Abortion advocates are warning that the recent US supreme court ruling overturning Roe v Wade will empower anti-choice groups in Canada to push for restricted access, making a settled matter appear controversial in a country where nearly 80% of people are pro-choice.
A key anti-choice strategy in Canada revolves around enacting abortion legislation – an idea that has been gaining traction amid the fallout of the US court ruling. There is currently no abortion law in Canada, making it the only country in the world where the procedure is totally free of legal restrictions.
“There’s a lot of talk right now about whether or not the Canadian government should pass a proactive law protecting our right to abortion – a pre-emptive strike, if you will. That would be a big mistake,” said Daphne Gilbert, a law professor at the University of Ottawa.
Gilbert and other abortion advocates say that while enshrining abortion rights may sound progressive, the opposite is true: consolidating rules would make it easier for anti-choice legislators to retract abortion rights if ever they found themselves in a majority. Last year, 81 Conservative MPs (and one independent) voted for anti-choice legislation.
And while the prime minister, Justin Trudeau, promised Canadians after Roe that his government would “always stand up for your right to choose”, advocates argue that may not always be true.
That’s why the country should focus on entrenching people’s rights by expanding abortion access, said Gilbert.
Since it became legal in a 1988 supreme court ruling, abortion in Canada has been designated as a medical service like any other, on par with procedures like X-rays and blood tests. But that doesn’t make it easy to get – especially in remote, religious or conservative parts of the country.
In 2014, Sarah (who asked to remain anonymous) sought an abortion on Prince Edward Island (PEI) – a province of 160,000 that, at the time, did not have a single publicly operating abortion provider.
It took Sarah a month to finally secure a provider – five hours away, in another province. The trip incurred travel and lodging costs, but the procedure itself was covered by the healthcare authority.
“The idea that anybody has to travel to take care of something that you should be able to get done close to home – it’s not fine,” said Sarah. Abortion care only arrived on PEI in 2017, after activists sued the provincial government for acting unconstitutionally.
Although there is no federal law, each province’s medical college sets its own guidelines on abortion, including gestational age limits for use of the abortion pill.
Those guidelines are shaped by the skills and training available in each province, said Martha Paynter, an abortion care provider in Nova Scotia and the author of the new book Abortion to Abolition: Reproductive Health and Justice in Canada.
But there is also a political dimension to providing abortion care that prevents some doctors and nurse practitioners from taking it up.
“More people could be doing it than are doing it,” said Paynter. “We as educators – I’m a prof at a nursing school – have the responsibility to teach in every medical and nursing program how to do this care, and hardly [any school] does it.”
Paynter is the creator of the country’s first university abortion course, at Dalhousie University, which is open to students across medical, nursing and other health programs with the purpose of inspiring future health workers to integrate abortion access into primary care.
The Society of Obstetricians and Gynaecologists offers an online course to teach professionals how to prescribe and manage medical abortion.
But most students and healthcare professionals are not required to learn about how medication and surgical abortion work – and many choose to abstain because they are afraid to enter the political fray around abortion.
According to Gilbert, that means a lot of primary care providers stay wilfully uninformed.
“A lot of doctors just aren’t political people. They’re scientists, and they don’t see the politics behind some of their care,” she said.
Further complicating access is the fact that many Canadians are unaware that nurse practitioners in the country are permitted to prescribe the abortion pill and refer patients to surgical abortion providers – or that most patients can self-refer directly to an abortion provider.
Addressing these issues is critical to expanding existing access to medication and surgical abortion, said Paynter and Gilbert.
In 2017, Natalie (also a pseudonym) discovered she was pregnant while visiting her parents in a small town in northern Alberta. After one doctor at a local walk-in clinic told her abortion was murder, she demanded an appointment with a different doctor.
That doctor told her that there was no such thing as medical abortion. “He looked me in the face and said, ‘That doesn’t exist,’” she said.
Mifegymiso – otherwise known as the abortion pill – was approved by Health Canada in 2015, but had only recently hit the market when Natalie found herself at the doctor’s office.
“I know it exists. It’s literally the front page of the news,” she told him.
Still, she went away empty-handed. She was only able to get an abortion after returning to her home province of New Brunswick, where only three hospitals and one clinic provide abortion. Natalie went to the clinic, where she paid $800 for a surgical abortion – a cost incurred because the province refuses to pay for abortions performed outside of hospitals.
New Brunswick is currently being sued for its restriction of abortion.
Stories like those of Sarah and Natalie show how abortion remains inaccessible in Canada, despite its federal legal standing.
“Our greatest problems really come in terms of provinces and what they may do to restrict access to abortion in light of what I think is now going to be a really emboldened anti-choice movement,” said Gilbert.