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While abortion can be an election issue, access is rarely discussed. | photo: Jonathan Hayward / CP Images

While abortion can be an election issue, access is rarely discussed. | photo: Jonathan Hayward / CP Images


part one of choice in Canada access to abortions

by Sarah Ghabrial | September 16, 2008

Abortion remains controversial. The right to have one continues to be questioned. And politicians still create bills that pro-choice supporters argue will threaten that right. During the last sitting of Parliament, there were two such private member’s bills – cheered by anti-choice activists, and condemned by pro-choice activists – C-484 and C-537. Claims were also made that neither bill had anything to do with abortion, really.

With the federal election called for October 14, these bills are no longer in play. This doesn’t mean we won’t see similar ones come up after Parliament begins again.

This year marks the 20th anniversary of the Morgentaler decision, which decriminalized abortion in Canada. The recent protest that followed Dr. Morgentaler’s naming to the Order of Canada demonstrates that there continues to be hostility to reproductive choice.

But beyond these recent bills, beyond the Order of Canada – beyond all the rhetoric for and against choice – many women still face huge barriers when it comes to getting safe abortion procedures in this country. Barriers some activists and providers describe as unconstitutional and vastly disparate from other less “controversial” forms of health-care provision.

These barriers may be geographic, economic, social, or any combination of the three. They severely restrict the reproductive choices of thousands of women every year. From one region to the next, funding and availability can be tenuous or non-existent. The Canada Health Act requires that reproductive health services be universal, reciprocal, safe, legal, and covered by Medicare. While abortions in hospitals are funded by the federal government, abortion clinics are under provincial jurisdiction, to be funded on pain of penalties. Still, some provinces choose not to, and often face little intervention from the federal level.

Contrary to the Canada Health Act:

  • New Brunswick will only cover the cost of an abortion if a woman has received approval from two doctors and if the procedure is performed in a hospital (but not in a clinic); procedures by family physicians are not covered.
  • There is no access to abortion in Prince Edward Island, no funded clinics in Manitoba, and no clinics at all in Saskatchewan.
  • Similarly, women in northern Canada, which is made up mainly of Aboriginal communities, must often travel hundreds of kilometers to the nearest clinic. Whether abortion is funded or not, this distance often means women cannot go. Statistically, Aboriginal women experience significantly higher rates of sexual assault and domestic abuse than other populations.
  • Access is limited in areas where procedures are only covered at hospitals, because fewer than one in five hospitals across the country offer abortions, most require a doctor’s referral (which can be difficult to obtain in more conservative areas), and hospitals generally offer little or no counseling. Moreover, many hospitals have long waiting lists – up to six weeks – but will not perform abortions after the first trimester.
chilly climate in the Maritimes

Peggy Cooke – volunteer coordinator at the Morgentaler Clinic in New Brunswick and the blogger behind Anti-choice is Anti-Awesome – says she sees several women per week make the long and expensive journey from P.E.I. Even upon reaching the relative hospitality of New Brunswick, they must still pay the entire cost of the procedure.

“It’s really scary that so many women are inhibited by the cost,” she says. “If these women can’t afford abortions they definitely cannot afford to have children.” Cooke believes that the first step towards relieving these problems is more public awareness and a conscious effort to remove the stigma surrounding abortion. “There is no ‘kind’ of woman who gets an abortion – all kinds of women find themselves in this situation. Most are mothers who are thinking about their kids and how they can best take care of them.”

rebirth: tradition and self-determination in northern Canada

A service-provider in one of the northern territories (who asked not to be named, for safety concerns) says that the main barrier for women in these communities is less financial – since all expenses related to the procedure are covered – and has more to do with education and “negotiating safe sex.”

These are predominantly Inuit populations, where the decimation of local culture and low secondary-school graduation rates lie at the root of many unwanted pregnancies.

Much of the problem stems from the government-enforced medicalization of birth – and birth control. Since the 1960s, and increasingly through the 1980s, the ancient midwifery traditions of Inuit peoples have been eroded by government initiatives to concentrate reproductive “expertise” within state-run hospitals – robbing midwives of their previously revered roles both as givers of life and assistants in the termination of pregnancies.

This builds a reliance on outside sources, says Jessica Yee, a reproductive-justice activist who works tirelessly in Native communities across North America. “Ninety per cent of service providers are white, and have not been trained in culturally appropriate care. So, for instance, many women have not been allowed to perform spiritual rituals [surrounding what some consider the death of a family-member].” Of late, Yee laments, a backlash to reproductive rights has been stirring within Native communities as well, whether motivated by religious conviction or a fear of depopulation.

This does not only affect women in Arctic regions, but throughout Canada’s north. In Ontario, for example, there are no facilities above the Trans-Canada Highway, leaving hundreds of thousands of people stranded without health care. “We are in relatively good shape here,” the anonymous source remarks, “In Ontario, they must pay for the flight south themselves.” That can cost around $3,000.

racism and cultural barriers deter women of colour

By contrast, the areas south of the Trans-Canada Highway – especially urban centres – appear to be almost teeming with facilities, though this does not always guarantee free and easy access to care.

Notisha Massaquoi is the Executive Director of Women’s Health in Women’s Hands (WHIWH), based in Toronto, and a professor of Social Work at Ryerson University. WHIWH is dedicated to the reproductive health of women of colour and immigrant women, works to raise awareness about reproductive health options in specific communities, adapts counseling models to be more culturally appropriate, offers interpretation services, and hosts client’s rights workshops, to name just a few of their programmes.

“There is an assumption,” says Massaquoi, “that, as long as we’ve got the legislation, the work is done. Newly arrived women face barriers when it comes to language, comfort, and confidentiality. Many are not aware of their rights here; they don’t know where to even begin looking or who to turn to.” Once again, racism in the health-care system prevents many women from accessing the care they need. For example, while Black women tend to be over-sexualized by health-care providers, Asian women are desexualized – both extremes having severe consequences. To compound these obstacles, women at various stages of the immigration process are not covered by federal or provincial health-care systems, and can only turn to organizations like WHIWH for relief.

“Without coverage,” says Massaquoi, “the costs of abortion are enormous, but especially for racialized women, who are the most economically and socially marginalized group.”