When Kandace Hagen told the nurse at her family doctor’s office she wanted to terminate her pregnancy, the woman abruptly stopped speaking to her. But she scribbled the name of the Morgentaler Clinic in Fredericton, New Brunswick, on a piece of paper before quickly leaving the room. “The entire atmosphere was very cold, very unsupportive,” Hagen, a Prince Edward Island native, recalls. “I assumed that was how women who wanted abortions were treated.”

Hagen had learned she was pregnant in July 2009 and knew immediately she couldn’t go through with it. A university student and already a mother to a young son, she felt it wasn’t the right time to have another child. But there are no abortion clinics on Prince Edward Island, the smallest of Canada’s 13 provinces and territories (population just over 145,000). And she didn’t know that her doctor could have referred her to a hospital in the province of Nova Scotia, where she could have had the procedure done for free. Instead, she made the four-hour trip to Fredericton and paid $1,000, because Morgentaler was a clinic of last resort.

But now, five years later, the Morgentaler clinic, which helped so many women like Hagen, will close its doors for good. After a 20-year funding battle with the government of New Brunswick, the clinic announced it will no longer offer its services after July 18. “It breaks my heart to have to do this. It absolutely does,” clinic manager Simone Leibovitch told reporters. “And I’m not sure what women are going to do after we leave. I really have no idea.”

The clinic has provided abortion services to more than 10,000 women since it opened in 1994, with roughly 10 percent of its clientele coming from Prince Edward Island. The unspoken policy of the clinic has been to never turn away a woman in need, and, consequently, the doctors have performed countless pro-bono abortions. Between providing free services and lacking sufficient provincial government funding, Morgentaler’s closure seemed almost inevitable. But the loss has laid bare the hurdles women in New Brunswick and Prince Edward Island face when trying to access safe, legal abortions, even with Canadian constitutional and health laws on their side.

In the 1988 R. v. Morgentaler decision—essentially Canada’s Roe v. Wade—Canada’s Supreme Court ruled that the country’s then-criminal abortion provision was unconstitutional, as it violated a woman’s right to security of the person established in the Charter of Rights and Freedoms. Under the Canada Health Act of 1984, the procedure is described as medically necessary, which means it should be covered by provincial health care, regardless of whether it is performed in a clinic or hospital.

Neither New Brunswick nor Prince Edward Island’s governments responded kindly to the 1988 ruling. The next year, New Brunswick tacked on regulation 84-20 to its Medical Services Payment Act, requiring women get written approval from two doctors that their abortion would be “medically necessary,” and stipulating that the procedure could only be performed by a gynecologist in one of two authorized New Brunswick hospitals. And Prince Edward Island remains the only Canadian province that doesn’t offer abortions within its territory.

The deal that Prince Edward Island made almost two decades ago—to only fund abortions for women whose physicians referred them to a Nova Scotia hospital—was quietly arranged but not advertised until 2011. Women like Hagen, whose physicians didn’t volunteer the information, suffered the consequences. Even with the Nova Scotia option available, over half of Prince Edward Island women who leave the province for an abortion don’t have a referral, and the Morgentaler clinic remained their only hope. Says Colleen MacQuarrie, a professor at the University of Prince Edward Island,

For the last 28 years, women in P.E.I. have been medical refugees in search of reproductive justice and safe abortion options. What an important beacon of choice for reproductive justice that clinic served. My heart aches thinking about the consequences.

She’s not wrong to be concerned. In New Brunswick, where 60 percent of women seeking abortion services don’t meet the province’s funding requirements, women will lose the single unrestricted avenue to the procedure. And Island women, MacQuarrie thinks, will lose hope.

In January, the professor published a research paper on the “trials and trails” women on the island faced when they tried to access abortion. She was alarmed to find that many had tried to self-induce, and spoke about suicidal ideation:

I’m just very deeply worried that we’re going to see more women do things in acts of desperation. I can’t imagine what life will be like here when the clinic closes if the province doesn’t have a better option.

Better options have not been forthcoming. Following the clinic’s announcement, New Brunswick pro-choice activists rallied in front of the legislature, calling on the government to revoke regulation 84-20. Conservative premier David Alward has asserted that the regulation doesn’t need changing, and the opposition Liberal party will only commit to “studying” the regulation if they form a government. But activists such as former clinic escort Kathleen Pye are optimistic that they can start making changes come September elections. “I think now there’s no doubt that it will be … an election issue, whether they want it to be or not.”

Island legislators have used the excuse for years that people have to leave the province for other medical procedures, and that abortion’s no different. But when the National Abortion Federation put forward a proposal for a twice-monthly clinic on the island, with the support of a Nova Scotia doctor who offered to come to the island to perform the procedures, it was initially approved and then abruptly shut down.

MacQuarrie says that, unlike in New Brunswick, the Morgentaler clinic’s closure is unlikely to prompt change on Prince Edward Island because of its staunch anti-choice climate. She says,

The specter of violence is there, holding people in an anti-choice pattern. So even though we have lots of people who may be choice supporters, there’s a strong element of fear about what happens when you speak out.

Both provinces are in violation of the Canada Health Act, and can be penalized by the federal government in the form of having health transfer payments withheld. But both Prime Minister Stephen Harper and health minister Rona Ambrose have refused to get involved, calling it a provincial issue. Says Niki Ashton, a member of parliament from the New Democratic Party,

Clearly a major obstacle here is a federal government that’s unwilling to move. The government of Canada should step up and take a leadership role in ensuring equitable standards across the country for women’s reproductive health.

When Hagen learned the clinic that had helped her when she was in need would close, her first emotion was frustration. “To find out that the key resource that was available to Island women is no longer available is definitely a blow to reproductive justice in the Maritimes,” she says. “It feels like we take one step forward and then we take 10 steps back.”

Meanwhile, there’s still a shred of hope that the Morgentaler Clinic could remain open. The group Reproductive Justice New Brunswick has started a crowd-funding initiative with the goal of reaching $100,000, and more than $83,000 has already been pledged. In a news conference last Friday, Kathleen Pye called it a “bandaid solution” for the access issues faced by women in New Brunswick face—specifically regulation 84-20. If the group does not meet its goal by July 31, the money raised will go toward efforts to overturn the Medical Services Payment Act.

Map courtesy Wikimedia Commons.