Access was promised a long time ago in this country. But the absence of a federal law has created different barriers from one province to the next.

When several American states established some of the most restrictive abortion laws since Roe v. Wade this spring, waves of Canadian millennials took to the web. They not only voiced their outrage but also noted their appreciation for Canada’s legal and accessible abortion services. Yet from these hashtags and public outcries, it became evident that many millennials have very little understanding of the patchwork that is abortion policy in Canada. For many born after 1988, the abortion debate has always been framed as an “American problem,” and they assume that Canada solved the issue decades ago. In reality, many Canadian women face the same sorts of barriers to abortion services as their American counterparts.

Since 1988, Canada has had no national abortion law to regulate this medical service at a federal level. Abortion is covered by federal criminal jurisdiction as well as by provincial health care laws, making it both politically and constitutionally sensitive. The last federal abortion law was implemented in 1969, under former justice minister Pierre Trudeau; it established therapeutic abortion committees (TACs) to approve individual procedures in hospitals. It was struck down by the Supreme Court in 1988, in the criminal case brought against Dr. Henry Morgentaler, who established freestanding clinics and advocated over several decades for more access to abortion.

Former prime minister Brian Mulroney’s government introduced Bill C-43, which would have recriminalized abortion, but it died on a tie vote in the Senate in 1991. No federal government has proposed a new law since. So abortion has remained within a policy grey zone. In the absence of any criminal prohibition, abortion services are left to each provincial government to deal with. Because both federal and provincial leaders are reluctant to reopen the politically potent abortion debate, the result is extremely inconsistent health services for Canadian women. As in the United States, fears of jurisdictional and constitutional challenges have led generations of Canadian politicians to avoid addressing the inconsistency in service and the substantial costs that women face when attempting to access a medical procedure that was promised to them decades ago.

The experiences of women in Prince Edward Island and Ontario illustrate two of the differing approaches to reproductive health care across Canada.

Prince Edward Island has long been a battleground for abortion rights. Well before the 1988 Supreme Court ruling, PEI was known for restrictive abortion laws, and today it has some of Canada’s strongest pro-life movements. Under the previous 1969 law, PEI had one TAC; it was dismantled in 1986, having approved no procedures for the previous four years. Between 1986 and 2016, PEI residents had to travel out of province to access abortions at one of two pre-approved Maritime hospitals — and at their own expense until 1996. It wasn’t until a local advocacy group filed a lawsuit that the PEI government agreed, in 2016, to establish a provincially operated clinic. Yet, as this one clinic has a capacity well under the annual demand, many women and girls are still paying out-of-pocket expenses to travel to neighbouring provinces for abortions.

Strongly held pro-life attitudes are common in Canada’s Atlantic region, as they are in American states where religious fundamentalism is influential. One Nova Scotia patient recently described the restricted options Atlantic women still face when securing a procedure. Because there are not enough facilities operating in the region, many Canadian women’s reproductive autonomy continues to be heavily politicized and severely limited.

By comparison, Ontario has been perceived as a more progressive province. Even though Ontario was one of the leaders in establishing TACs under the 1969 law, 46 percent of Ontario hospitals had no committee and 12 of the participating hospitals did not approve a single procedure from 1969 to 1988. Even after a government-commissioned task group reported in 1992 that access to abortion services was inadequate, Ontario made little effort to improve affordability and availability for all its residents.

The Ontario government of Bob Rae sought to improve access in 1990 by placing the five abortion clinics active at the time under the Independent Health Facilities Act, a move that made abortions performed there fully funded. But no later government has sought to amend the Act since, so procedures in clinics set up more recently have yet to be fully paid for. Additionally, all 13 clinics operating today are located in or near metropolitan centres, making their services largely inaccessible for northern residents. Furthermore, if these facilities have any reduction in provincial funding, they are at risk of potential absorption into the much larger Catholic hospitals. For example, the Wellesley Hospital in Toronto was forced to suspend all abortion services in 1998 after its merger with St. Michael’s Hospital, a Catholic institution; the merger effectively eradicated the possibility of 1,000 safe procedures each year.

Unlike women in PEI, Ontario women rarely encounter the abortion debate on the political stage, but they face challenges of geographic and financial inaccessibility instead. Across Canada, even with the introduction of Mifegymiso (a medical abortion pill that can be taken outside a clinical setting), the health care system has overwhelmingly failed to produce the desired results of privacy and accessibility. As with surgical abortions, Mifegymiso is still primarily obtained at urban clinics; in more rural areas, few patients can find doctors willing to prescribe it. Even though this medical alternative is available to help alleviate accessibility issues in larger provinces such as Ontario, the stigma surrounding abortions within the medical community still causes significant barriers to reproductive health services for women.

Prince Edward Island and Ontario illustrate the unique situation that Canadian abortion policy has existed within for decades. While women in one province had to fight to get just one abortion provider, residents in the other have many clinics, in theory, but geography and religious practices create challenges of accessibility. Across Canada, barriers of one kind or another persist. With very few instances of the federal government enforcing the Canada Health Act in the area of abortion, Canadian women have been left to navigate their reproductive futures alone.

Canadian and American women were given similar hopes by our Supreme Courts for legitimate rights over our reproductive choices. Decades later, American women are still having these rights taken away, while Canadian women must acknowledge that reproductive rights were never really given to us in the first place. With a clearer understanding of where we are and how we got here, Canadian women must ensure that abortion returns to the public agenda. All Canadian voters need to ask candidates in this fall’s election how they will ensure not only that reproductive rights are strengthened but that they are upheld in every region and province.

Photo: January 19, 2019 San Francisco / CA / USA – Participant to the Women’s March event holds “My body, my choice, my power” sign while marching on Market street in downtown San Francisco. Shutterstock / Sundry Photography

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