GRSJ224/disparities in abortion access in Canada

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Overview

Currently, pregnancy termination (induced abortion) is legal in all provinces within Canada at all stages of pregnancy.[1] Legalized in Canada since 1969 under the Criminal Law Amendment Act, then further decriminalized in 1988 by the Canadian Supreme Court (R. v Morgentaler), safe, and open access to abortion clinics continuously been made more available.[2] However, there still stands manny legal and social barriers to abortion, thus creating observable inequalities in abortion access among Canadian provinces. As a result, many people often have to travel to access such abortion services, which thus increases socioeconomic, spatial, and cultural disparities with regards to abortion access.[3]

Legalization and Decriminalization Processes

Proceeding 1969, all abortion methods were considered criminal in Canada.[3] Due to various efforts, Canada has become one of the only countries that does not consider obtaining an abortion as criminal behaviour.[3]

Criminal Law Amendment Act (1968-69)

The Criminal Law Amendment Act was a bill that altered the Canadian Criminal Code in many aspects, greatly influencing criminal procedures in Canada. It was passed in 1968 after previous editions of the bill, Bill C-195 and Bill C-150, were modified over the 27th and 28th parliamentary periods. This bill legalized abortion under very strict conditions, permitting women to receive the procedure only if they received three physicians' opinions that the pregnancy was a threat to her life or overall health.[4] Abortions were also only permitted to be conducted in hospitals, and women were required to report instances of abortion to a Therapeutic Abortion Committee.[4] However, as providing abortion services was optional to hospitals and physicians, social stigmas and lack of funding continued to reduce the availability of abortion procedures.

R. v. Morgentaler (1988-89)

The strict restrictions of the Criminal Law Amendment Act stimulated the emergence of illegal abortion clinics that provided abortions to those not legally qualified to receive them. Dr. Henry Morgentaler, Dr. Leslie Smoling and Dr. Robert Scott founded one of such clinics in Toronto.[5].

In 1988, Morgentaler directly challenged that the Criminal Code section pertaining to abortions in a Supreme Court trial, arguing that the regulations and restrictions imposed on people seeking abortions decreases accessibility.

On January 28, 1988, the R. v. Morgentaler trial concluded, ruling, in a majority judgement, in favour of Morgentaler. This constituted the previous section of the Criminal Code "arbitrary", "unfair" and "unconstitutional".[5] The Chief Justice of Canada, Brian Dickson, stated: "Forcing a woman, by threat of criminal sanction, to carry a foetus to term unless she meets certain criteria unrelated to her own priorities and aspirations, is a profound interference with a woman's body and thus a violation of security of the person."[5] Federal jurisdiction on the issue provided limitations of provincial power on abortion service provisions and patient eligibility. Additionally, this bill allowed private and public clinics to open in Canada.[2]

Modern Access Issues

Despite its decriminalization and legalization within Canada, many issues continue to limit abortion access for individuals today.

Provincial/Territorial Availability

Though the determination of criminality is under federal jurisdiction, healthcare provision is decided and enacted upon by each individual province and territory.[2] This leads to divergent provincial funding strategies, varying access issues emerging among each jurisdiction, and cross-provincial travel to obtain abortion services.

For example, 46 of Canada's 94 facilities that provide abortions are located in Quebec, comparable to the second highest: British Columbia and Ontario's 16.[6]

Abortion Services in Canada by Region (2015)[4]
QU BC ONT PRAIRIES (AB/SK/MB) ATLANTIC (NB/NL/NS/PE) TERRIRORIES (YT/NT/NU)
46 16 16 8 4 4

This suggests that there is a lack of abortion services in most provinces within Canada.

In 2016, the United Nations’ Committee on the Elimination of Discrimination against Women stated that they remained concerned about persisting disparities in Canadian access to legal abortion services.[7] Though some provinces have attempted to follow United Nations directives, by ensuring "that invocation of conscientious objection by physicians does not impede women’s access to legal abortion services", and making "affordable contraceptives accessible and available to all women and girls, in particular those living in poverty and/or in remote areas,"[7] many have continued to majorly fund urbanized areas. This has increased disparities in some provinces and territories, leaving many socio-economic issues to persist today, including higher rates of teenage pregnancies carried to full-term, lower rates of women pursuing secondary or post-secondary education, and higher rates of impoverishment among rural families.[3]

Further, there are legal and extra-legal obstacles that can limit access to abortion, such as differences in institutional policies, locations of abortion services, imposed gestational limits, and the presence of pro-life harassment.[3]

Rural Access

In 2016, the UN Human Rights Office of the High Commissioner determined that Canadian rural populations face a larger proportion of challenges when it comes to obtaining abortion procedures.[7]

The presence of facilities that preform abortion services vary within provinces, but are more often found in urbanized city centres due to larger populations inhabiting those areas and increased provincially allocated funding. In 2012, only 15.9% of Canadian hospitals offered abortion services, with a majority of these located in urban areas.[3]

Quebec has shown continual and steady support for abortion services through dedicating funds to establish abortion clinics in underserved areas since the 1970s.[6] This, in part, explains the high number of abortion facilities that can be found there. Quebec is also now the most equitable province in Canada, with half of these abortion-providing facilities being located in rural areas.[6] As abortion access varies so widely across provinces and territories (such as no facilities being located in Prince Edward Island) there is an abundance of provincial/territorial border crossings in order to access these services.[3] For those residing in rural settings, obtaining timely abortions can be difficult because such travel needs to be scheduled and completed. Because of this, studies have indicated that women travelling from rural areas have higher rates of late-gestational ages, signifying that medicinal abortion is largely unavailable to them.[4]

Travel and Procedure Costs

The preferred method for pregnancy termination in early gestational periods (such as within the first trimester of pregnancy) is drug-induced abortion (medical abortion) due to its non-invasive nature and lessened recuperation time. Medicinal abortion increases access to abortion services as it can be obtained through most clinics and hospitals. However, drug-induced abortion is largely unavailable in many westernized nations, and Canada was exceedingly slow to approve commonly used medications to induce abortion,[8] leading to 96% of Canadian abortions being done surgically[6] in fewer than 100 facilities across the country.[9]

The recuperation time of a surgical abortion is approximately two days, during which a woman can experience extreme cramps and vaginal bleeding. This loss of potential income spent recovering can have very uneven impacts for those who receive a lower economic income, further creating a barrier to those needing or wanting such a procedure. Furthermore, both surgical and medicinal abortions require multiple visits to the doctor, which similarly increase the personal costs of time and money that all women would have to sacrifice to obtain an abortion. However, this disproportionately impacts women from rural areas of Canada as they typically have to travel further to obtain abortions, increasing their personal costs in the form of transportation and time expenses.[10]

Social Aspects

"Gate-Keeper" Complexes

As these procedures often spark moral and ethical debates, some medical staff have come to identify as "gate-keepers"[2] who feel as though they are qualified to determine if an individual should have access to full reproductive care. There are many reports available of doctors who have deceived or coerced their patients into carrying out a full-term pregnancy by misinforming the patients about their eligibility to obtain the procedure, its effects, its availability, or the timing of it.[2] Additionally, many doctors refuse to provide these procedures. In 2012, abortions were offered by less than 300 Canadian doctors.[9]

Anti-Abortion Movement

There have been various societal movements which aim to limit abortion access in Canada. For example, the anti-abortion movement in Canada protests open access to abortions and provincial health care funding for abortions. This can create social norms and pressures that can negatively affect an individual's perceived reproductive choices, creating a hostile environment for women who may choose to obtain an abortion.

Statistics and Relevancy

  • 31% of Canadian women receive an abortion during their lifespan.[4]
  • As distance from abortion services increases, the likelihood that an individual is willing/able to get the procedure decreases.[3]
  • As distance from abortion services increases, the more likely an individual is to be younger and less privileged.[3]
  • Only 15.9% of general hospitals in Canada offer abortion services.[2]
  • 18.1% of Canadian women travel more than 100 km to access abortion.[3]
  • In 2012, abortions were offered by less than 300 Canadian doctors.[9]

References

  1. Legislative Services Branch. “Consolidated Federal Laws of Canada, Criminal Code.” Justice Laws Website, Government of Canada, 14 May 2020, laws-lois.justice.gc.ca/eng/acts/C-46/section-287-20030101.html.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Kaposy, Chris. "Improving Abortion Access in Canada." Health Care Analysis, no. 1 (03, 2010): 17-34. doi: doi.org/10.1007/s10728-008-0101-0.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Sethna, Christabelle, and Marion Doull. “Spatial Disparities and Travel to Freestanding Abortion Clinics in Canada.” Women’s Studies International Forum, vol. 38 (May 2013): 52-62. doi: doi.org/10.1016/j.wsif.2013.02.001.
  4. 4.0 4.1 4.2 4.3 4.4 Norman, Wendy V., Edith R. Gilbert, Christopher Okpaleke, Althea S. Hayden, E. Steven Lichtenberg, Maureen Paul, Katharine O'Connell White, and Heidi E. Jones. "Abortion Health Services in Canada: Results of a 2012 National Survey." Canadian Family Physician, vol. 62, no. 4, 2016, pp. e209-e217.
  5. 5.0 5.1 5.2 “R. v. Morgentaler.” Supreme Court Judgments, Supreme Court of Canada, 3 Dec. 2012, scc-csc.lexum.com/scc-csc/scc-csc/en/item/288/index.do.
  6. 6.0 6.1 6.2 Vogel, Lauren. “Abortion access grim in English Canada.” Canadian Medical Association Journal, vol. 187, no. 1 (2015): 17. doi:10.1503/cmaj.109-4947.
  7. 7.0 7.1 7.2 United Nations Human Rights Office of the High Commissioner. Committee on the Elimination of Discrimination against Women. Concluding observations on the combined eighth and ninth periodic reports of Canada. CEDAW/C/CAN/CO/8-9. Heidelberg (Germany): ETO Consortium Secretariat; 2016:13 Available: www.westcoastleaf.org/wp-content/uploads/2016/11/2016-Canada-CEDAW-Concluding-Obs.pdf.
  8. Berer, Marge. “Abortion Law and Policy Around the World: In Search of Decriminalization.” Health and Human Rights Journal, vol. 19, no. 1 (June 2017): 13-27. JSTOR, doi: https://www.jstor.org/stable/10.2307/90007912.
  9. 9.0 9.1 9.2 Norman, Wendy V., Sarah Munro, Melissa Brooks, Courtney Devane, Edith Guilbert, Regina Renner, Tamil Kendall, Judith A. Soon, Ashley Waddington, Marie-Soleil Wagner, and Sheila Dunn. "Could Implementation of Mifepristone Address Canada's Urban-Rural Abortion Access Disparity: A Mixed-Methods Implementation Study Protocol." BMJ Open, vol. 9, no. 4, 2019, pp. 1-9, doi:10.1136/bmjopen-2018-028443.
  10. Foster, Angel M., et al. “If I ever did have a daughter, I wouldn't raise her in New Brunswick:” Exploring Women's Experiences Obtaining Abortion Care Before and After Policy Reform.” Contraception, vol. 95 (2017): 477-484. doi:10.1016/j.contraception.2017.02.016.

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