Here’s the reality of abortion access in Canada

The attention generated by the potential overturning of Roe v. Wade in the United States has many favorably comparing the situation in Canada to that of its neighbour.

But advocates say abortion access in this country remains inequitable due to stigma and a disregard for women’s health issues.

While Canada decriminalized abortion in 1988, experts told the Star on Tuesday that adequate access to routine abortions often depends on wealth and proximity to a major city.

“Just because abortion is legal doesn’t mean it’s always accessible,” says Christabelle Sethna, a professor at the Institute of Feminist and Gender Studies at the University of Ottawa.

In 2020, about 10.1 per 1,000 women ages 15 to 44 in Canada had an abortion, according to data compiled by the Abortion Rights Coalition of Canada.

Sethna said that most abortion services are within major cities and that they can be difficult to find in rural areas.

Eastern Canada, meanwhile, has sparse abortion access even in major cities, due in part to a long history of Catholicism and political decisions that have been traditionally anti-choice, she said.

In New Brunswick, there are five abortion providers and all of them are in urban areas, meaning people in rural areas have to travel to gain access, according to data compiled by Action Canada for Sexual and Health Rights.

Alberta, Manitoba, Prince Edward Island, Saskatchewan, the Northwest Territories and the Yukon also do not have a single rural clinic.

In populous provinces such as Ontario, there are only four rural clinics and British Columbia only has a single one.

“We found in earlier research that the younger a woman is, and the poorer a woman is, the further she has to travel,” Sethna said.

Clinics or hospitals may have limits on the number of weeks they will perform an abortion at, so many women have to find and pay for transportation quickly, or be faced with having to find another provider, potentially out of province, she explained.

Indigenous women also face impediments, especially if they live in remote regions and only have access to a single hospital for abortions — where they can encounter discrimination, she said.

It’s important to understand that the entrenched stigma around abortion access stems from larger ignorance and dismissal of women’s health needs — from abortion, to childbirth, to contraception access, Sethna said. For instance, having to pay out of pocket for contraception, and not having access to affordable daycare or housing, are all issues that affect women and their ability to live well, she said.

The stigma around providing abortion continues, further, to create a chilling effect. It can affect whether hospitals and health-care staff feel comfortable providing the service, says Joyce Arthur, the executive director of the Abortion Rights Coalition of Canada.

The abortion pill was introduced in Canada in 2017 and has helped many have an abortion at home, but there is some reluctance to become a provider of abortions due to fear around protests or being targeted, Arthur said.

Six provinces have some legislation around safe access to prevent harassment of abortion providers and those seeking abortions — Alberta, BC, Newfoundland and Labrador, Ontario, Quebec and Nova Scotia — but the other provinces and territories need to catch up, she said.

“It’s really important, as it gives a sense of security for doctors,” she said.

There are also issues around clinics not being fully funded by the government, which is a violation of the Canada Health Act, she said. In August, the federal health minister announced the government would be researching challenges women face in New Brunswick, including those arising from the fact the province has refused to fund Clinic 554 in Fredericton.

“Anytime there is a challenge in access or barrier or restriction, it’s always going to hit the most marginalized populations, so people of colour, Indigenous people, people who speak English as a second language and new immigrants,” she said.

The main issue often comes back to awareness, as many patients do not realize the options they have and that can be due to health-care providers being uncomfortable providing care, said Dr. Sarah Munro, an assistant professor in the department of obstetrics and gynecology at the University of British Columbia.

But primary-care providers can prescribe the abortion pill fairly discreetly, help patients gain access and can do more to make them aware, Munro said.

As patients, it’s important to remember that options are available, she said.

“In the context of what’s happening in the US, we need to remember there are no legal restrictions on abortion in Canada; it’s an essential health service and patients have a choice about when and where to access an abortion,” she said. “And there’s certainly room for improvement, there’s always room to increase access.”

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