A recent leaked draft opinion that came from the United States Supreme Court confirmed what many feared: a conservative-dominated court was going to upend 50 years of abortion protections and overturn Roe v. Wade.

The news prompted Prime Minister Justin Trudeau to reassure Canadians: “A woman’s free choice is a choice to be made by her alone. Every woman in Canada has the right to a legal and safe abortion.”

However, in Canada, abortion isn’t exactly a right. The 1988 ruling R. v. Morgentaler decriminalized abortion but that doesn’t inherently guarantee us the right. Instead, it became a part of our health care.

Accessing reproductive health care isn’t always so easy. The Independent spoke with people all over the province about the state of abortion access. Some of the news was chilling, highlighting major gaps in health care. (We also recognized cis women aren’t the only ones who access abortion services.)

Abortion as Health Care

To terminate a pregnancy through a procedural abortion—also known as a surgical abortion, which Rolanda Ryan said is a misnomer because it isn’t a surgery—the only options are in St. John’s, through the Health Sciences Centre and the Athena Health Centre. Ryan is a registered nurse who owns the Athena Health Centre, the province’s only abortion clinic.

“I believe in the life of the woman who’s standing in front of me,” she told The Independent. “I believe in treating her with respect and dignity. And I believe in trusting them to know what is best for them, to be experts in their own life.”

“I believe in them making their own decisions in their own best interest and supporting their right to do so. A developing tissue inside that person’s body does not have feelings. Does not have a life. Does not have complications that go on that make people lead to these sorts of decisions.”

Typically, the clinic performs between 800 to 900 abortions a year. 90 percent are procedural, and the remaining 10 percent are through Mifegymiso, the abortion pill. Ryan said one of the reasons people tend to prefer a procedural abortion is because they know when they leave the clinic they won’t be pregnant.

In Canada, Mifegymiso can be taken up to the ninth week, and in NL its cost has been covered by MCP since September 2018.

The abortion pill also has a failure rate of at least five percent, she said, so if you take that route you still may end up getting a procedural abortion.

The clinic also does telehealth, where people call the clinic and then Ryan and her staff can order their blood work to determine how far along in a pregnancy they are, and order Mifegymiso for them—either from nearby pharmacies that have it or they ship it, she said.

Ryan said about 95 percent of abortions performed in the province are at the clinic, even though it’s also available at the Health Science Centre. One of the reasons behind that is the procedure at the Health Science Center takes two days and you need to be at least eight weeks pregnant. That isn’t an issue at the Athena Health Clinic, she explained, where you could be four and a half weeks pregnant and still get it.

The clinic doesn’t share clients’ medical records, and those records are destroyed after a decade. An abortion at the Health Science Centre means the information is stored in a patient’s file, so there’s an issue with privacy, she said—pointing out the recent cyberattack on Newfoundland and Labrador’s health care system.

The Athena Health Clinic also opens up a monthly satellite clinic, alternating between Central and the Island’s west coast, said Ryan.

In this province procedural abortion is capped at 15 weeks. Otherwise, the person will need to leave the province. Neighbouring Nova Scotia has the same cut off point, but Ontario will do it up to the 23rd week. The further along in a pregnancy the person is, the more complicated the procedure. Most people get it before the 12th week.

Abortion Services in Canada, by province. (Source: Action Canada for Sexual Health and Rights.)

Abortion in the Canadian Courts

Canada is a case of where abortion has been decriminalized since the 1980s. But that isn’t the same as accessible.

You can’t really compare the precedent-setting cases in the US with Canada either. They aren’t the same.

In 1969, the federal Liberal government led by Pierre Trudeau allowed abortion under certain circumstances, but the person had to appear before a committee made up of doctors who would decide if the pregnancy might endanger their life or health.

In 1970, the Abortion Caravan was kicked off by the Vancouver Women’s Caucus. At the start, seventeen women traveled in a few vehicles, picking up steam along the way as hundreds of people descended upon Ottawa to protest the rules around abortion. This was major news, as a group of activists infiltrated Parliament and peacefully shut down the House of Commons. While it helped put the spotlight on the issue, the laws didn’t change.

It wasn’t until Canada enacted the Charter of Rights and Freedoms in 1982, where any law found contravening those rights could be found unconstitutional and struck down. It would prove vital in the fight for abortion rights.

In 1988, a doctor named Henry Morgentaler was before the Supreme Court of Canada in R. v. Morgentaler. In that decision, Canada’s abortion law was struck down as unconstitutional.

Chief Justice Brian Dickson wrote: “Forcing a woman, by threat of criminal sanction to carry a fetus 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 her security of the person.”

As a result, Canada no longer had any laws restricting abortion access.

The very next year, in Tremblay v. Daiglem, the Supreme Court ruled that a man had no right to veto someone’s decision to get an abortion. The case started when a man got a court injunction against his girlfriend, preventing her from terminating a pregnancy. While the courts went on to settle the issue if someone could force you to carry a pregancy to term, she had gone to the U.S. for an abortion.

There have been attempts to overtly regulate abortion over the years. The PC Brian Mulroney-led government introduced Bill C-43 in the early 1990s which sought up to two year jail terms for doctors who performed abortions when the pregnant person’s life wasn’t at risk. It passed the House of Commons but thankfully died in the Senate in 1991.

There have also been other attempts to cut off access, like the Unborn Victims of Crime Act and The Protection of Pregnant Women and their Preborn Children Act.

Current Conservative Party leadership contender Leslyn Lewis has said she wants to bring in a ban on sex-selection abortion and also so-called “coercive” abortions.

Access Restricted Beyond St. John’s

Planned Parenthood NL is a holistic sexual health care centre with its own doctors and sexual health care clinics. They provide education to schools, community groups, and businesses, as well as offering harm reduction programs and providing safer sex supplies. People can drop by and get a pregnancy test or counseling about their options.

“We are basically most people’s first stop when they find out they’re pregnant, especially if they don’t have a family doctor or they’re seeking abortion,” said executive director Nikki Baldwin.

If you’re in the St. John’s metro area, then access is great. But you’re “screwed” if you live outside that, she said.

Baldwin said it’s wonderful that the Athena Health Clinic has a satellite clinic, but if you miss it then you have to travel to St. John’s—and that’s expensive.

In Labrador you have to travel by plane. If you’re from a small town, there’s also the worry that everyone will know your business.

She also cited the same issue as Ryan did when it came to the abortion pill: a lot of doctors don’t know how to prescribe it, so you need a medical practioner who is wiling to learn about it and prescribe it. You’ll then need to find a pharmacy that has it in stock or is willing to order it. If the pill doesn’t terminate the pregancy, then they’ll still have to arrange a surgical abortion.

“The issue of access is a massive problem,” Baldwin told The Independent. “Even if your doctor knows how to prescribe [Mifegymiso] and is willing to prescribe it, because doctors do not have to give abortion care. They don’t have to give any care as long as they refer you to someone who will. Which is a very loose thing in Newfoundland and Labrador.”

The crux here is that people need to make all these plans and they don’t always have the latitude to make them and leave their hometown, she added.

Of course, these barriers aren’t unique to Newfoundland and Labrador; they are present throughout the country. Ontario has 11 abortion clinics but 77 crisis pregnancy centers—places that intentionally look like clinics but are fronts for anti-choice organizations.

There is also one active in St. John’s and Baldwin said it was just down the road from Planned Parenthood NL’s old home. It’s called the Center for Life, its name is actually the Right to Life Association. Baldwin said they claim to offer options counseling, but only tell people horror stories about abortion.

Abortion Doula

Emma Duke operates the Mindful Doula, providing postpartum support services in the St. John’s area to pregnant and parenting people.

She’s also an abortion doula with the Abortion Support Services Atlantic, acting as a non-medical support person in ending a pregancy. That can mean she provides general information on how to access abortion services, acts as an emotional support person, or even helps them navigate logistics.

“A lot of the support that I offer as an abortion doula with Abortion Support Services Atlantic is either finding rides for folks or providing them with information around different funding that might be available to them for covering transporting costs,” Duke told The Independent.

She said this work doesn’t keep her too busy in this province, adding her Nova Scotia colleagues are busier. She did see a spike during the pandemic, explaining international students were in a bind during the lockdown and many were forced to pay out of pocket for an abortion because they had lost their MCP coverage.

Duke also recently helped someone who was beyond the provincial cut off of 15 weeks.

“Just recently I supported someone who had to navigate that, so I might connect them with Action Canada or the National Abortion Federation to avail of different funding or Hope Air to get their flight covered.”

Hope Air has been around since 1986, and it’s a national charity that offers free travel and accommodations for Canadians.

West Coast and the Great Northern Peninsula

NorPen Status of Women Council executive director Nicole Bursey said that unfortunately, as with many other types of medical services, abortion is hard to access on the west coast of Newfoundland. For many medical services, people have to head to Corner Brook or St. Anthony.

As it stands, surgical abortion is only possible in St. John’s, she said, which means people have to travel about 800 km—if not further. That’s a major problem if you don’t have access to a vehicle, or funds to pay for other travel expenses like meals and accommodations (because it’s not just a one-day trip). If you want to bring a support person, that also makes it more expensive, she said.

She added in the winter, weather can mean there’s no getting off the peninsula—something that is alarming if you have a time sensitive procedure.

“Saying that it’s a right is one thing, but if it’s a right that is not really accessible it doesn’t make sense,” said Bursey.

At the Port Saunders hospital they haven’t had a doctor in four weeks, and their nurse practitioner is kept busy with other duties. If someone needs an ultrasound, the closest ultrasound is in Corner Brook or St. Anthony, which is several hours either way, she said.

“Sometimes, especially with health care, we’re so dependent on what health care professionals will do that even though, really, yes it is our choice. The choice is taken from us.” 

That’s the situation on the west coast. But what about even further afield in Labrador?

Abortion Access in Labrador

There are major geographical barriers to abortion that are unique to Labrador, said Labrador West Status of Women Council executive director Michelene Gray. A roundtrip flight to St. John’s can cost $2000—something many people don’t have lying about.

The province does have a Medical Transportation Assistance Program, she said, and while “that’s a lovely concept, 90 percent of the time, it’d have to come out of your own pocket and then you get reimbursed.” Getting the money back can also take a long time, she added.

Filling out a form to say where you’re going also poses a breach of confidentiality, she said. This is a personal choice but people still face judgment, “And it should be a private and informed decision.” In a small community, people might also know why someone is traveling to the capital.

Many of the doctors at the Labrador West Health Centre are fee-for-service physicians, which means they are contractors, Gray explained. And there have been instances where a doctor has refused to prescribe the abortion pill.

“She’s facing judgment, right from medical care,” she said—adding in one instance a person ended up calling the Athena Health Clinic and getting medication shipped in.

In response to that situation, two years ago Gray contacted Labrador-Grenfell Health’s Chief Operating Officer about developing a safe, non-judgmental plan for people who wanted to access abortion. Gray wanted to compile a list of pro-choice doctors, but “so far we don’t have anything established. I wasn’t given the name of any doctors that they could suggest that were okay with this.” 

There was also a case where someone went to a pharmacy to have an abortion pill prescription filled and was judged by the pharmacists.

Labrador West Status of Women Council also has an abortion doula on its board and available to support people, she said.

“We’re a 100 percent confidential organization,” said Gray. “We’ll support whatever choices women make and stand besides them. So I think it’s important for women to know that we are here and we are a point of contact. We do offer services to help them through their decisions and what may come after.”

Rally for reproductive rights in St. John’s, NL, October 2021. (Source: Planned Parenthood – Newfoundland and Labrador Sexual Health Centre.)

Protecting Reproductive Health Care Access

Earlier this week, Prime Minister Trudeau announced he was considering legislation that would enshrine access to abortion in the country.

Planned Parenthood NL executive director Nikki Baldwin argues that’s not necessarily the way to go.

While onlookers watching the US try to scramble and figure out ways to save access to abortion, Canada doesn’t actually have any laws regarding abortion. Some have said the government needs to step in and make it a law, but Baldwin says our current situation works in our favor.

“There is no law in Canada about abortion,” Baldwin said. “That is the way we prefer it stayed. We prefer that abortion be simply covered under your health care rights. That it not be considered a separate issue from your health care.”

Once it’s separated from general health care, then you can start laws banning it, she explained. R. v Morgentaler was about abortion as health care—and health care is a human right in Canada. But if it becomes a law, then it could be constrained.

She said what we have to worry about in Canada is not abortion being banned in one fell swoop, but the chipping away at abortion and putting differerent regulations in place. “Or politicians who want to do it sneakily,” she cautioned—like saying giving humans rights to fetuses at a certain week or legislation against sex-selection abortion.

“When things like this happen in America that’s so close to us, it brings up which of our human rights are up for debate.”

Looking at the US, it feels like this could happen here if we’re not careful. And what happens in the US impacts us across the border.

“The issue of all of this coming up in America is it does empower the anti-choice people to push,” Baldwin said. “Even if that doesn’t change laws, that makes the stigma higher. It makes it hard to go to an abortion centre. There are people outside screaming at you, sometimes taking pictures. And that all ramps up. When things get back in America, things get bad here too.”

Athena Health Clinic’s Rolanda Ryan said ideally, every community would have a doctor who knew how to prescribe Mifegymiso and every hospital has someone there to do abortion care.

Realistically, abortion providers are trained to give this type of care, and are invested in and committed to reproductive rights. She said there are very religious places in the province and the abortion providers might get harassed.

Back in 2016 the government signed into law the Access to Abortion Services Act, which bans protestors 50 metres away from the clinic and 160 metres from the homes of staff. It also includes 10 metres around doctors’ offices and 160 metres from doctors’ homes, hopefully protecting them from harassment and stalking. The bill also banned filming or photographing patients, doctors, and service providers in those zones.

Ryan said she’d like to see the boundary be extended to 150 metres around health care facilities. As it stands now, the protestors—who now carry graphic signs—stand at the intersection of Pleasant Street and LeMarchant, and people coming to the clinic end up seeing them.

Back in January of this year the Furey government announced it would be introducing legislation to create safe access zones around educational and health care facilities.

A government spokesperson told The Independent in an email that “Notice has been given and it is currently on the order paper for the House of Assembly.”

UPDATE, 16 May 2022: An earlier version of this article reported that some international students had been forced to pay for abortion services out of pocket because MCP did not cover the procedure. In fact, MCP did not decline to cover the procedure, but the students had lost their MCP coverage. The Independent regrets this error.

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Elizabeth Whitten is a St. John's-based journalist and The Independent's St. John's municipal politics reporter. She's previously worked for allNewfoundlandLabrador and Downhome Magazine, and her work has been published by CBC, The Overcast, and the Toronto Star. She's currently writing a book about how Dr. Cluny Macpherson invented the gas mask in World War One.