More than 13 years after the law that criminalized abortion in Canada was struck down and despite its status as a medically necessary service, access to abortion services is becoming more and more restricted across the country. An increasing number of barriers are being placed in the path of women who seek this legal medical service. Today, there is arguably no medical service that is subject to so many programmatic and economic restrictions. No other medical service in Canada is open to such levels of state interference.

Abortion is the only medical procedure in Canada that does not meet the most basic requirements of the Canada Health Act. In 1995 Diane Marleau, the Canadian Health Minister at the time, deemed that because pregnancy and childbirth affects the health and lives of women, abortion is a medically necessary procedure. Most provincial and territorial Colleges of Physicians and Surgeons have since ruled that abortion is a ‘medically necessary’ procedure. This means that abortion should be covered by Healthcare whether it is performed in a hospital or in a freestanding clinic. However, New Brunswick still refuses to pay for clinic abortions and in Prince Edward Island, there are no abortion services whatsoever. In Quebec, women still have to pay for abortions performed outside of hospitals or public clinics, despite the August 2006 Quebec Superior Court ruling that mandated that all women who had paid for an abortion in a clinic between 1999-2005 be reimbursed. Failing to have insurance that covers the cost of abortions performed in clinics can be dangerous to a woman’s health since she may be faced with anti-choice staff, long wait times and other barriers at a hospital.

Unfortunately, some provinces have placed abortion on the list of excluded services for reciprocal billing with other provinces. This means that a woman who has an abortion outside of her province of residence may need to pay fees, in many cases over $500, and is often not able to be reimbursed through her provincial health plan.

Reality Check, a research report produced by Canadians for Choice in 2006 shows that only 15.9% of all Canadian hospitals provide abortions. This percentage is down nearly 2% since the Canadian Abortion Rights Action League (CARAL) report published in 2003. That means only one in every six hospitals in Canada offers accessible abortion services. The vast majority of abortion services are only available in urban areas, withing 150 kilometres of the American border. To access these services, many women have to travel long distances from their communities at their own expense.

Women have difficulties accessing abortion information and care. Many doctors and health care workers are opposed to abortion. Often, physicians who oppose abortion are not only refusing to perform the procedure but they are also refusing to provide referrals to providing hospitals. In many cases, a doctor’s referral is needed in order for a woman to have access to an abortion in a hospital. Opposed doctors can deny women the information that they need in order to make an informed decision. Also, in communities where it is difficult to get a family doctor, women seeking abortion services are often threatened with having their name and the name of their family withdrawn from the doctor’s list of patients.

Hospital staff members are not always sensitized to the issue of abortion. Some women have stated that after an abortion at a hospital, nurses have yelled, “You must be happy, you have killed a human being” at them. Needless to say, these women have not received the level of care they are entitled to after the procedure. Hospital receptionists or switchboard operators can also serve as gatekeepers. In many cases, they will provide inaccurate information to women calling to inquire about abortion services or will refer them to counseling centers with an anti-choice bias. There are many anti-choice centers throughout Canada. Their entire purpose is to convince women not to get an abortion. They often give out false medical information. For example, a young woman revealed that when she called a “crisis pregnancy center”, she was told that almost all young pregnant women have miscarriages so she should wait to have a miscarriage before deciding to have an abortion. The young woman was asked to call back in 3 months if she did not have a miscarriage. When she called back, she was told that no abortions are performed after 20 weeks so her only option was to continue with the pregnancy. Most young women do not miscarry and being told this is one way anti-choice organizations trick women into putting off an abortion until it is too late to access one.

Hospital mergers have also contributed to the decline of abortion access. When hospitals merge in a community, Catholic institutions often become the primary health care provider. Catholic hospitals are required to follow the “Ethical and Religious Directives for Catholic Health Care Services”, adopted by the National Council of Bishops. These directives prevent Catholic hospitals from offering birth control, sterilization, infertility treatments and of course, abortions. This means that many hospitals that were formerly providing these services under a secular board, are no longer providing them.

Anti-choice crimes like shootings, death threats, and clinic bombings have reduced the availability of abortion services because many Canadian doctors feel that in order to protect their families and themselves from these terror attacks, they need to cease performing abortions. The majority of Canadian medical schools do not include instruction on abortion procedures and have instead relegated it to as elective subject at the residency level. There are almost no new doctors taking the place of retiring abortion providers.

Opponents to a woman’s right to choose are active everywhere. They organize rallies at schools and in street demonstrations and they distribute anti-abortion propaganda to the community and to doctors. The generation which has come of age since the decriminalization of abortion has been exposed to an unrelenting anti-choice public relations campaign directed at high-school and university students. Many young people take abortion for granted. They have not witnessed the struggle that took place to decriminalize this critical medical procedure and are often not aware of the horrific occurrences that took place before abortion was legal. Many are also not aware of the problems in access that Canadian women, especially in rural areas, continue to have. This can explain why many people don’t feel the need to work on improving access and to continue the struggle to maintain abortion rights so that all Canadian women can exercise their reproductive choices.