Recent events in the United States have reopened the conversation about abortion care in Canada. In this country, there is no “abortion law” like there is no hip replacement law. Abortion is health care. But the story of abortion care in Canada is a complex one. And while we don’t find ourselves confronted with a Supreme Court ruling as devastating as Roe v Wade, we can’t lose sight of Canada’s own shortcomings.
In 1969, access to abortions was legal in Canada under limited circumstances. To have an abortion, a committee of doctors had to decide that continuing the pregnancy would or would be likely to endanger the pregnant person’s life or health. In 1982, Canada enacted the Canadian Charter of Rights and Freedoms. In 1988, in R v Morgentaler, the Supreme Court of Canada struck down the relevant section of the Criminal Code of Canada as unconstitutional because under Section 7 of the Charter, it violated an individual’s right to “life, liberty and security” of the person. In 1989, the federal government introduced a bill that would make doctors liable for up to two years of imprisonment for providing an abortion where the pregnant person’s health was not at risk. The bill was passed in the House of Commons but died in the Senate following a tie vote. Yes — in 1990, Canada was one vote away from criminalizing abortion.
In 1995, the Federal government deemed abortion services as medically necessary under the Canada Health Act, yet access to abortion care remains neither equitable nor universal in the Canadian health care system.
The province of New Brunswick, for instance, does not pay for surgical abortion services outside of hospital settings. Patients who are unable to receive abortion care in hospital must cover the costs of a surgical abortion in a private clinic themselves. Access also depends on where you live as only three out of more than 20 hospitals in the province offer abortion care.
In several provinces, including Alberta, Saskatchewan, Manitoba, and Ontario, abortion providers are located in urban centres only, despite 35 to 40 per cent of the population living in rural or remote communities. Travel to another city for health care means time off work, travel costs and possible childcare costs, creating significant equity issues. If a pregnant person needs time to raise the needed funds, this delay may cause them to exceed the gestational limit to obtain abortion care in their province, thus necessitating further travel costs.
Indigenous people seeking abortion care face barriers due to systemic racism and lack of access to services in their communities.
In 2015, Health Canada approved Mifegymiso (the “abortion pill”) for use in Canada after the longest drug approval process in Canadian history. In 2017, Health Canada expanded the list of health professionals who could prescribe Mifegymiso from “physicians only” to “health professionals,” thereby expanding prescribing and dispensing privileges to pharmacists, nurse practitioners and midwives. Increasingly, primary care providers are incorporating medical abortion care into their practices, a critical aspect of improving access that should be scaled further.
How can abortion care in Canada be protected and sustained? Provincial and territorial government adherence to the Canada Health Act (and federal government accountability and enforcement) would be needed for comprehensive, universal and accessible abortion care to be achieved. Increased funding for sexual and reproductive health services, including permanent funding for Health Canada’s new Sexual and Reproductive Health Fund, could improve access to health care for Canadians, especially those who face the greatest access barriers. Further integration of sexual education, contraception and abortion care into training curricula for health care providers is also important.
Health decisions are made by patients and their health care teams, and this must be preserved. The role of government is to facilitate equitable access to health care for its citizens. The reality is that we have a lot more work to do in Canada.
By Dr. Katharine Smart, President, Canadian Medical Association; Dr. Gigi Osler, President, Federation of Medical Women of Canada; Dr. Deidre Young, President, Canadian Women in Medicine