Abortion advocates warn that the recent U.S. Supreme Court ruling overturning Roe v. Wade will give anti-choice groups in Canada a chance to push for limited access, making a settled issue seem controversial in a country where nearly 80 percent of people are for the choice.
A key anti-choice strategy in Canada revolves around pro-abortion legislation, an idea gaining traction amid the fallout from the US court’s decision. Canada currently has no abortion law, making it the only country in the world where the procedure is completely free of legal restrictions.
“There is 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 sounds progressive, the opposite is true: Consolidating the rules would make it easier for anti-choice lawmakers to roll back abortion rights if they ever find themselves in the majority. Last year, 81 Conservative MPs (and one independent) voted for anti-choice legislation.
And while Prime Minister Justin Trudeau has promised Canadians since Roe that his government will “always stand up for your right to choose,” advocates say that may not always be true.
That’s why the country needs to focus on strengthening people’s rights by expanding access to abortion, Gilbert said.
Since becoming legal in a Supreme Court decision in 1988, abortion in Canada has been defined 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 in Prince Edward Island (PEI), a province of 160,000 that at the time did not have a single publicly-operated abortion provider.
It took Sarah a month to secure a supplier – five hours away, in another province. The trip included travel and accommodation expenses, but the procedure itself was covered by the health authority.
“The idea that someone has to travel to take care of something that you should be able to do close to home — that’s not good,” Sarah said. Abortion care only arrived in PEI in 2017 after activists sued the provincial government for unconstitutional action.
Although there is no federal law, each province’s medical college sets its own guidelines on abortion, including gestational age limits for the use of abortion pills.
Those guidelines are shaped by the skills and training available in each province, said Martha Painter, an abortion care provider in Nova Scotia and 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 accepting it.
“More people might be doing it than they are,” Painter said. “We as educators—I’m a professor in a school of nursing—have a responsibility to teach in every nursing program how to do that care, and hardly [any school] really.”
Painter is the creator of the nation’s first undergraduate abortion course at Dalhousie University, which is open to students in medical, nursing and other health care programs with the goal of inspiring future health care workers to integrate abortion access into primary care.
The Society of Obstetricians and Gynecologists offers an online course to teach professionals how to prescribe and manage medical abortion.
But most students and health professionals aren’t required to learn how medical and surgical abortions work—and many choose not to because they’re afraid to enter the political battle over abortion.
According to Gilbert, this means that many primary care providers remain willfully uninformed.
“A lot of doctors are just not political people. They are scientists and they don’t see the politics behind some of their care,” she said.
Further complicating access is the fact that many Canadians do not know that nurse practitioners in the country are allowed to prescribe abortion pills and refer patients to surgical abortion providers – or that most patients can go directly to an abortion provider themselves .
Addressing these issues is critical to expanding existing access to medication and surgical abortion, Painter and Gilbert said.
In 2017, Natalie (also a pseudonym) discovered she was pregnant while visiting her parents in a small town in northern Alberta. After a doctor at a local clinic told her that abortion was murder, she asked to see another doctor.
This doctor told her there was no such thing as a medical abortion. “He looked me in the face and said, ‘That doesn’t exist,'” she said.
Mifegymiso — also 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 front page news,” she told him.
Still, she left empty-handed. She was able to have an abortion only after returning to her home province of New Brunswick, where only three hospitals and one clinic perform abortions. Natalie went to the clinic, where she paid $800 for a surgical abortion, an expense incurred because the province refused to pay for abortions performed outside hospitals.
New Brunswick is currently being sued to restrict abortion.
Stories like Sarah’s and Natalie’s show how abortion remains inaccessible in Canada despite its federal legal status.
“Our biggest issues really come down to the provinces and what they can do to limit access to abortion in light of what I think is now going to be a really emboldened anti-choice movement,” Gilbert said.
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