 1981. For women in their late thirties and in their forties, over 4% of births in 2005 were twins or more compared to less than 2% in 1981.

Table 2.2
Births distribution (in percentage) by type of birth and age group of the mother, Canada, 1981 and 2005

The transition to older motherhood is evident not only in the changing age distribution of mothers having single births but also for multiple births. The share of multiple births has fallen for women aged 15 to 29 but risen for women aged 30 and older. For example, in 2005, among women who gave birth to twins, the proportion of women aged 35 to 39 years was 19.3% whereas nearly a quarter of a century earlier, in 1981, this figure was 5.2%. Among women who had twins, the proportion aged 40 or older also increased from 0.6% to 4.2%. In contrast, among the women who had twins, the proportion of those in their late twenties fell from 39.4% in 1981 to 27.2% in 2005. The patterns for triplets or more were similar. There are a number of factors that could contribute to the increase in multiple births for women aged 30 and older, including both the overall shifting of childbirth to older ages as well as the use of reproductive technologies which often leads to multiple births.

Fertility in the provinces and territories

Reflecting the pattern at the national level, six provinces and one territory had a higher number of births in 2005 than in the preceding year: Newfoundland and Labrador, Quebec, Ontario, Manitoba, Alberta, British Columbia and the Northwest Territories (table A-2.1). The biggest gains were for the provinces of Alberta and Quebec. The number of births in the demographically and economically booming province of Alberta increased 3.3% between 2004 and 2005 to 42,100. The total fertility rate in Alberta was 1.75 children per woman, higher than the national figure (1.54). The number of births in Quebec grew 3.1% to reach 76,300 births in 2005. The total fertility rate for Quebec (1.52 children per woman) as well as Ontario (1.51) in 2005 were similar to Canada overall, however, the rate in Quebec was up from 1.48 the preceding year whereas there was no change for Ontario.

The Western provinces of Manitoba and Saskatchewan had higher fertility than the nation as a whole. The fertility of women in Saskatchewan was 1.87 children per woman in 2005, the highest level of all the provinces. In Manitoba, the rate was 1.82. Fertility in those two provinces showed an increase from the preceding year. The proportionally larger Aboriginal population in the western provinces as well as in the territories, which has higher fertility than the non-Aboriginal population, could contribute to above-national-average fertility in these regions.

In Atlantic Canada, the provinces of Prince Edward Island, Nova Scotia and New Brunswick had fewer births in 2005, although there was a slight upturn for Newfoundland and Labrador. The total fertility rates in these provinces were below the rate for Canada overall. Newfoundland and Labrador had the lowest fertility rate of all the provinces and territories (1.34 children per woman), however, this was the highest total fertility rate in this province since 1994. Second to Newfoundland and Labrador, British Columbia had a fertility rate of 1.39 children per woman, with relatively little change since the year 2000.

Given the low population in the territories, even modest changes in fertility behaviours can create a large variation in the number of births from year to year. The largest decrease in the number of births between 2004 and 2005 in Canada was in the Yukon (-12.3%) where the total fertility rate was the lowest of the territories (1.48 children per woman in 2005). Nunavut also experienced a decline in births between 2004 and 2005, but the total fertility rate in this territory remained the highest in the country (2.72). In contrast, the total fertility rate in the Northwest Territories increased from 2.04 children per woman in 2004 to 2.11 in 2005.

Areas where women begin motherhood at earlier ages could contribute to higher fertility. Results indicate that Nunavut had the youngest average age of mothers at first birth (22.3 years) in 2005 followed by Saskatchewan (25.7 years). Among the provinces with the oldest mothers at first birth, on average, were Ontario (28.5 years) and British Columbia (28.7 years). In fact, Ontario and British Columbia were the only two provinces where the average age of mothers (for all births) exceeded 30 years compared to the national average of 29.6 years.

Subprovincial

Overall, census metropolitan areas (CMA) had a lower total fertility rate (1.51) in 2005 compared to non-CMA (1.59). Table 2.3 shows the variation in fertility levels that exists across different census metropolitan areas in Canada which generally reflects differences in the demographic and ethnocultural composition of the population. Abbotsford, British Columbia had the highest total fertility rate at 1.84 children per woman in 2005, followed by Calgary (1.68) and Edmonton (1.66) in Alberta. The populations in these three census metropolitan areas have been growing more rapidly than Canada overall in recent years. In contrast, St. John’s in Newfoundland and Labrador, had the lowest total fertility rate in Canada (1.24). Other census metropolitan areas with low total fertility rates were on the west coast, notably, Victoria (1.29) and Vancouver (1.30).

Table 2.3
Total fertility rate by census metropolitan area, Canada, 2005.

Table 2.3
Total fertility rate by census metropolitan area, Canada, 2005

At 1.52, the total fertility rate in Toronto was very near the level of the nation (1.54). The fertility rate in Canada’s second most populous census metropolitan area, Montréal (1.51), was slightly below the national figure.

Induced abortions

It is important to take into consideration some background information when analyzing trends related to induced abortions, also called voluntary interruptions of pregnancy. Prior to 1969, abortions in Canada could only be performed if the continuation of the pregnancy endangered the life of the woman.7 As of August, 1969, women in Canada were able to obtain an abortion for therapeutic or health reasons at a hospital if agreed by a committee of at least three doctors. In January 1988 the Supreme Court of Canada struck down the 1969 amended abortion law so that a reason is no longer required in order to obtain an abortion.

Abortion statistics are drawn from the Therapeutic Abortion Survey, which began in 1969. This survey collects data on women obtaining abortions in hospitals and clinics in Canada, as well as limited information on Canadian women who obtained abortions in some American border states prior to 2004. Spontaneous abortions, or miscarriages, are not included in these statistics. From 1969 to 1994, Statistics Canada was responsible for this survey. As of 1995, the data have been collected and processed by the Canadian Institute for Health Information (CIHI) although Statistics Canada is still involved with data approval and dissemination.8

Data on the number of induced abortions are provided by each province or territory, however, there is variation in what information is supplied by each jurisdiction. Since 1983, Prince Edward Island has not reported induced abortions in either hospitals or clinics.Clinical abortions are also not reported by Saskatchewan, Yukon, Northwest Territories and Nunavut. As of 2004, there have been no clinics in Nova Scotia. In 2004 and 2005, Manitoba did not submit information on abortions performed in clinics. Two facilities in British Columbia, one in 2003 and the other in 2005, did not report to the Therapeutic Abortion Survey, therefore estimates were made based on the number of abortions at these facilities in previous years.For 2002 and 2003, there was incomplete reporting of induced abortions in Nunavut.

Since 1999 in Ontario, clinical abortions have been reported only for provincial residents who have made health insurance claims. Consequently, data on Ontario residents who do not submit a claim or abortions performed on non-residents are not included in the clinic counts of induced abortions for this province. In Ontario, the undercoverage of abortion counts was estimated to average 5% to 6% each year between 1995 and 1998. Similarly, data from Quebec are based only on insured residents of that province. Furthermore, the collection of data on abortions to Canadian women in the United States has also changed. Between 1971 and 2003, limited information about induced abortions obtained by Canadian women was supplied by several American states, particularly those states along the American-Canadian border. As of 2004, however, this information has no longer been collected.

Other data collection issues regarding induced abortion statistics are related to undercoverage or overcoverage of data. Voluntary interruptions of pregnancy that do not occur in hospitals or clinics would not be included in the survey. For example, data on medical or pharmaceutical abortions that may be initiated in the office of a physician are not collected, which could result in undercoverage. In contrast, overcoverage could result if women have an abortion in one setting and then seek further treatment related to the procedure elsewhere, which could result in being counted twice. The Canadian Institute for Health Information estimated that as of 2000 approximately 90% of the induced abortions performed in Canada on Canadian women have been collected in the Therapeutic Abortion Survey.9

As a result of these above-noted limitations, the data in this section on induced abortions should be interpreted with caution.

Recent trends

The number of induced abortions performed on Canadian women in hospitals and clinics decreased from 2004 to 2005. About 96,800 abortions were obtained by Canadian women in 2005, 3,200 less than in 2004 (table 2.4). More than half of the abortions performed on Canadian women occurred in hospitals (52.1%) in 2005 while the rest took place in clinics. This was down slightly from the preceding year (53.6%) and has been dropping over the past several decades. Until the end of the 1980s, almost all abortions were performed in hospitals, and following legislative changes in 1988, more clinics offered this procedure.

Table 2.4
Induced abortions by place of residence and abortions to
births ratios, Canada, provinces and territories, 2004 and
2005.

Table 2.4
Induced abortions by place of residence and abortions to births ratios, Canada, provinces and territories, 2004 and 2005

The extent to which abortions occur can be measured as a percentage of births in a given year (table 2.4). There were about three abortions for every ten births since the mid 1990s, but this figure has been falling. The number of induced abortions per 100 live births fell to 28.3 in 2005 from 29.7 in 2004.

The decline in the number of induced abortions between 2004 and 2005 which was evident for Canada as a whole also occurred for residents in all provinces except New Brunswick and British Columbia. Even in these two provinces, the numbers of residents obtaining abortions were only slightly higher in 2005 compared to the previous year. The highest percentage of abortions per 100 births in 2005 occurred for residents of Quebec (38.3%) while it was lowest for women from Prince Edward Island (9.4%)10 and New Brunswick (13.7%). The levels in the remaining provinces ranged between the figures for New Brunswick and Quebec.

Distribution of induced abortions by age of the woman

According to table 2.5, more than half of all induced abortions in 2005 were performed on Canadian women in their twenties (53.5%), especially women aged 20 to 24 (31.4%). An additional 14.9% of abortions in 2005 were performed on women in their early thirties.

Table 2.5
Number, rates and distribution of induced abortions by age group of women, Canada, 1981 to 2005.

Table 2.5
Number, rates and distribution of induced abortions by age group of women, Canada, 1981 to 2005

Since 1981, the share of induced abortions by age group of women has gradually shifted to older ages. About one-tenth (10.3%) of abortions took place for women in their late thirties in 2005, up from 5.5% nearly 25 years earlier. In 2005, 4.4% of all abortions were obtained by women aged 40 and over, more than doubling from 1981 (2.0%). The proportion of abortions performed on teenagers aged 19 or less has dropped over time. In 2005, 16.6% of all abortions were obtained by teens aged 15 to 19, down from 27.4% in 1981. Very few abortions occurred for individuals under age 15 (0.3% in 2005).

Induced abortion rates by age group and the total abortion rate

The age-specific abortion rate measures the number of abortions per 1,000 women in particular age groups. Overall, induced abortion rates decreased for all age groups in 2005 compared to the previous year except for women in their late thirties, for whom the rate remained stable. Compared to the early 1980s, rates of induced abortions were higher in 2005 for all women aged 20 and over. The general trend since the late 1990s, with only a few exceptions, has been downward for women at all ages under age 35. For example, the rate for induced abortions per 1,000 women in their early twenties fell from a high of 34.2 in 1997 to 27.7 in 2005.

The total abortion rate is the sum of the induced abortion rates. It provides an indicator of the average number of abortions that a hypothetical cohort of women would undergo if they experienced the rates observed in a given year. This measure is analogous to the total fertility rate, which indicates the average number of children per woman for a particular calendar year. In 2005, the total abortion rate was 0.44 per woman. Similar to the total fertility rate which is a summary measure reflecting the average number of children born to women the total abortion rate reflects the average number of abortions performed on women. Just as some women will have several children while others have none, the total abortion rate indicates that some women may have multiple abortions while others have none. This rate has steadily fallen since 1996 when it was 0.53 induced abortions per woman, but remains higher compared to the 1980s.

Table A-2.1
Births and birth rates, Canada, provinces and territories, 1981 to 2005.

Table A-2.1
Births and birth rates, Canada, provinces and territories, 1981 to 2005

Table A-2.2
Total fertility rate (children per woman), Canada, provinces and territories, 1981 to 2005.

Table A-2.2
Total fertility rate (children per woman), Canada, provinces and territories, 1981 to 2005

Table A-2.3
Total fertility rate by birth order (per 1,000 women), Canada, provinces and territories, 1981 to 2005

Table A-2.3
Total fertility rate by birth order (per 1,000 women), Canada, provinces and territories, 1981 to 2005

Table A-2.4
Fertility rate by age group (for 1,000 women), Canada, provinces and territories, 1981 to 2005.

Table A-2.4
Fertility rate by age group (for 1,000 women), Canada, provinces and territories, 1981 to 2005


Notes

  1. Statistics Canada. 2007. Births 2005. Statistics Canada Catalogue number 84F0210XIE; and US Census Bureau. 2008. International Data Base (IDB). Country Summary, 2005 Total fertility rate.

  2. Centers for Disease Control and Prevention. 2007.Births: Preliminary Data for 2006. National Vital Statistics Reports. 56 (7).

  3. United States Census Bureau. 2008. International Database. Table 028: Age-specific fertility rates and selected derived measures.

  4. Ages 45 to 49 are also considered part of the childbearing years for women but very little childbearing occurs for this age group. In 2005, the fertility rate was 0.3 births per 1,000 women aged 45 to 49 although it was higher earlier in the 20th century (for example, 5.8 births per 1,000 women in 1926).

  5. Dumas, J. and Y. Péron. 1992. Marriage and Conjugal Life in Canada: Current Demographic Analysis. Statistics Canada Catalogue number 91-534E.

  6. Multiple births comprised of quadruplets or more are very rare.

  7. Statistics Canada. 2007. Induced Abortion Statistics 2004. Statistics Canada Catalogue number 82-223-X.

  8. Ibid.

  9. Ibid.

  10. As of 1983, abortions performed on residents of Prince Edward Island have been only those reported by other provinces.