There’s a renewed conversation about abortion accessibility and women’s rights in Canada after a leaked draft showed Supreme Court justices set to strike down abortion rights Roe v. Wade in the United States.
Since abortion was decriminalized in Canada in 1988, Canada has long been considered an abortion-friendly country for women around the world.
However, decriminalizing abortion has not guaranteed abortion equity or necessarily improved access, experts say.
“As a country, we say we are pro-choice and we care. But to be pro-choice, we need to be able to offer choice in the first place,” says Frédérique Chabot, Director of National Health Promotion at Action Canada for Sexual Health and Rights.
A 2016 report by the United Nations Commissioner for Human Rights noted a lack of access to abortion in Canada and called on the government to address inequalities, and since COVID-19 ravaged health systems country’s health, waiting lists for almost all services, including abortions, have become untenable. .
“There’s a serious capacity issue that’s not being talked about,” says TK Pritchard, executive director of Kitchener’s SHORE Center, a nonprofit that provides sexual and reproductive services to women.
“With clinics being overwhelmed, people not having access to a family doctor…if you’re outside of an urban center, that means abortion isn’t accessible to a lot of people. And it’s definitely time we stopped pretending it’s accessible in Canada,” he said.
Long waiting times add up to the four main abortion access issues in Canada that can be boiled down to geography, knowledge, equity and immigration status.
Geography: Access to abortion depends on where you live
According to a 2006 report by the non-profit charity Canadians for Choice, geography is directly linked to abortion accessibility and that barriers exist despite “the fact that abortion is generally a simple procedure that any hospital with an obstetrics department can be equipped”. carry out.”
People living in rural parts of Canada continue to face barriers to getting abortions, says Pritchard.
“Most abortion providers are located within 150 kilometers of the southern border and typically only one in six hospitals offer abortion services,” he said.
“So if you are outside of these areas it can be very difficult to find an abortion provider. And this may be true for surgical abortions as well as long-term medical abortions. Too many women have to leave and travel for treatment.
Pritchard said that when you start to factor in the financial constraints of transportation costs, including accommodation, childcare, elder care, lost wages and maybe even procedure itself, abortion services are becoming increasingly out of reach for Canadian women who do not have them. I don’t live in urban areas.
Chabot says it’s “really an infrastructure issue.”
“There are so many maternities that have been closed during the pandemic because there are no staff, no resources and no money, so people had to drive three hours to deliver or terminate a delivery and so there is a real need to invest in sexual and reproductive health infrastructure,” she said.
Access also depends on the province in which the women live.
In New Brunswick, the government only funds abortions at three hospitals, which means patients who don’t live in Bathurst or Moncton have to travel for the procedure.
There are 11 abortion clinics in Ontario, nine of which are located in the Greater Toronto Area and the other two in London and Ottawa. Abortion clinics do not exist far from the Canada-US border, with the largest number of abortion providers located in the province of Quebec.
Experts argue that the uneven distribution of clinics across provinces across the country results in inequitable access to abortion for many Canadian women.
A woman walks into the Morgentaler Clinic in Montreal, Wednesday, May 29, 2013. (THE CANADIAN PRESS/Ryan Remiorz)
Knowledge: Access to abortion is limited to women who are aware of the services available
In Canada, abortion-related health services are not publicly advertised and the primary mechanism for finding care is referral from a primary care provider or individual research.
According to an article on abortion law published by the University of British Columbia in 2019, many patients are still unaware that abortion services do not require a referral.
The paper suggests that this lack of knowledge can be taken advantage of by some providers who have a conscientious objection and “may delay referral, order unnecessary testing, or refuse to refer or see a person seeking an abortion.”
The problem is deeper among women who are uninsured because of their immigration status, or women who are in low-income groups.
“So as providers ourselves, advertising one’s services…is an ethereal issue in abortion care,” said Shezeen Suleman, midwifery team leader and abortion provider at the South Riverdale Community Health Center in Toronto.
“Usually you have to assess security on your own, explaining that to your supplier and we decided as a team that we felt comfortable with that part. And then the other part is like how not to alienate your other customers who themselves might have values, which you can assume to be conservative.
Suleman says her health center provides abortion and reproductive services to uninsured women and women from low-income backgrounds, including additional services like ultrasounds and blood tests.
However, she was less concerned about these groups finding their way to accessible health care.
“Uninsured people are incredibly resourceful people. You survive here by talking to other people who might know and you build informal networks, and you talk to your friends and family and colleagues and that’s how you access things,” she said. declared.
“It’s never out in the open, especially not for these people. But they are very, very ingenious.
Equity and Immigration: Access to Abortion Depends on Who You Are
As Canada continues to be a hub for immigrants and refugees from around the world, there are growing concerns about inequitable access to health care for them.
A 2020 University of Montreal study concluded that 50% of immigrants “without health insurance perceived their health as negative”, with a “high rate of unmet health care needs among migrants with precarious status”.
“One of the biggest issues for anyone needing an abortion without medical insurance is the cost,” said Lindsay Larios, an assistant professor at the University of Manitoba who studies immigration and reproductive policy.
“It really depends on, you know, what stage of pregnancy the person is in, or sometimes the location or the city. But we’re really looking at costs ranging from $600 to $2,300 to get abortion care” , she said.
Larios says a whole slew of residents in Canada fall into the uninsured category.
This includes undocumented migrants, immigrants with work permits who have not worked full-time for six months, international students with private insurance that does not cover abortions, and asylum seekers awaiting their requests.
“There is therefore a real risk for anyone without permanent residence to fall into this category,” she said.
According to a study published by Action Canada for Sexual Health and Rights in 2019, no providers in Canada offer abortion services after 23 weeks and six days of pregnancy.
Those who are this far into their pregnancies and seek an abortion often travel to the United States for the procedure, which could be at risk if Roe v. Wade was canceled.
“There is still a great need for clinics and hospitals that provide care until later in pregnancy,” Chabot said.
“This option of going to the United States for a delayed pregnancy abortion is really only for those who can afford it. People end up having to pay for plane tickets, hotels, they have to make sure they have enough food.
Traveling to the United States also means people have to pay passport fees.
While forced sterilization of Indigenous women remains a persistent problem in Canada, Chabot is also concerned about discrimination against Indigenous women who seek abortion services.
“Racism in the healthcare system is also a barrier that women seeking abortion care face,” she said.
“It is reasonable to assume that they may not want to go to hospital or that it is risky for them to go to hospital. And so this also closes access to services.
Prime Minister Justin Trudeau, a long-time self-proclaimed advocate of progressive values, this week vowed to protect the ability of Canadian women to obtain safe and legal abortions, though no clear plan has been offered.