Refocusing the Abortion Debate

Despite legalization, women face more barriers to abortion
June 1, 2013

For the past year, Canadian national news outlets have led a distracting narrative about the status of abortion in Canada. They have focused almost solely on covering two motions in the House of Commons -- motions with the potential to reopen the abortion debate. The first motion proposed to study when a fetus in utero becomes a person, the second to have Parliament condemn sex-selective abortion.

Both motions failed to pass, but their defeats have only solidified a flawed assumption that the legal status of abortion is what determines a woman's right to abortion in Canada.

Abortion effectively became legal through decriminalization in Canada in the 1988 R. v. Morgentaler Supreme Court ruling. Until recently, Canadians have been content with leaving the issue alone and have rarely discussed abortion nationally. What is being ignored is the growing logistical challenge of obtaining an abortion in Canada.

We can no longer pretend that the legal status of abortion is the only factor impacting its availability; a more honest dialogue is essential.

Threats to abortion

Access to abortion is being impacted from the bottom up, starting with providers and hospitals. Across the country, the number of hospitals providing abortions is decreasing. Remaining hospitals and new specialized clinics are concentrated in large urban centers. Perhaps most concerning is the growing possibility there will be a large shortage of abortion providers in the future. These challenges are already affecting young, poor, and rural Canadian women. Given time, they have the potential to create barriers for all Canadian women.

Since 1992, the number of abortion providers in the United States has dropped by 25%, from 2,380 abortion providers to 1,787. No one has ever studied or surveyed Canadian abortion providers, but experts fear that there has been a similar decrease in this country. Many abortion providers in Canada are at or nearing the age of retirement. Unfortunately, new medical graduates, despite being overwhelmingly pro-choice, are far less likely to provide abortion services.

Between 1977 and 2006, the number of hospitals providing abortions in Canada fell by 21%. Currently, less than 16% of Canadian hospitals provide abortion services, and almost all of them are in or near the larger cities.

There has been a trend towards providing abortion services through specialized clinics, but these clinics are similarly located in large cities. Surveys of women using these clinics suggest they remain inaccessible for many women. Most women visiting a Toronto abortion provision clinic traveled over an hour to reach the clinic. More than 15% needed to travel between 101 and 1,000 km. For many women, traveling these distances to access abortion services is not feasible.

Abortion accessibility also varies a lot provincially. Half the provinces still require a referral from a primary care physician. To obtain an abortion in New Brunswick or P.E.I., women must first obtain a referral from two physicians stating that the abortion is "medically necessary." Despite being mandated as an essential medical service, women in the Maritimes must frequently pay out of pocket at private clinics, at an average cost of $500 - $900. The majority of clinics have a wait time of 1-4 weeks. Longer wait times make the procedure riskier, and women may have to undergo more invasive procedures due to increased gestational age.

Many clinics have rules that disproportionately impact marginalized individuals. Most common is the requirement of at least one visit to the clinic prior to the procedure. This makes access to these services especially difficult for women traveling from long distances, women who are not able to take time off work or have family responsibilities, or younger women who are living at home and do not want their families to know of their pregnancy.

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While Canadians overwhelmingly feel that the issue of abortion has been laid to rest, the reality is that it may soon become more difficult to get an abortion in Canada than it was before the Morgantaeler decision. The legality of abortion is unlikely to change in the foreseeable future, but threats to women's choice continue to exist and grow. Media and activists now need to switch their focus to address these new barriers to abortion access.

(Daniel Myran and Caitlin Carew are third-year medical students at the Schulich School of Medicine at Western University in London, Ontario.)

 Partial List of References

Canadian Abortion Rights Action League (CARAL). 2003. Protecting Abortion Rights in Canada: Special Report to Celebrate the 15th Anniversary of the Decriminalization of Abortion. Ottawa: CARAL; 2003.

Downie, J., & Nassar, C. 2007. Barriers to Access to Abortion Through a Legal Lens. Health Law Journal, 15: 143 - 174.

Eggertson, L. 2001. Abortion services in Canada: a patchwork quilt with many holes. Canadian Medical Association Journal, 164: 847 - 849.

Kaposy, C. 2010. Improving abortion access in Canada. Health Care Analysis, 18: 17 - 34.

Wayne J. M., Surinder, W. & Stanley K. H. 1997. Repeat Abortions in Canada, 1975–1993. Family Planning Perspectives, 29: 20 - 24.

Sethna, C., & Doull, M. 2007. Far from Home? A pilot study tracking women's journeys to a Canadian abortion clinic. Journal of Obstetrics and Gynaecology Canada, 29: 640 - 647.

Shaw, J. 2006. Reality Check: a close look at accessing abortion services in Canadian Hospitals. Ottawa: Canadians for Choice.

Wiebe, E.R., & Sandhu, S.J. 2008. Access to abortion: what women want from abortion services. Journal of Obstetrics and Gynecology Canada. 30: 327 - 31.