Dr. Katharine Smart is president of the Canadian Medical Association. Dr. Gigi Osler is president of the Federation of Medical Women of Canada. Dr. Deidre Young is president of Canadian Women in Medicine.
Every individual has a fundamental right to health, personal safety and security, and control over their own bodies. This applies to any individual who can become pregnant.
To this end, in its official guidelines the World Health Organization states: “Lack of access to safe, timely, affordable and respectful abortion care poses a risk to not only the physical but also the mental and social well-being of women and girls.”
Recent events in the United States have reopened the abortion-care conversation in Canada. The circumstances in each country are vastly different; unlike the U.S., there is no “abortion law” in Canada (just as there is no “hip replacement law.”) Abortion care is health care. But the story of abortion in Canada is a complex one. And while we don’t find ourselves confronted with a Supreme Court decision as devastating as the overturning of Roe v. Wade, we can’t lose sight of our own shortcomings.
In 1969, the federal government under prime minister Pierre Trudeau made abortion legal in Canada, but only under limited circumstances. A committee of doctors was required in deciding whether the continuation of a pregnancy would, or would be likely to, endanger the pregnant person’s life or health. In its 1988 ruling in R v. Morgentaler, the Supreme Court of Canada struck down this abortion law as unconstitutional because it violated Section 7 of the relatively new Canadian Charter of Rights and Freedoms (enacted in 1982): An individual’s right to “life, liberty and security of the person.” Even still, in 1990 the federal government under prime minister Brian Mulroney 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. Canada had been just one vote away from criminalizing abortion.
While the federal government would go on to deem abortion services as medically necessary in 1995 under the Canada Health Act, 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. 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 only located in urban centres, despite 35 to 40 per cent of the population living in rural or remote communities. Across Canada, Indigenous people seeking abortion care face especially high barriers owing to systemic racism and lack of access to services in their communities. For anyone who has limited access to abortion care where they live, travelling 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 funds for these costs, this delay may cause them to exceed the gestational limit to obtain abortion care in their province, thus leading to an even greater financial burden.
In 2015, Health Canada approved Mifegymiso (the “abortion pill”) for use 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 giving prescription 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 even further.
How can abortion care in Canada be protected and sustained? Full provincial and territorial government adherence to the Canada Health Act (and federal government accountability and enforcement) is needed for comprehensive, universal and accessible abortion care to be achieved in all corners of the country. Increased funding for sexual and reproductive health services – including permanent funding for Health Canada’s new Sexual and Reproductive Health Fund – would also improve access to abortion care for Canadians, especially those who face the greatest barriers. Further integration of sexual education, contraception and abortion care into training curriculums for health care providers is also paramount.
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.
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