Each year on September 28, advocates around the world mobilize for access to safe and legal abortion. This year's theme is about busting abortion myths to fight stigma and discrimination.
Abortion stigma is fueled by myths. Myths that place safe, legal and accessible care and services out of reach for people worldwide and deny those who are weighing their options the evidence-based and judgment free information they need to make the choice that is right for them.
Abortion myths vary in size and scale but the biggest one in Canada? That abortion is easily accessible.
Abortion is legal in Canada and has been for over 30 years. There are no criminal laws restricting access to abortion or post-abortion care in Canada and it is a recognized essential medical procedure, required to be fully accessible and financially covered by provincial and territorial health insurance plans under the Canada Health Act. And so naturally, many of my friends and colleagues -- in Canada and abroad -- are often surprised to hear how many barriers actually exist.
The lack of access to safe abortion services is an ongoing obstacle and barrier for those who choose to terminate their pregnancies, particularly for individuals living in rural or remote areas. Only one in six hospitals provide abortion services in Canada, the majority of which, like free standing sexual health clinics, are disproportionately dispersed across Canada, and primarily located in urban centres. There are zero abortion services available in the province of P.E.I. and only four facilities that cover the one million km2 across Nunavut, the Yukon and the Northwest Territories.
The lack of services offered through clinics and hospitals in many regions of the country is compounded by other barriers related to the need to travel great distances or across provincial borders, wait times, age, financial resources, migration status and physician's invoking clauses of conscientious objection. Only Ontario and just recently Saskatchewan have adopted policies ensuring that doctors who refuse services to patients due to religious or personal beliefs have an obligation to refer to another capable doctor -- especially significant for abortion care, given the time-sensitive nature of the procedure and limited availability of service providers.
When abortion providers aren't available nearby, there are unforeseen expenses like transportation, accommodation, lost wages, childcare, eldercare and possible procedural costs (clinics are excluded from reciprocal billing agreements between provinces even though they assume a significant number of abortions in Canada). So, while abortion is technically available in Canada like any medically necessary procedure, there are a number of barriers that make access to abortion services uneven and inequitable, disproportionately affecting low income Canadians.
Some people who are seeking to terminate a pregnancy are also bombarded with anti-choice myths from services they trust. A recent University of Ottawa study found that Crisis Pregnancy Centers (with a record number in Ontario) provide medically inaccurate information, judgmental counselling and shaming that contribute to abortion stigma -- a significant barrier that is heightened for those from racialized or other marginalized communities.
So where does the government come in?
The right to health requires governments to ensure the availability, accessibility, acceptability and quality of comprehensive and integrated sexual and reproductive health information and services, including abortion, and to remove any barriers that impede access to such services. With the 2015 Federal elections in our midst, this moment represents an opportunity for our leaders to lay out their plans and commit to their promises. Some have already begun to point out the discrepancy in access across provinces and their willingness to enforce the Canada Health Act by withholding transfer payments to provinces violating the Act, but we need real action.
We need to see our federal leaders engage provincial and territorial governments in discussions to ensure that access to abortion services across Canada complies with international human rights law, especially Canada's obligations under the right to health.
We need our federal government to play a leadership role in ensuring access to medical abortion in rural and remote areas, training family physicians to provide the service and exploring appropriate task-shifting for the provision of medical abortion which would allow other health professionals to provide this service.
We need our federal government to establish a national protocol for individuals seeking later-term abortion services and coverage for travel fees incurred by those seeking to access the procedure at any stage.
We need our federal government to ensure that all people in Canada have access to this medically necessary procedure, regardless of immigration status.
And we need provinces to regulate the provision of reproductive health information and counselling to ensure that such publicly-available services do not stigmatize abortion and that they only provide accurate and evidence-based information.
In short, we need real, barrier-free access to abortion services for all people across Canada from coast-to-coast-to-coast.
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