Image by Jonathan Dyck
Image: Jonathan Dyck

CANADA’S ABORTION PROBLEM

A Story of Activism in New Brunswick

by Cynthia Spring 

 

People are talking about it—abortion. It’s a conversation reminiscent of a movement that started over forty years ago, when Ms. magazine published a petition signed by fifty-three well-known American women declaring they had received abortions, and activists from across Canada shut down the House of Commons to call attention to women’s rights. Today, a similar movement is taking place. Not only are feminist activists still calling for better access to adequate sexual and reproductive health care and social supports, people are boldly sharing their abortion experiences in blog posts, major films, online videos, and elsewhere.

The general sentiment among the voices speaking out: abortion is not unusual, nor is it shameful. The decisions surrounding abortion can be complex or simple; these choices do not need to be explained to or understood by outside parties, but supported and accommodated within our medical system. Talking or writing about abortion can encourage others to share their stories—it can help to establish solidarity and overcome individualized feelings of embarrassment or guilt. But telling an abortion story can also prove to be an incredibly difficult process. Those who speak out, for instance, might feel pressured to explain their decisions, fearing the judgment of their listeners. As my good friend and GUTS contributor Katie L wrote earlier in this issue:

When abortion is framed, narrativized, and presented as an event exclusively about decision making, then the audience (a public) becomes a jury who will answer for themselves, Did she make the right decision? Yes, if she was young. No, if she was rich. Yes, if she was raped. No, if she was married. Yes, if she was as student. No, if she was healthy. Yes, if she was an addict. No, if she was reliable. Yes, if she was planning to have children later when she could offer them a better life, and more love. Each judged separately. Each removed from collectivity.

Centering an abortion story around the decision itself plays to an expectation that there must be a good reason for going through with the procedure. It invites listeners to judge whether your reasoning is legitimate. Employing “choice” as a politicized term in the struggle for reproductive rights, as Lew brilliantly suggests, has a similar effect. When we base advocacy for abortion in a person’s ability to choose, reproduction (and the rights and oppressions that go along with it) is framed as an individual’s personal responsibility, rather than a collective concern worthy of public funding and support. This limitation begs a question central to many conversations around reproductive justice taking place today: By prioritizing choice in the fight for abortion, are we reducing complex and far-reaching social problems to a matter of personal interest?

The pro-choice movement has clearly been instrumental to changing abortion legislation in Canada, but with many people in Canada still unable to receive abortions, or other adequate forms of reproductive and sexual health care, it is time to consider whether it is still an effective means of creating positive and necessary change.

While research shows that people in many parts of Canada continue to travel huge distances and pay substantial fees in order to access abortion, the Maritime provinces are acutely experiencing the consequences of a precarious reproductive and sexual health care system. When the Fredericton Morgentaler clinic (the only private abortion clinic in Canada east of Montreal) closed last summer, people started to face longer wait times to get an abortion in a hospital. Some Maritimers were travelling across the border to undergo a medical service that could easily be performed in most Canadian hospitals and doctors’ offices. Others, who perhaps could not afford or were not aware of that alternative, were turning to dangerous means to induce a miscarriage.

Up until this month, New Brunswick’s Regulation 84-20 required a patient to get two referrals from separate physicians in order to receive a fully covered abortion in one of the province’s two hospitals authorized to perform the procedure. On November 26, 2014, Premier Brian Gallant announced that he would amend  Regulation 84-20 from the province’s Medical Services Act, in an effort to place abortion and reproductive health services in the same category as any other insured medical procedure. It was a major feat in a province where activists have been working to abolish this restrictive legislation since it was instituted over twenty years ago. Despite this advance, Gallant’s Liberal government has no intentions to fund abortions that are performed in private clinics outside of the hospital. This decision violates the Canada Health Act, which requires all abortions to be publicly funded whether performed in a hospital or in a clinic.

New Brunswick’s government has justified its decision by arguing that in order to make access to abortion equal and fair, it will need to be insured, provided, and regulated like any other medical service. As Health Minister Victor Boudreau said in November 2014: “We do not provide funding for any procedures performed in a private clinic. So again this [repeal] brings abortion in line with any other insured service.” Treating abortion as a procedure like any other presents certain possibilities, but it also risks writing off much needed forms of women- and trans*-centred health care as a result of their specificity. Without addressing a number of major barriers to access and quality of care that stigmatize or isolate those seeking to abort, to have a child, or to receive general sexual and reproductive health services, Gallant’s amendment is really just a first step in an ongoing fight for reproductive justice.

 —

Securing access to safe, self-referred, and publicly funded abortion in Canada has been a long and tenuous process. When the federal Liberal government legalized abortion in 1969, it did so under certain conditions: a woman seeking an abortion had to be referred to an accredited hospital, where a therapeutic abortion committee (TAC) would determine if a pregnancy threatened the woman’s life or health and was thereby necessary. On average, a hospital’s TAC, composed of at least three physicians, would take up to eight weeks to come to a decision regarding a single case. While some TAC’s treated the evaluation process as a mere formality, others rarely approved a single abortion. Under these seemingly arbitrary conditions, getting an abortion often ended up being a lengthy process that required people to travel between accredited hospitals (mostly located in larger urban centres), with no guarantee of even getting a procedure.

During these years, a person seeking an abortion needed to have not only a certain amount of tolerance for the degrading and time-consuming TAC process, but also enough economic resources and work flexibility to make numerous appointments and journeys throughout Canada—or even across the border to the US. According to the 1977 Badgley Report on abortion laws, 50,000 Canadian women travelled to the US for an abortion between 1969 and 1975. (First and second trimester abortions were fully legalized in the US in 1973.) For those living rurally in communities where hospitals refused to create TACs, having an abortion was hardly an option, especially if a person wanted to keep their situation private or if they didn’t have the money to travel to the nearest hospital with a TAC to try their luck.

Canada’s women’s movement did not keep quiet about this unjust disregard for reproductive rights. The contradictions of laws regulating abortion in Canada gave rise to the country’s first national feminist protest, the abortion caravan. In 1970, activists from all over the country traveled as a group from Vancouver to Ottawa, mobilizing over 500 women to demand better access to abortion and reproductive health care and to oppose the 1969 amendments to section 251 of the Canadian Criminal Code, which legalized abortion only in cases where the pregnancy threatened a woman’s health. Over the course of Mother’s Day weekend, hundreds rallied on Parliament Hill, and on May 11, 1970, thirty activists entered the House of Commons and chained themselves to their chairs. The women interrupted the proceedings in the House by shouting their demands, effectively shutting down the House of Commons while security forcibly removed them.

Although the caravan activists’ demands were not met in 1970, efforts to secure safe and accessible reproductive care continued with increased momentum. Grassroots networks and women’s advocacy groups helped patients who were refused abortions by the TACs and members of socially marginalized communities find care at non-TAC-approved clinics. Many of these clinics were founded and overseen by Dr. Henry Morgentaler, a physician and pro-choice advocate. Morgentaler’s clinics often provided abortions on the same day as the first examination, thereby challenging the TAC’s federal standards.

In 1973, Morgentaler was first tried and acquitted for defying the abortion law in Quebec, marking the beginning of his long-term legal battle against various provincial governments. Over a decade later, and after numerous raids, charges, sentences, and acquittals, Morgentaler’s legal efforts to secure women’s rights to accessible abortions finally paid off. In 1988, the Supreme Court struck down Canada’s abortion law under the ruling that it violated a woman’s rights to the security of person, a notion first established in Canada’s 1982 Charter of Rights and Freedoms.

When abortion was removed from the Criminal Code, it became the provenance of the Canada Health Act (CHA), a piece of federal of legislation that specifies how health care should be provided and funded throughout the country. According to the act, abortion is a medically necessary procedure that should be accessible to everyone and covered by provincial health care, whether it is performed in a public hospital or a private clinic.

This is where things get a bit messy: provinces and territories have been granted some liberty for interpretation when it comes to securing adequate reproductive health care and rights. Funding for and access to abortion varies throughout the country according to provincial/territorial legislation and medical care, often in defiance of the CHA’s clear requirements. Quickly after the 1988 ruling, for example, Nova Scotia banned abortions in private clinics. In 1989, New Brunswick’s Liberal provincial government added regulation 84-20 and, in 1993, the same government made an amendment to Section 2.01 of the Medical Services Payment act, prohibiting funding for abortions performed in private clinics.

Similarly, in PEI, a province without any hospitals or clinics authorized to perform abortions, people can only receive coverage for their abortion if they are referred by a family doctor to a Nova Scotia hospital. If they can’t get a referral, they have to travel to the nearest private clinic or hospital (likely for multiple appointments) without any public financial support. Just last year, PEI’s provincial government rejected a proposal to have three willing physicians travel to the province on a regular basis to perform abortions; as Premier Robert Ghiz said in May 2014, his government believes “the status quo is working.” Implementing this proposal would have saved the province money, not to mention the personal funds spent by those who are travelling out of province for the procedure.

The problem of access isn’t specific to the Maritimes. In many of Canada’s provinces and territories, it has taken nearly two decades to secure full coverage for abortions performed in clinics (New Brunswick, Nova Scotia, and PEI are still the exceptions—they don’t fully fund clinic abortions.) As of 2013, less than 16 percent of Canada’s hospitals provide abortions, and most private clinics are located in cities. This means that even in provinces where abortion is fully covered by provincial health care, people who need abortions and are living in rural areas may need to make a long commute, sometimes for multiple appointments, often on their own dime. Needless to say, for people who are unable afford travel expenses, childcare, or time off work, abortion is sometimes not an option.

The days of the abortion caravan and TACs don’t feel too far away when we acknowledge that quality of care still depends on a person’s location, their socioeconomic status, and their health providers’ position on abortion. The reality of these social determinants of reproductive health makes it all too clear that, for many people, the system is broken. And yet, despite all the facts, stories, and legislation that expose the barriers limiting access to abortion across the country, there has been surprisingly little talk about the topic in major media sources throughout the past decade. Save for the moment in 2012 when Conservative MP Stephen Woodworth attempted to introduce a private member’s bill to reconsider when human life begins, meaningful conversations about reproductive health in Canada are rarely given national attention.

Much of this changed in the spring of 2014 when Fredericton’s Morgentaler clinic announced it was closing its doors. The clinic’s closure marked the beginning of an unresolved crisis for those seeking abortions in the region, and as a result, reproductive health care in the Maritimes was granted some well-overdue national attention. For many Canadians who had neither lived in nor sought reproductive or sexual health services in the Maritimes, the news came as quite a bit of a shock. In a country that decriminalized abortion over twenty-five years ago, one question was asked again and again: how could this be happening here?

 —

The Fredericton Morgentaler clinic closed on July 31, 2014, after an unsuccessful twenty-year-long endeavour to secure provincial funding. The clinic, which operated under the unspoken policy to never turn away a woman in need, relied heavily on the private support of Henry Morgentaler. Without public funding, the clinic was a precarious band-aid solution in a province with limited safe and sustainable reproductive and sexual health care. With the added costs incurred after a flood damaged the building in 2008, the clinic, which was performing over 60 percent of the province’s abortions, was simply unable to stay open.

Without the Fredericton clinic, New Brunswick entered a time of crisis. In order to get an abortion in the province, you were now required go to a hospital and, because the Medical Care Act had not yet been reformed, you had to be referred by two physicians and have the procedure performed by a specialist in the field of obstetrics or gynecology. Jessi Taylor, a spokesperson of Reproductive Justice New Brunswick—a collective dedicated to ensuring publicly funded and self-referred abortion is available throughout the province—explained how this referral process could potentially disempower a person in their decision to abort. When we spoke in early November 2014, Taylor said, “If you have a family doctor, whether or not you get a referral is dependent on whether or not the doctor is pro-choice. It’s your doctor’s prerogative whether they will refer you or not.”

In a province where approximately 50,000 people are without a family doctor, the already unnecessary requirement of two referrals became a serious barrier to access. Even if you were able to get two referrals, there are currently only two hospitals in the province authorized to perform the procedure. As a result, wait times are long, sometimes pushing upwards of ten weeks (the maximum gestation period in New Brunswick is just thirteen and a half weeks).

When I spoke with Kathleen Pye, a founder of RJNB, last October, she explained that in New Brunswick, there is sometimes an expectation that things won’t change as quickly as the rest of the country: “We don’t generally make a stink about things.” But when the rest of the country became aware of this crisis, national outrage acted as a catalyst. In New Brunswick, said Pye, “people started to get angry.”

Similarly, Moncton-based feminist activist Beth Lyons explained that the clinic’s closure, while devastating for people needing abortions immediately, also presented certain opportunities for action: “The status quo for abortion access in New Brunswick has been unacceptable for a very long time,” she explained in early November 2014. “With the clinic closing there was no longer this band-aid solution, and it was no longer possible to say: ‘It’s too bad that folks can’t get publicly funded abortions with self-referral, but at least we have the Morgentaler clinic.’”

The existence of the Morgentaler clinic made it easier for both Conservative and Liberal governments to ignore the issue for decades. Up until last summer, women in New Brunswick were technically able to choose whether they would get two referrals and travel to a hospital for a provincially covered abortion, or if they would pay out-of-pocket for a self-referred abortion at the clinic. Without the clinic, however, the inadequacy of this choice could no longer be ignored.

And so, the provincial government started to feel the pressure. In the lead up to New Brunswick’s provincial elections last fall, the province’s regulations on funding for and access to safe abortions were being discussed. Liberal candidate, and the current premier of New Brunswick, Brian Gallant, openly expressed his pro-choice leanings, giving feminist activists some hope that change might be possible.

Lyons recalled seeing Gallant speak at a pro-choice rally in Fredericton in August 2014. During this powerful demonstration, young feminists stepped forward to support seasoned activists, calling for change together. Although Gallant, who was campaigning throughout the province at this time, was met with general enthusiasm, Lyons explained that the crowd’s cheers diminished as Gallant spoke “euphemistically, saying there would be a review to discover if there were in fact barriers to access.” The crowd expressed their disappointment loudly; not only did they want explicit commitment to repeal the regulations that demanded referrals and limited publicly funded abortions to hospitals, they were stunned to realize that Gallant felt the need to review the province’s obvious barriers to safe and accessible reproductive services.

Four months after the Fredericton Morgentaler clinic closed, Premier Gallant announced the details of his government’s decision to amend Regulation 84-20. Although the two-referral requirement would be removed from the Medical Services Payment Act (implemented on January 1, 2015), Gallant has confirmed that private clinics will not be funded, nor will hospitals be required to provide abortions: “New Brunswickers are used to that kind of health care system, and it’ll be the same case here.”

The reluctance to expand access in hospitals can’t be chalked up to a lack of resources; all hospitals have the capacity and equipment to perform abortions because, as Taylor explained to me, “it’s the same equipment you would need for a miscarriage.” Even so, with the recent change in legislation, it’s not clear how long it will take before access expands beyond the two hospitals currently providing abortions in Northern and Southeastern New Brunswick.

Many feminist activists are insisting that this change in legislation is really just the bare minimum in terms of securing safe and accessible reproductive and sexual health care provincially, and this time they won’t be settling for it. Abortion needs to be made available in hospitals widely as well as in private clinics. Both of these options are not only legislated federally, but are integral to providing safe and supportive spaces for women and trans* people to receive the self-referred, non-judgemental, and timely care that isn’t available within the current system.

It is also important to remember that access to abortion in New Brunswick is not an isolated matter, but part of a much bigger issue. The need for reproductive justice, and all of the social supports and services it demands, will not be resolved, as Gallant once said, “swiftly and cleanly.” Promoting a new understanding of sex and reproduction that does not reduce these intersecting problems to isolated issues or the private interests of a marginalized few is key to establishing a community that supports and protects everyone’s reproductive rights. This shift is desperately needed not only in the Maritimes, but across Canada, and it is precisely this politicized struggle for reproductive justice that feminist activists are taking upon themselves in New Brunswick.

 —

For years now, a number of groups involved in the reproductive rights movement have been questioning the use of the term “choice.” Reproductive justice—an intersectional framework developed by women of colour in the United States—offers an important alternative. For activists who have adopted the framework in New Brunswick, this doesn’t mean forgetting about the work done by the pro-choice movement, but rather expanding the scope of our terminology and perspectives: “I think when we talk about pro-choice we really need to understand that choice is a necessarily broad term that means so many things, and it has to be a meaningful choice,” said Beth Lyons. “We need to remember the root of where reproductive justice comes from and acknowledge that it’s not a single issue. Just as it’s not a single issue, there’s not going to be a single solution. What we need is a conceptual shift in New Brunswick.”

Reproductive justice, as coined by SisterSong Women of Color Reproductive Health Collective, is based on “the right to have children, not have children, and to parent the children we have in safe and healthy environments.” This framework looks beyond individual choice and legal access in order to incorporate other social justice movements. Led by women of colour, immigrant women, and Indigenous women—communities whose reproductive abilities have, historically, been oppressively regulated by the state—reproductive justice links a woman’s control over her reproductive health to the racial, social, environmental, and economic conditions of her community. Loretta Ross, national coordinator of SisterSong says:

 Moving beyond a demand for privacy and respect for individual decision making to include the social supports necessary for our individual decisions to be optimally realized, [reproductive justice] also includes obligations from our government for protecting women’s human rights.

The reproductive justice model calls on governments to treat and support abortion, sexual health, maternal well-being, social and racial inequality, childcare, and other social justice issues as interconnected concerns that must be addressed simultaneously and cohesively. This is a radical demand that challenges our political leaders’ tendencies to treat issues of oppressed groups in isolation from one another. In New Brunswick, the decision to deny private clinics public funding is just one example of the provincial government’s failure to acknowledge and protect women’s human rights in their entirety.

Several other cuts have negatively impacted women in New Brunswick, and have been similarly justified as a means of ensuring equality or making better use of resources. In 2011, for example, David Alward’s Conservative government cut funding to New Brunswick’s advisory council on the Status of Women, the province’s only publicly-funded, independent voice dedicated to community and policy development towards equal opportunity and freedom from discrimination for women and trans* people. In the same year, the province blocked anyone over the age of nineteen from using the province’s sexual health clinics, centres located throughout New Brunswick that provide free testing for sexually transmitted infections, prescribe birth control, and provide counselling services for unexpected pregnancies. Despite the fact that the rates of chlamydia and gonorrhea infections are steadily on the rise among people (predominantly women) between the ages of fifteen and twenty-four, the province decided to allocate its resources elsewhere.

Then, in 2013, the province cut funding to the Midwifery Council of New Brunswick. Without the council, which had been working to develop a practice within the province, midwives looking for work in the province could no longer register with a license to practice. The reasoning behind this decision was to preserve resources in a time of fiscal restraint, as then-health minister Ted Flemming explained in an email: “It does not seem prudent to introduce a new profession in the midst of systemic change.” The licensing body has since been reinstated, but the provincial government still does not fund midwifery services.

These separate instances of government cuts may not come as a huge surprise: when money is tight, services and organizations oriented around women’s particular needs are often the first to go. It’s a familiar neoliberal move: in an effort to make better use of available resources, we’re told we need to more fluidly incorporate, or in some cases, do away with entirely, those particular interests of specific groups. In order to truly achieve equality, neoliberalism informs us, we must abolish the organizations that advocate on behalf of the marginalized and supposedly further enforce outdated social divisions. In the free market, projects that challenge the notion of individual autonomy, that appeal to the politics of the welfare state, only threaten to regulate and constrain our recovering economy.

This logic is toxic for feminist advocacy and organizing, and it is particularly infuriating when talking about people’s sexual and reproductive health. These services aren’t luxuries—they are basic human rights. These supports aren’t targeted at the few—they are essential to anyone in the province who has been or will be sexually active.

When I think about why New Brunswick, like so many other places, has been able to ignore the inadequacies of its reproductive and sexual health care system for so long, I sometimes find myself at a loss for answers. One theory I keep returning to is this: however inadequate the bare minimum might be in the province, there is still a semblance of choice. In New Brunswick, people can still choose whether they want a midwife (if they can afford one, that is), if they want an STI test at a sexual health clinic (if they are allowed to access one, of course), and if they can have an abortion (if they can get the procedure in time, naturally). But these options should not conceal the fact that the ability to make decisions about one’s reproductive and sexual life is a privilege determined by a number of social and economic factors—conditions that can either make these rights a reality or place people’s health and well-being at risk. With these structures of inequality and oppression limiting the reach of essential services and supports, a more holistic approach, one that accounts for the connection between reproductive rights and other social justice issues, becomes absolutely necessary.

Reproductive justice demands that our governments and legal systems hold seemingly separate issues together in order to address the underlying social and political structures that determine our reproductive well-being. It also encourages us to think beyond each individual’s decision making process, to fight for a community that provides everyone with adequate, non-judgemental, and timely support and care. These strategies are, of course, difficult to see through: such a radical shift would require rallying against deeply rooted systems that fragment and depoliticize feminist activism and interests on account of its specificity, as well as finding new ways to share our stories without reducing them to our own isolated choices.

This is the project that so many activists in New Brunswick are boldly calling for and actively participating in. And they are making progress. On January 16, 2015, it was announced that a new health centre will be opening in the former Fredericton Morgentaler clinic, purchased with the funds raised by Reproductive Justice New Brunswick and Fredericton Youth Feminists’s successful 2014 kickstarter campaign. Clinic 544 will provide a number of reproductive and sexual health services, including contraception, cancer screenings, prenatal care, emergency IUDs, and abortions. The clinic will also treat people who do not have a family doctor and provide specialized care to the LGBTTQ community. But without provincial health care covering abortions performed in clinics or family doctor’s offices, visitors will still need to pay up to $800 for abortion services. While the clinic aims to provide its services to underserved and marginalized communities, this funding constraint makes that goal very difficult to achieve.

Feminist activists and organizations in New Brunswick are doing incredible work—but without adequate infrastructure and financial support, they can only go so far. An effective framework, if it is to abolish the patriarchal and capitalist structures that isolate and oppress our reproductive experiences, requires so much more government support and public participation. Because the reality is, securing reproductive justice isn’t an issue specific to the Maritimes—it’s relevancy is expansive.

Together we need to resist those forces that reduce abortion to a matter of personal interest, and instead uphold reproductive rights as a collective concern. We need to analyze how the social and material conditions of our communities impact our reproductive and sexual lives. We need to secure the necessary social supports and services for those who do have children, not only during a period of decision making, but throughout childbirth and parenthood. We need to push for more than the bare minimum in terms of access and funding for abortion. And, at the same time, we need to find ways to talk about abortion that, as Lew writes, “unconditionally locate[s] the woman who aborts within a public rather than before one, within a collectivity and a history of women who have aborted.”

It is entirely possible to feel supported, safe, and part of a community when exercising our reproductive rights; many people, if they are lucky enough, can have an abortion without explaining their decision, travelling long distances, or paying for the procedure. Other people can access sexual health clinics when they need to, can take control of their own birthing experiences if they so desire, and can raise their children in a healthy environment. But too many of us aren’t afforded these privileges. Until we are able to ensure the necessary reproductive and sexual supports and services are available to everyone, especially those vulnerable populations who need them the most, the fight for our reproductive rights will not be over. Now is the time to rethink our strategies of resistance and institute meaningful and long-standing change. ♦

 

“Canada’s Abortion Problem” is from our Sex Issue (winter 2014/2015)

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This term has replaced “repeal” since the regulation has only been amended (Change made January 22, 2015).
See Nancy Janovicek, Christabelle Sethna, Beth Palmer, and Katrina Ackerman’s article on travel and access to abortion.
Nova Scotia now provides limited funding to abortions performed outside the hospital.
In total, Canada’s territories have only three hospitals authorized to provide abortions. Travel costs to the nearest facility within or out-of-territory, however, are covered by territorial medicare.
The abolition of this advocacy group, while justified as an effort to better fund front-line services and consolidate women’s advocacy in provincial government bodies, marked a huge loss for women’s rights and equality initiatives in New Brunswick.

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