There is renewed talk about the availability of abortion and women’s rights in Canada after a leak showed that Supreme Court justices were preparing to overturn Roe’s abortion rights against Wade in the United States.
Since abortion was decriminalized in Canada in 1988, Canada has long been considered an abortion-friendly country for women around the world.
However, the decriminalization of abortion has not ensured equality in abortion or necessarily improved access, experts say.
“As a country, we say we have a choice and we care. But in order to be in favor of the choice, we need to be able to offer the choice first, ”said Frederick Chabot, director of action promotion for home health at Action Canada for sexual health and rights.
A 2016 report by the UN Commissioner for Human Rights notes the lack of access to abortion in Canada and calls on the government to correct inequalities, and after COVID-19 devastates the country’s health systems, waiting lists for almost all services, including abortion , have become beyond sustainable.
“There is a serious problem with capacity that is not talked about,” said T. K. Pritchard, executive director of Kitchener-based SHORE, a non-profit organization that offers sexual and reproductive services to women.
“Because the clinics are overcrowded, people do not have access to a family doctor – if you are outside the city center, this means that abortion is not available to many people. And it’s definitely time to stop pretending it’s available in Canada, “he said.
Complicating long waiting periods are four major problems with access to abortion in Canada, which can be reduced to geography, knowledge, justice and immigration status.
Geography: Access to abortion depends on where you live
According to a 2006 report published by the non-profit charity Canadians for Choice, geography is directly linked to the availability of abortion and that there are barriers despite “the fact that abortion is usually a simple procedure that any obstetric hospital can be equipped to conduct. ”
People living in rural Canada are still facing obstacles to abortion, Pritchard said.
“Most abortion providers are less than 150 kilometers from the southern border, and usually only one in six hospitals offers abortion services,” he said.
“So if you’re out of these areas, it can be really hard to find an abortion provider. And this can be true for surgical abortions, as well as long-term medical abortions. Too many women have to leave and travel for care. ”
Pritchard said that when one begins to take into account the financial tensions associated with transport costs, including accommodation, childcare, adult care, lost wages and possibly even the procedure itself, abortion services become increasingly inaccessible to Canadian women. who do not. do not live in urban areas.
Shabot says this is “really an infrastructure problem”.
“There are so many maternity wards that were closed during the pandemic because there are no staff, no resources and no money, so people had to drive three hours to give birth or stop giving birth, so there is a real need to invest in infrastructure for sexual and reproductive health, “she said.
Access also depends on the province in which the women live.
In New Brunswick, the government only funds abortions at three hospitals, which means that patients who do not live in Bathurst or Moncton have to travel for the procedure.
There are 11 abortion clinics in Ontario, nine in the Toronto area and two in London and Ottawa. Abortion clinics do not exist far from the Canadian-US border, with the largest number of abortion providers located in Quebec.
Experts say the uneven distribution of clinics in the provinces across the country leads to unfair access to abortion for many Canadian women.
A woman enters the Morgentaler Clinic in Montreal on Wednesday, May 29, 2013 (CANADIAN PRESS / Ryan Remiorz)
Knowledge: Access to abortion is limited to women familiar with the services available
In Canada, abortion health services are not publicly advertised and the main mechanism for finding care is through the guidance of a primary care provider or through individual research.
According to a document on abortion laws published by the University of British Columbia in 2019, many patients are unaware that abortion services do not require a recommendation.
The document suggests that this lack of knowledge could benefit some providers who have a conscientious objection and “may delay targeting, order unnecessary tests or refuse to refer or see an abortion seeker.”
The problem is exacerbated among women who are not insured due to their immigration status or women who are part of low-income groups.
“So, like the providers themselves, advertising someone’s services … is a vital issue in abortion care,” said Shezin Suleman, midwife team leader and abortion provider at South Riverdale Municipal Health Center in Toronto.
“In general, you need to evaluate safety for yourself by explaining this to your supplier, and we decided as a team that we are comfortable with this part of it. And then the other part is like not alienating your other customers, who may have values that you might assume are conservative.
Suleman says her health center provides abortion and reproductive services to uninsured and low-income women, including additional services such as ultrasound and blood tests.
However, she was less concerned that these groups were finding their way to affordable healthcare.
“Uninsured people are incredibly resourceful people. “You survive here by talking to other people who may know and building networks that are informal, and talking to friends, family and colleagues to gain access to things,” she said.
“It’s never outdoors, especially not for these people. But they are very, very inventive. ”
Justice and immigration: Access to abortion depends on who you are
As Canada continues to be a hub for immigrants and refugees around the world, concerns about unequal access to health care for them are growing.
A University of Montreal study from 2020 concludes that 50% of immigrants “without health insurance perceive their health as negative” with “a high percentage of unmet health care needs among migrants with uncertain status.”
“One of the main problems for anyone who needs an abortion without health insurance is the cost,” said Lindsay Larios, an assistant professor at the University of Manitoba who studies immigration and reproductive policies.
“It really depends on, you know, the stage of the pregnancy the person is in, or sometimes on the location or the city. But we’re really looking at costs that range from about $ 600 to $ 2,300 to get abortion care, “she said.
Larios says a number of Canadians fall into the uninsured category.
These include undocumented migrants, immigrants with work permits who have not worked full time for six months, international students with private insurance that does not cover abortion, and refugee applicants awaiting their claims.
“So there is a real risk that everyone without permanent residence will fall into this category,” she said.
According to a study published by Action Canada on sexual health and rights in 2019, no provider in Canada offers abortion services more than 23 weeks and six days after pregnancy.
Those who are so far away from their pregnancy and seeking an abortion often travel to the United States for the procedure instead of what could be jeopardized if Rowe v. Wade is canceled.
“There is still a really great need for clinics and hospitals that offer care until later in pregnancy,” said Shabot.
“This option to go to the United States for an abortion with a delayed pregnancy is really reserved for those who can afford it. People ultimately have to pay for plane tickets, for hotels, they have to make sure they have enough food.
Traveling to the United States also means that people have to pay passport fees.
As forced sterilization of indigenous women remains a continuing problem in Canada, Shabot is also concerned about discrimination against indigenous women seeking abortion services.
“Racism in the health care system is also a barrier faced by women seeking abortion care,” she said.
“It is reasonable to assume that they may not want to go to the hospital or it is risky to go to the hospital. And so it closes access to services. ”
Prime Minister Justin Trudeau, a longtime self-proclaimed advocate of progressive values, vowed this week to protect Canadian women’s ability to have safe and legal abortions, although no clear plan has been proposed.
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