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Opinion If abortion is medically necessary, why isn’t access universal?

Is it possible, years after a consensus was reached that a woman's rights include reproductive choice, that abortion could become an election issue again? It's hard to imagine that any politician in the country would want to touch a fire that has lain dormant for so long.

Yet two anti-abortion groups, Campaign Life Coalition Youth and the Canadian Centre for Bio-Ethical Reform, are attempting to stir the embers with a "#No2Trudeau" campaign targeting what they call the "extremist position" of Liberal Leader Justin Trudeau, who has said all his MPs will be expected to vote the pro-choice party line.

I can't think that this campaign will get very far, especially when the majority of Canadians accept that reproductive decision-making lies with women, rather than with doctors or the government. But perhaps the very notion of this consensus has made us complacent about abortion access, and blind to the distance that still needs to be travelled before every woman in the country has the safe, affordable, local service that is her right.

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Take the situation in New Brunswick, for example. Until this year, the province had some of the most restrictive abortion laws in Canada. A woman required the signature of two doctors (in a province where 17,000 people are without family doctors), and it had to be performed by a specialist in a hospital in order to be covered by public insurance.

Abortion was a central issue in last year's New Brunswick election campaign, and provincial Liberal Leader Brian Gallant made his pro-choice position clear. After his party came to power, he removed some of the hurdles to access – now, a woman doesn't need two doctors' approval, and a family doctor can perform the procedure. But the government didn't go far enough. Abortion services have been extended to just one extra hospital, in Moncton, and government still refuses to pay for the procedure anywhere else.

This leaves the women using Fredericton's freestanding Clinic 554, formerly the Morgentaler Clinic (which was forced to shut down after it ran out of money last summer) out in the cold.

This situation frustrates Adrian Edgar, Clinic 554's new medical director, to no end. For Dr. Edgar, the main issues are privacy and accessibility. He believes many women in New Brunswick would prefer to have the procedure in a setting more private than a hospital, due to the lingering stigma and social ostracism that surround abortions. There can be repercussion for families, relationships, even jobs. Many women travel to Maine in order to protect their privacy.

"I don't know why the government isn't listening to women on this," he says over the phone from Fredericton. "People want to have the procedure in an anonymous way, they don't want to go the hospital. It's a small province. You go to the hospital and everyone knows, and everyone talks … and it's on your medical record."

The situation in New Brunswick just highlights how unequal abortion provisions are across the country. There are 46 clinics or hospitals providing the service in Quebec, but just one in Nova Scotia (in Halifax) and none in Prince Edward Island. That is not universal access.

Clinic 554 offers a full range of family health care, and also provides services to the gay and transgender communities. In keeping with Dr. Morgentaler's policy, it will not turn away women who can't afford to pay for an abortion, and Dr. Edgar knows that some patients, especially women who are in vulnerable positions to begin with, are already stretched to the limit.

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"I feel like it's absolutely unacceptable for people to feel that pressure," he says. "It's Canada, and this should be a publicly funded service because it's a medically necessary one. It doesn't make sense to me that we should be targeting women to pay for health care."

Dr. Edgar has been trying to meet with provincial ministers to discuss the funding situation, to no avail. If invited to a meeting, he would point out not only the unfairness of some women having to pay for a service that should be publicly insured, but also that it's actually more cost-effective to provide that service outside of hospitals. And, as he points out, the province is in the midst of a cost-cutting exercise to move some services away from hospitals. Why not this one?

"I'm trying hard to do the province's job for them," he says, "but I would like not to, very much."

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