Judge Amy Coney Barrett’s United States Supreme Court confirmation was especially jarring for pro-choice activists, who worry Roe V. Wade—the US Supreme Court decision that made seeking an abortion a constitutionally protected right—may be overturned in the near future.
Here in Canada, abortion was restricted under the Criminal Code until 1988, when the Supreme Court ruled that existing abortion laws violated Section 7 of the Charter of Rights and Freedoms.
Now a nationally protected medical procedure, abortion is regulated by provincial governments, meaning that each province and territory approaches abortion differently.
This, combined with other factors like population density and health funding, has led to unequal abortion access across Canada. While some regions make it easy to receive care, others force patients to jump through hoops—and, in some parts of the country, getting an abortion is nearly impossible.
With so much discourse surrounding America’s legislation and abortion, how does Canada compare?
Broadly, Canadian abortion providers encounter political, financial, and regional barriers when it comes to establishing accessible care models.
Abortion care providers and reproductive rights advocates in Canada say distance is the largest limiting factor for equitable abortion services in the country. Most provinces and territories struggle to match the health care they provide to urban, southern regions in more rural or northern areas.
Joyce Arthur, the founder and executive director of Canada’s national pro-choice group, the Abortion Rights Coalition of Canada (ARCC), thinks federal and provincial governments need to prioritize rural needs if they want abortion access to increase.
“In many of the cities, [abortion] access is pretty good, sometimes excellent, like in Vancouver or Toronto,” she said. “Outside the cities, it really deteriorates rapidly, because of rural areas being more conservative, but also having no providers and people having to travel.”
Arthur has a point—Conservative governments have a consistent track record for holding back increased abortion access. In Alberta, for example, an NDP-led motion to include the right to access abortions in the Public Health Act was vehemently opposed by United Conservative Party (UCP) members.
While the Conservative party has largely upheld the legal status of abortion, individual members—including former party leader Andrew Scheer—have publicly expressed anti-choice views.
More recently, Ontario PC MPP Sam Oosterhoff spoke at a Toronto anti-choice rally alongside two other provincial elected officials.
“We have survived 50 years of abortion in Canada and we pledge to fight to make abortion unthinkable in our lifetime,” he said to the crowd.
A lack of financial investment and political will easily translate into a lack of abortion care according to Frederique Chabot, according to Frédérique Chabot, director of health promotion at Action Canada, a national reproductive rights organization.
“Some provinces have not prioritized financial and political support for equitable access to abortion care [like in] Saskatchewan, Manitoba and the Atlantic provinces,” she said. “Those are provinces where we see one, two or three points of service for entire provinces and the absence of infrastructure to make sure all people have the same access to care.”
Unfortunately, specialized reproductive care often falls to the wayside when funding is low. Provinces have long stated that federal health funding for these services is insufficient to meet residents’ needs.
For patients across Canada, there are two kinds of pregnancy termination options available. Medical abortion, where pills are taken orally, is generally available in early-stage, low-risk abortions, whereas surgical abortion, where instruments are used internally, is preferred for later-stage or more complicated cases.
Medical abortions are made possible through the prescription of Mifegymiso, a combination of two drugs that are taken in sequence. The drug has become more available in recent years as different provinces and territories have chosen to cover it through their respective health plans—although it still isn’t universally accessible.
Arthur hopes the country’s recent progress in making Mifegymiso more easily available to general practitioners will let isolated communities have more control over their health decisions.
“There’s this promise of Mifegymiso,” Arthur explained. “Theoretically, any family doctor can prescribe it, and then one can just go to a local pharmacy and pick it up. But there’s been slow uptake.”
In areas without clinics focused on reproductive health, individual doctors may prescribe the drug, but many are still reluctant to do so. According to the Globe & Mail, doctors wary of Mifegymiso cited “a professional reluctance to be seen as an abortion provider and a perception that the pill is too complex to administer.”
With these barriers in mind, here’s how each Canadian region measures up when it comes to abortion access.
Provinces in Atlantic Canada have long struggled with a lack of accessible abortion options.
For 35 years, P.E.I. had no abortion providers in the province. Those looking to terminate a pregnancy had to leave the island by ferry or plane—or, more recently, by car—to access care in other provinces, meaning only those with the time and money to travel for appointments could easily have abortions.
The Women’s Wellness Centre in Summerside’s Prince County Hospital opened its doors in late Jan. 2017, becoming P.E.I.’s only abortion provider. Before then, a strong Catholic anti-choice influence halted abortion services in the province, setting a precedent for inaction.
Now, P.E.I. seems to be catching up to other regions, and has even made it possible for people to self-refer for abortions.
In neighbouring province New Brunswick, abortion access is actually becoming less available.
As The Pigeon reported this August, Clinic 554—New Brunswick’s only independent clinic that offered abortions—ceased most operations permanently on Sept. 30, despite a community outcry in support of the Fredericton-based clinic.
In Fredericton, Clinic 554 was the only option for terminating pregnancies. Patients who had abortions at the clinic often had to pay between $700 and $850 out of pocket for the service.
In New Brunswick as a whole, out-of-hospital abortions aren’t covered through the provincial health plan. However, the province only has three hospitals with this service—two in Moncton and one in Bathurst—making it difficult for residents outside of those cities to access care.
Clinic 554 has stopped providing most services, but told The Pigeon in an email statement it will continue to offer abortions until the practice’s building sells. Those seeking abortion care may phone the clinic to learn more.
Chabot said the clinic’s closure will severely reduce abortion access in the province.
“[Clinic 554 is in] the capital of New Brunswick, and the other three locations [to access abortion] are in Moncton and Bathurst,” she said in an interview with The Pigeon. “[This is] leaving huge swaths of the province unable to access abortion in their own communities.”
Letter 12.— Letters4NB (@Letters4NB) October 26, 2020
I gave myself an abortion at home because I live in New Brunswick.
Why does our Premier, @premierbhiggs hate New Brunswickers? When will the federal government intervene? @PattyHajdu @JustinTrudeau #saveclinic554 #axe8420 pic.twitter.com/BbR2zggeOd
In Dec. 2019, federal Health Minister Patty Hajdu stated that because New Brunswick legislation creates a distinction between clinical and hospital abortions, the provincial government—under Conservative party leader Blaine Higgs—is in violation of the Health Act.
The federal government has yet to intervene formally in Clinic 554’s closure but has spoken out on social media in support of “a woman’s right to choose.”
Despite this federal pressure, New Brunswick’s provincial government continues to allege it is following the Canada Health Act because abortion is available in hospitals.
We’ve been clear: all women have a right to access reproductive services, and we will use all options available to support a woman's right to choose. https://t.co/qcPaVnMBlo— Patty Hajdu (@PattyHajdu) October 1, 2020
Meanwhile, in both Newfoundland and Labrador and Nova Scotia, abortion access is hit or miss.
There are four places to get a surgical abortion in Nova Scotia—in Halifax, Truro, Kentville, and Bridgewater—but people living in cities like Cape Breton must still travel distances for care.
In St. John’s, NL, the Athena Health Clinic is the province’s only clinic providing surgical abortions, and is responsible for 90 per cent of abortions performed within the area.
Despite slow progress, Atlantic Canada has recently taken steps forward to make abortion more available; the abortion pill Mifegymiso is covered by all provincial health plans and is free in each province, ensuring that early-term pregnancies can be more easily terminated.
With the region’s high population density, it’s no surprise that in southern Ontario and Quebec, it’s easier to schedule an abortion. Both governments cover surgical and medical abortions, making procedures free for patients. Northern parts of both provinces, however, continue to struggle with abortion access.
Quebec has some of the most comprehensive abortion care in Canada. It has the greatest number of locations providing abortions of any Canadian province or territory with a total of 44 surgical abortion providers.
“Quebec is the one province that has integrated abortion into their primary care network,” Chabot explained. “Over half of all abortion clinics [in Canada] are in Quebec.”
The province has even introduced provincial legislation ensuring residents have equal access to abortion care province-wide, mandating a certain number of abortion providers in different regions.
According to Action Canada’s website, “each region in the province must have at least two [abortion providers] and most regions meet or exceed that standard with access points in several hospitals, women’s health centres, and community health centres.”
The northernmost abortion provider in Ontario—Umbrella Medical Clinic—is located in Thunder Bay. The clinic provides medical abortions to patients up to nine weeks into a pregnancy, and can refer them for surgical abortions at the local hospital up to 12 weeks.
Past Thunder Bay, pregnancy termination is still available with a Mifegymiso prescription, but those needing surgical abortions have to travel up to thousands of kilometres away for care.
In an interview with The Pigeon, Kingston, Ont. resident Cassidy—who asked to be referred to by her first name—remembered how lucky she felt to live near a hospital with established abortion care.
When Cassidy experienced an unwanted pregnancy and wanted to schedule an abortion, all it took was a phone call.
“I just called the women’s clinic at [the Kingston General Hospital]. They booked me in for an ultrasound to see how far along I was, and that was about a two-week wait,” she explained. “Then the day that [my ultrasound] happened, I was able to book the procedure for two weeks after.”
Cassidy goes to Queen’s University, with Kingston General Hospital (KGH) on campus, meaning her appointments were within minutes of her lecture halls and club buildings.
“I felt ridiculously lucky,” she remembered. “Being at Queen’s, knowing that if I ever had to [have an abortion], I felt very comfortable in knowing that it was right at my fingertips.”
When asked how her perception of accessing abortion services might change if she lived in a rural area, Cassidy said it would be much harder for her to terminate a pregnancy without local care.
“I don’t drive, and I’m not close to my family either,” she said. “Having to do that by myself would have been both terrifying and a huge burden on myself financially.”
“I can’t imagine having to do that much work to get a simple medical procedure by myself while being as sick as I was [while pregnant].”
Manitoba, Saskatchewan, and Alberta have had similar difficulties making abortion more widely available for residents.
With only one location in Brandon and two in Winnipeg providing surgical abortion services, it’s much more difficult to access abortion across Manitoba than in neighbouring Ontario.
Someone needing a surgical abortion may have to drive for hours to reach one of the three hospitals that offer abortion procedures. Additionally, while the abortion pill Mifegymiso has been universally covered in the province since 2019, local advocates say isolated communities still struggle to access the medication.
Saskatchewan has encountered similar issues. Saskatoon and Regina are the only places where surgical abortions are performed, leaving northern communities in the lurch. Access has been worsened by recent provincial transportation cuts, making it harder for residents to travel south for medical care.
Over in Alberta, there are only two cities where surgical abortions can be accessed; Calgary has two locations, while Edmonton has one. Like other prairie provinces, it is often up to rural patients to travel south for reproductive health care.
Alberta advocates and physicians alike have expressed their worries about a recent uptick in provincial discussions about conscientious objection, a health-care provider’s ability to refrain from providing certain medical procedures—including abortion—on the basis of moral convictions.
The Canadian Medical Association upholds a practitioner’s right to conscientious objection, provided they “meet [their] duty of non-abandonment to the patient by always acknowledging and responding to the patient’s medical concerns and requests whatever [their] moral commitments may be.”
More than 200 citizens are gathered at #ableg in protest of #bill207 on consciences rights, which opponent say could limit access to abortion, reproductive health care, assisted dying and trans affirming care in Alberta #abpoli pic.twitter.com/DgX5fo8h9q— Moira Wyton (@moirawyton) November 16, 2019
In Nov. 2019, a proposed bill in the Alberta legislature was voted down that sought to grant protection to health-care providers who morally object to procedures like “abortion, contraception, medical assistance in dying (MAID) and gender-affirming care.”
The proposed legislation would also give health-care providers the right not to refer patients to other professionals who would be willing to help them.
Some Alberta abortion providers told the Globe & Mail that this kind of legislation could “make it even harder on patients” to seek abortions in the province.
On the West coast, population density and regional differences continue to have a stark impact on the accessibility of abortion care.
Most abortion services in B.C. are concentrated in Vancouver, the province’s largest city. It has three established independent abortion clinics and an in-hospital clinic at the B.C. Women’s Hospital, making it the most accessible area for terminations in the province.
Kelowna, Nelson, Cranbrook, and Terrace—B.C.’s only northern site for abortion—also offer termination options, allowing people across the southern mainland to find abortion services.
On Vancouver Island, there’s a single abortion clinic and a handful of hospitals offering reproductive care. Most of them are located on the south end of the island, making hours-long travel necessary for rural islanders.
The Vancouver Island Women’s Clinic is believed to be the only one to have quit providing surgical abortions because of the demand for the abortion pill. https://t.co/ljWs5nGzOw pic.twitter.com/d0WdB7LI2P— CdnPhysiciansforLife (@CdnLifeDocs) April 1, 2019
In 2019, Vancouver Island’s standalone clinic stopped providing surgical abortions and started only prescribing Mifegymiso because an overwhelming percentage of its patients were seeking medical abortions.
Like Ontario and the Prairies, providing comprehensive abortion care in northern and isolated communities has proven difficult for the B.C. government. Transportation issues have been repeatedly flagged by northern health care providers as a significant barrier to abortion access.
Northern Options for Women, run out of the Stanton Territorial Hospital in Yellowknife, N.W.T., is a program providing abortion services to people in the Northwest Territories and the Kitikmeot region of Nunavut. It’s Canada’s northernmost abortion clinic, but surgical abortions are also offered at hospitals in each northern territory’s capital city.
In Whitehorse, Yellowknife, or Iqaluit, getting an abortion is relatively straightforward as a result of hospital access. Mifegymiso is also available and covered by health care plans in N.W.T. and Yukon. In Nunavut, the pill isn’t covered for all residents yet, making it the last Canadian region without full access.
When northern isolated communities come into play, however, the disparities in care become apparent. With less demand and funding in rural areas, travelling to urban centres for an abortion is usually the only option.
Travel isn’t as simple in some parts of northern Canada as it is in the south. Depending on where someone resides, getting to a capital city usually means taking a plane arranged through medical travel benefits. Plane travel is often covered through northern territories’ health plans, but time away from family and work still takes a toll on residents.
While Canadians’ right to abortion care can’t be overturned any time soon, it’s clear the country still has barriers to remove before abortion access is truly made equal across the country.
Although health care is a provincial jurisdiction, Chabot wishes the federal government would take more of a supporting role in encouraging standardized abortion access.
“It’s not okay that abortion depends on which province you live in, or which part of the province you live in,” she said. “If you’re in a rural community, you do not get to see your right to that care realized in the same way [as] someone who’s in an urban centre.”
While many Canadians have expressed their dismay at seeing Amy Coney Barrett’s appointment, perhaps they should also turn an eye to the lapses in care happening at home.
Correction: This article has been updated to reflect that Clinic 554 in Fredericton, NB is still providing abortions until the practice is sold. The article originally stated that all services at the clinic ended in September. The Pigeon regrets the error.