Open this photo in gallery Minister of Health Ginette Petitpas Taylor speaks at a press conference at the National Press Theatre in Ottawa on July 22, 2019. Justin Tang/The Canadian Press

Federal Health Minister Ginette Petitpas Taylor is asking all provinces to remove abortion access barriers, saying she is concerned about policies and fees that are “out of step” with federal law.

However, her provincial counterparts in Ontario and New Brunswick – where some patients must pay to access abortion services, in a practice that abortion advocates have flagged as breaching federal health law – have swiftly rebuffed Ms. Petitpas Taylor’s request.

Ms. Petitpas Taylor made the comments in a letter to provincial health lawmakers Wednesday. The letter came after an investigation by The Globe and Mail that revealed many women across Canada are facing difficulty accessing abortion care because of costs and a lack of prescribers for the abortion pill.

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“Given the particular importance of timely access to abortion services, I am very troubled by reports that some patients may be facing unnecessary barriers or delays in receiving these medically necessary services,” Ms. Petitpas Taylor wrote. She also raised concerns in a separate letter to Ontario Health Minister Christine Elliott, which also criticized a provincial proposal to end a provincial program that offers basic out-of-country travel insurance.

Ms. Petitpas Taylor’s office said it was too early to specify what actions it would take if provinces continue to flout federal health law. In the past, the federal government has used clawbacks in health transfer payments to respond to Canada Health Act violations.

Ms. Elliott’s spokesman, Travis Kann, accused the federal minister of seeking to “play politics with such a sensitive issue.”

“She knows what she is saying is false and we will not dignify her misleading claims by engaging in this debate,” he said in a statement to the Globe.

In a statement, a spokesman for New Brunswick’s health department rejected Ms. Petitpas Taylor’s request for a policy change.

“There is no intention to change the status quo,” Bruce Macfarlane wrote.

The group representing Canada’s family doctors, however, said it shares the federal government’s concerns about access.

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“We are committed to connecting [doctors] with the education and the support they need to do this care, and to ensuring that there’s more routine access in postgraduate training,” Dr. Jeff Sisler, an executive director at the College of Family Physicians Canada, said in an interview with The Globe.

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Canada’s National Abortion Federation has said that New Brunswick and Ontario are violating a federal health law by forcing patients to pay for their abortions.

The New Brunswick government doesn’t pay for surgical abortions performed outside of hospitals, meaning patients at a private clinic in Fredericton must pay $700 to $850, according to the clinic website. The only other abortion clinics in New Brunswick are in Bathurst and Moncton. They are in hospitals and receive public funds, but are several hours from Fredericton by car. Many parts of the province have no abortion clinic nearby.

Several abortion clinics in Ontario are not funded by the government, meaning women who seek treatment there pay a fee, typically under $100, said Jill Doctoroff, director of NAF, which is the professional association of abortion providers. The cost is less than in New Brunswick because doctors can bill the province for their services. Other clinic-related costs are not covered. Fees can help make up the shortfall, Ms. Doctoroff said.

Examining nationwide access barriers, The Globe investigation revealed that the majority of abortion-pill prescriptions in Canada are written at abortion clinics, which are primarily in large urban centres. In Alberta, for instance, nearly three-quarters of prescriptions came from a single abortion clinic in Calgary. In Manitoba, 95 per cent of prescriptions came from abortion clinics in Winnipeg and Brandon.

This means many women who live outside those cities must travel hundreds of kilometres to get a prescription that any family doctor could write. While some doctors have an ethical objection, numerous clinic directors told The Globe the main reason many don’t prescribe is that they don’t want to be seen as abortion providers and that some believe the care involved with prescribing the pill is too complex.

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Mifegymiso, known as the abortion pill, came on the market in Canada in 2017 and can be prescribed to end pregnancies safely in the first nine weeks. It is 95 per cent to 98 per cent effective.

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