The declining birth rate and the increase in life expectancy is producing a steady change in the distribution of the Canadian population. Every country needs a balance between different age groups in order to maintain equilibrium between the working and nonworking sections. This allows the elderly to be supported by the younger groups without being a burden to society. In countries with a pyramidal distribution of the population the elderly are taken care of inside the family. When the pyramid is reversed and the older members outnumber supporting group, the care of the elderly rests mainly with the government. This is the situation in Canada.

The main factor in the growth of Canada’s population has been natural increase (or the excess of births over deaths), but this has declined progressively, from 23 per 1000 population in 1961 to only 8.3 in 1977. Since the crude death rate has leveled off since 1967, the reason for this decline is obviously the significant reduction in the number of births.

The “baby boom” in the 1950’s increased the number of women currently in the reproductive years, but there has also been a progressive decrease in fertility rates. The main reasons for this decrease are the availability of better contraceptive methods and the liberalization of abortion laws in 1969. An average of 60,000 therapeutic abortions are performed annually in Canada. If therapeutic abortions were included among other causes of death they would represent the second most frequent cause of death.

Statistics Canada has projected that the annual rate of population growth in 2026 will have a negative value of 0.1 in spite of a presumed constant net immigration of 50,000 per year. Emigration also plays an important role, but it is difficult to estimate because the only statements required when a Canadian resident leaves the country are those on an income tax return. However, at least 48,000 Canadians emigrated each year between 1966 and 1976.

If we analyze the present age distribution of the Canadian population and then project these figures to the year 2026 we will observe a significant decrease in the groups of working age. The slowdown in population growth and the changes in the age group distribution will force modifications in health care facilities. In the United States similar changes have occurred and have induced changes in the health care system. Obstetric units, for example, have low occupancy rates and may be under pressure to close. There is less demand for the services of obstetricians, although abortions may keep some obstetricians busy. In Canada, the obstetrics unit at the Montreal General Hospital has been closed, but the pregnancy termination unit remains open.

The elderly make more demands on physicians’ services than other age groups, and their medical problems persist longer. In the future, preference will be given to units involved in the treatment of cardiovascular diseases, arthritis, rheumatism, prostate disease and depression. Already, in our hospital over 20% of the coronary bypass operations in 1982 were performed on patients over 65 years of age. Other social problems faced by the elderly in areas such as housing, jobs, clothing and nutrition will force radical structural changes to society.

The only adequate support to a pyramid is a strong, broad base – in this case a younger population.

Therapeutic abortions have been extensively condemned for religious and moral reasons; these arguments have not been strong enough to prevent them. This objective statistical analysis poses an argument for all those who require a different approach to the problem. The child of the woman you persuade not to undergo an abortion today may be the person whose productivity will save your existence tomorrow.

Dr. Carlos Del Campo, MD, FRCS© is a practicing physician at Victoria General Hospital, Halifax, Nova Scotia.