In the weeks approaching the annual ”˜March for Life’, we will hear much about the 1988 Supreme Court decision in the Morgentaler case. Essentially, the decision struck down the section of the federal Criminal Code regulating abortion. You will hear reductionist, and incorrect, interpretations of Morgentaler as having created a wild west where abortion is available on demand. You may even hear that the lack of federal law means foetuses can be terminated mere moments from birth.

This reductionism both mischaracterises the Morgentaler decision, and fails to reflect the reality of provincial access to abortion care. So let’s examine provincial abortion policies and regulations, and contrast them with their impact on abortion access on the ground.

By means of illustrating that access, let’s take Ottawa as an example. One would expect, in a generally progressive province with a positive rights view of Morgentaler, and being a fairly major urban hub, abortion care would be equitable and accessible.

The common method of medical abortion in Canada is a combination of two drugs – misoprostol and methotrexate. Both drugs are also used to treat other conditions like arthritis and cancer. To obtain a medical abortion, you need to find a doctor willing to prescribe. In Ottawa, before the Ottawa Hospital began performing medical abortions last year, there were only two doctors in the greater Ottawa area willing to dispense these drugs. One recently resigned after admitting to giving women incorrect medications for abortion.

Some locations require patients to go off site for blood work, while ultrasounds are performed onsite. The cost is covered by OHIP, but wait times can be 2 weeks. The medication itself costs $50-60. You must return to the doctor about seven days later, to check the abortion has completed. About 10% of these abortions fail to complete, and require a subsequent surgical abortion.

A medical abortion can generally only be performed before eight weeks, and in some locations, before seven weeks. Given a woman typically only discovers she is pregnant at 5-6 weeks, this leaves just three weeks to get enough information to make a decision, obtain bloodwork and an ultrasound, and find a prescribing doctor.

The chances of this happening within 21 days are slim. And this is in an urban centre with generally good access to healthcare.

In Canada, the so-called ”˜gold-standard’ of medical abortion is not available. RU-486 (or mifepristone) is widely available in 50 other countries, but its application is still waiting approval by Health Canada. Its rate of incompletions is less than half the current method.

The inter and intra provincial availability of and access to surgical abortion varies even more widely, and essentially hinges on how provinces interpret the Morgentaler decision. For example, it’s widely known that PEI does not perform abortions, but will pay for women to obtain them in two other provinces. PEI will not however, cover the cost of travel, accommodation, childcare, a companion, time off work or other expenses. These expenses can amount to thousands, making access effectively impossible for many.

In New Brunswick, much has been written about Regulation 84-20, which until this year, required abortions to be carried out registered hospitals, with two doctors certifying the abortion medically-necessary. While Premier Gallant amended the regulation this year, major barriers still exist, particularly around the lack of provincial coverage of abortions in clinics. For many women, taking time off work, covering costs of childcare, travel, accommodation and a companion, make travelling to a hospital beyond the realms of possibility.

So let’s take Ottawa again. Abortions are performed at two locations – the Ottawa Hospital, and the Morgentaler clinic. At the hospital, the process takes two days – one to prep for anesthetic and the second day for the procedure. It can be conducted under general or local anesthesia.

At the Morgentaler, you may need to negotiate protesters because Ottawa does not have bubble zone legislation. The preparation and procedure are done under local anaesthetic.

For both locations, you’ll need 1-3 days off work. If you’re not covered by OHIP – for example you’re recent immigrant, or have just moved provinces – it’ll cost you anywhere from $1,500 to $3,000.

If you need an abortion after 19 weeks and 6 days, you will need to travel to Toronto -– where you can get an abortion up to 23 weeks. There’s nowhere in Canada (that we know of) where you can get an abortion after 24 weeks. You have to travel to the United States.

When both pro-choice and pro-life advocates frame Morgentaler as meaning abortion on demand, they miss the reality of life for many women. Even in Ottawa, abortion care can be difficult to access. Equity is an even larger problem for those living in rural or remote communities, for First Nations, Inuit and Metis women, for the unemployed, street-involved, people raising three kids with two jobs, women of colour and trans people.

These costs may not seem a high barrier. But they are to many. Recent immigrants, the working poor, people without private health coverage, people with chronic health conditions who already pay out-of-pocket for other medications. I spoke to a client earlier this year who simply could not afford the $40-60 cost for Plan B from a pharmacy. She didn’t even have the bus fare to get to the Sexual Health Centre to get Plan B for a reduced cost, and the Centre was closed anyway. I suspect for want of $60 for emergency contraception, the province ended up paying for a $2,000 abortion.

With thanks to Dr Emmett MacFarlane who shared with me a draft of his paper on abortion access in Canada.