By Jasmine Law
In 2016, the United Nations Committee on the Elimination of Discrimination against Women released a report stating that Canada needed to improve equitable access to abortion, as the disparities in access between provinces and territories was too wide.[1] The Committee identified timely abortion services, especially for those in rural areas, as a main concern.
Despite it being decades since the Supreme Court’s decision in R v Morgentaler, access to abortion remains varied and challenging among urban and rural lines. The experience of obtaining an abortion depends greatly on where one resides. In particular, residents of New Brunswick face logistical, financial and emotional burdens in obtaining abortion care due to restrictive provincial regulations. NB’s unnecessary policy barriers result in significant health inequities for women in the province, due to the cost of travel and consequent wait times (which impact disclosure and gestational age at time of abortion, which in turn affects the cost of procedure).[2]
A study done in 2017 (pre-Mifegymiso) documented women’s experiences obtaining an abortion in New Brunswick before and after the Regulation 84-20 amendment. 84-20 historically restricted funding abortion care in the province. Those restrictions were slightly eased in 2015.[3] More than half of the study’s participants had to wait at least two weeks or more for an abortion after having decided to get one. A few had to wait more than a month to access services. Roughly half also paid out-of-pocket for the procedure for at least one abortion. The ones who did get the procedure done in-hospital described the process as “arduous and complicated.”[4]
Some major findings from the study:
- Hospital abortions, while covered by insurance, required multiple visits which usually resulted in high accumulated costs and other burdens. On average, participants in the study who went the hospital route had to make three visits in total.
- Significant out-of-pocket costs are incurred when trying to obtain an abortion. Even for those who did meet the requirements for provincial coverage incurred great costs associated with lost wages, childcare needs, travelling and accommodations for multi-day visits. For women who obtained clinic-based abortion care in-province, the costs were also high (from $300-$1,600, excluding travel).
- French-speaking women were unable to receive care in their preferred language, though they expressed greater concern about the overall accessibility issue than receiving services in French.[5]
- Wait times and out of pocket expenses negatively influenced disclosure. The majority of participants waited between 2-4 weeks to have the termination. Consistently, costs and delays in care forced women to disclose their pregnancy to their families or partner, which they otherwise would have preferred to keep to themselves.[6]
Mifegymiso (the abortion pill, which became publicly available in Canada in 2017) represents a window of opportunity for improving both the accessibility and timely delivery of abortion in New Brunswick, but if the province continues to enforce its policy of requiring funded care to be performed in a hospital setting, the potential of Mifepristone will not be realized. Each province so far has also made varying commitments to the provision of the drug. At the time of this blog post, five provide universal coverage of Mifegymiso: Alberta, Ontario, Quebec, New Brunswick, and Nova Scotia. Four provinces offer coverage only to a few patient groups: BC, Manitoba, PEI, and Saskatchewan.[7] Physician refusal also remains to be a problem.[8]
The fact of the matter is that access to surgical abortion remains troublesome and burdensome for women in New Brunswick. The inability of rural residents to access timely and affordable services is distressing and an undue inequity in healthcare.
[1] 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/89 Heidelberg (Germany) (18 November 2016) at paras 40-41, online (pdf): http://www.westcoastleaf.org/wp-content/uploads/2016/11/2016-Canada-CEDAW-Concluding-Obs.pdf
[2] Angel M Foster 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” (2017) 95 Contraception 477 at 477.
[3] Ibid at 478.
[4] Ibid at 479
[5] Ibid at 481.
[6] Ibid at 482.
[7] Abortion Rights Coalition of Canada, “Access to Abortion in Rural/Remote Areas” (2017) ARCC Position Paper No. 7 at 2.
[8] Foster, supra note 2 at 483.
University of Ottawa Association of Women and the Law 