Improving the Reproductive Health Services Process Across Canada

BACKGROUND: Decriminalized in 1988 by Supreme Court of Canada R Vs Morgentaler [1988] 1 SCR 30 and provided as a publicly-funded service, abortion remains inequitably accessible. Although receiving funding for abortion services through Canada Transfer Agreements, each province and territory distributes these services differently. Differences include the availability of qualified abortion providers, limits on the number of weeks at which abortions can be performed, and facilities where abortions occur may vary from hospitals only to private clinics or none (National Abortion Federation Canada, 2023).The use of Mifegymiso, a drug regime more commonly known as the “abortion pill”, has not increased access to either medical or surgical abortion services. This pill must be prescribed by a doctor in person, only after the doctor has completed a training course, and it must be administered within 49 days of becoming pregnant (Long, 2022).
Patients with abnormal or unintended pregnancies may choose only between abortion and birth. Women in rural areas and provinces that do not offer sufficient access to centers that offer abortions, whether clinics or hospitals, often experience a delay in accessing abortion services. Delays in obtaining an abortion increase the risk of severe maternal morbidity from complications and severe adverse reactions to surgical abortion (Schummers, 2019). Once the decision is made to have an abortion, time becomes critical for access to the procedure.
The federal government is establishing a Canada Mental Health Transfer to deliver quality and equitable mental health services (Office of the Prime Minister of Canada, 2021). Both the National Association of Women and the Law (NAWL) and Action Canada support the establishment of a similar template/model to deliver reproductive health and abortion services, feeling that this transfer system can be used to “incentivize” action to provide better services and also to penalize provinces and territories that do not meet standardized care and services (Action Canada, 2022).
An announcement by the Minister of Health and the Minister of Women and Gender Equality and Youth in November 2022 identified that the federal Budget of 2021 committed $45 million over three years (starting in 2021-22) to improve access to sexual and reproductive health care supports and provided that these services for all people in Canada, including those who identify as members of various marginalized groups in Canada and who face barriers to access such as consultations with health professionals and travel for access to abortion services. In addition, it outlined the reason for creating the Sexual and Reproductive Health Fund. Funding for these initiatives will end after 2024 (Government of Canada, 2022).