Four months after the closing of Fredericton's Morgentaler clinic spurred a national debate about abortion access in rural Canada, New Brunswick's Premier has announced his government is doing away with most of a regulation that made his province one of the most difficult places in the country to end a pregnancy.
Beginning on Jan. 1, New Brunswick women will no longer need two doctors to confirm an abortion is "medically necessary" before they can receive public funding to have it. The changes also mean public health insurance will cover abortions performed by family doctors – not just specialists.
"Personally, I'm pro-choice," Premier Brian Gallant told The Globe and Mail on Wednesday. "As a Premier and when I was leader of the opposition and made this commitment, it wasn't difficult to make this choice because I know it's the right one. We don't have the flexibility to start picking which rights we want to respect."
The main pro-choice group that pressed Mr. Gallant's Liberal government to scrap regulation 84-20 of the Medical Services Payment Act praised the changes and thanked the Premier, but said the amendments do not go far enough to ensure swift, widespread access.
"It falls short in a couple of places," said Jessi Taylor, a spokeswoman for Reproductive Justice NB. "The most obvious is in that it still restricts abortions to hospitals. That's a huge barrier because, first of all, hospitals can make their own policies that can restrict abortions. It's also problematic because there's still no self-referral in a hospital."
Regulation 84-20 has existed in its current form since 1989, when premier Frank McKenna's Liberal government adopted it after the Supreme Court of Canada struck down the federal abortion law in 1988.
In most of the 25 years since, the Morgentaler clinic in Fredericton provided abortions to women who paid.
The clinic performed 612 abortions in 2012, the last year for which statistics are available, according to the Canadian Institute for Health Information. By contrast, 483 abortions were performed in New Brunswick hospitals in 2013-2014 at a cost to the public system of between $500,000 and $600,000 annually, a spokesman for the Premier said.
Simone Leibovitch, the former manager of the Morgentaler clinic, said last spring the clinic could no longer afford to spend about $10,000 a year helping women who could not pay the fees – nor could it continue to tolerate New Brunswick's policy on abortion. It closed at the end of July.
"When the clinic closed," Mr. Gallant said, "there's no doubt that forced the conversation as a province."
Although New Brunswick's regulations were the most restrictive in the country, other provinces have not done enough to make abortion widely available, especially in rural regions, said Wendy Norman, a family physician and professor in the department of family practice at the University of British Columbia.
She co-authored a study that found that, in 2012, nearly half of all the hospitals, clinics and doctor's offices performing abortions in Canada – 46 of 94 in total – were in Quebec, where the government has made a concerted effort to expand access outside large cities.
"In jurisdictions where the health policy makers haven't made this kind of health policy provision, we aren't seeing the same kind of primary-care or community-based or rural access for women," said Dr. Norman, who presented her initial findings from the 2012 survey at the Family Medicine Forum in Quebec City this month.
British Columbia and Ontario both had 16 abortion facilities in 2012, while there were eight in the three Prairie provinces, four in the territories and four in the Maritimes, including the now-closed Morgentaler clinic in Fredericton. Prince Edward Island has no abortion services.