Ashley Fraser was just 18 the night she stole away from Prince Edward Island, bound for the nearest abortion clinic.

As a college student already raising a one-year-old boy on her own, Ms. Fraser felt she did not have the resources to care for a second child. But because PEI does not provide abortions, she had to drive to the Morgentaler clinic in Fredericton and pay out-of-pocket to end her pregnancy.

"The worst part of it all was the struggle to get there," she recalled.

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That struggle shows no sign of easing for women seeking abortions in PEI or elsewhere in the Maritimes and rural Canada. The PEI government has quashed a proposal for a twice-monthly, hospital-based abortion clinic staffed by three out-of-province doctors, a decision that drew the president of the powerful Washington-based National Abortion Federation (NAF), which represents abortion clinics and providers, to Charlottetown on Wednesday for a news conference aimed at reviving the plan. Meanwhile, the Fredericton clinic that treated Ms. Fraser and sees several dozen PEI women every year will close on July 29, citing lack of funds.

As a major international summit on maternal and child health gets under way in Toronto, and as politicians in Ottawa continue to debate the theoretical points of a sensitive issue – should Liberal Leader Justin Trudeau shut out new anti-abortion candidates? – the reality is that abortion services remain hard to find in Canada except in big cities.

A study published last year in the journal Women's Studies International Forum found 45 per cent of nearly 1,200 women surveyed at 17 freestanding abortion clinics had to travel more than an hour to terminate their pregnancies. In the case of the Fredericton Morgentaler clinic that is about to close, 73 per cent of the women surveyed travelled more than 100 kilometres.

"I would say the majority of Canadians do not have any idea how difficult abortion access can be if you are living outside or far away from an urban centre," said Christabelle Sethna, an associate professor of Women's Studies at the University of Ottawa and co-author of the study.

For Canadians who oppose abortion, ensuring it remains difficult to access is a moral imperative. PEI's main anti-abortion group is not only fighting what it calls "abortion-on-demand," it is also calling on Premier Robert Ghiz to stop funding abortion for women seeking the procedure on the mainland unless their lives are in danger.

"I am convinced that most islanders are pro-life," said Holly Pierlot, president of the PEI Right-to-Life Association. "The silent majority who come out once or twice a year [to anti-abortion events] but otherwise live their normal daily lives are counting on Ghiz to keep our island abortion-free."

Island women who want a publicly funded abortion must get a doctor's referral and travel to a hospital in Halifax, which Health PEI says 70 to 80 of the province's women do every year. Dozens more travel to Fredericton, where the procedure is not covered.

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In the past, the chief executive officer of Health PEI told the media the island could not find doctors willing to perform the controversial service. So last year, NAF's branch in Canada began working with the province's health department and two island hospitals on a plan to bring in doctors every second week.

Three doctors agreed, including Robyn MacQuarrie, an Amherst, N.S., obstetrician willing to go public with her intentions. The working group estimated the clinic would save the PEI government about $35,000 a year, NAF says.

The group's proposal to the province's medical advisory committee went nowhere.

Richard Wedge, the CEO of Health PEI, declined an interview request. But in an e-mailed statement, he made clear why the proposal was shelved. "Government has indicated that there is no desire to broaden the current abortion services; therefore, it would not make sense for Health PEI to put resources into a proposal that is not in line with government policy," he wrote.

Mr. Ghiz said in a statement that abortion is no different from other health services PEI pays for regionally. The island is small and can't offer everything, he said. "There are many competing priorities in healthcare and there is no plan to change the current policy as the status quo is currently being maintained as Islanders have access to the service."

Vicki Saporta, the president of NAF and NAF Canada, dismissed that explanation.

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"There's no excuse with them not being able to find a doctor. There's no excuse that they can't afford it. And there's no excuse that there aren't facilities here that would be willing to offer the care," she said in an interview after the news conference. "The Premier is not considering the health-care needs of women in the province."

The Supreme Court of Canada struck down Canada's federal abortion law in 1988, leaving the impression that abortions are generally available with little restriction in this country. But at least one province, New Brunswick, still enforces the Medical Services Payment Act, a provincial law passed in the early 1980s that forces women who want a publicly funded abortion to get the approval of two doctors that the procedure is "medically necessary" and then have their pregnancy terminated in a hospital by an obstetrician.

For between $700 and $850, the Morgentaler clinic in Fredericton provides abortions for women who can't satisfy those criteria or who fear approaching disapproving doctors in their small communities. The clinic has been scraping by for years, providing the equivalent of about $10,000 in services every year to women who cannot afford the full fee, according to Simone Leibovitch, manager of the clinic.

Without the clinic's founder to provide a financial safety net, the building has been put up for sale. Henry Morgentaler, the abortion doctor who brought down the country's abortion law, died a year ago Thursday. The Fredericton clinic will celebrate his life under the cloud of the pending closure.

Ms. Fraser, meanwhile, will continue her fight to make abortion available in PEI. Now a 27-year-old mother of three and fourth-year psychology student, she says it "scares the hell" out of her that the clinic that helped her nearly a decade ago is about to shut down.

"It makes me incredibly angry that in 2014 we're putting women's health at risk the way that we are. Abortion is going to happen in Fredericton. It's going to happen in PEI ... it's whether it's going to happen safely or not."