Trends in Barriers to Abortion Care

Abortion is a basic healthcare need for women, girls, and people who can get pregnant. In Canada, one in five pregnancies is unintended and one person who can get pregnant in three will have an abortion in their lifetime.

While the need for abortion is common, access to safe and legal abortion services is far from guaranteed for those who may need it.

The work of supporting people's access to abortion: Patient assistance programs

Action Canada runs a 24/7 hotline and text service where people with questions about their sexual and reproductive health can get support and referrals to service providers. Concurrently, we manage a travel fund for anyone in Canada needing support to access abortion. The National Abortion Federation Canada (NAF Canada) works closely with abortion facilities and providers across the country to support their patients in overcoming the barriers to accessing the care that they need. NAF Canada has a hotline that women, people who can get pregnant, and people who support them can call to get financial, information, and/or logistic support. Through our work responding to requests for emergency financial assistance, we get to intimately know how barriers to abortion manifest. We support people through the navigation of complicated, complex situations every day. The majority of those who need to access our financial assistance programs, which provide direct financial support to people who must travel long distances to access abortion services, are from smaller, rural, and remote areas and/or in provinces where services are very hard to access due to the scarcity of points of services, medically unnecessary regulations, and underfunded services. They are also marginalized in other ways and are disproportionately low socio-economic status, racialized, young, undocumented or in precarious immigration situations or facing constant emergencies because of intimate partner violence, homelessness, substance use disorders or disabilities. In the context of a global pandemic and economic crisis, this has been truer than ever.

Trends in barriers to abortion care in 2022

In 2022, both NAF Canada and Action Canada received funding from Health Canada’s new Sexual and Reproductive Health Fund to expand our ability to offer financial support to people in Canada who face financial and logistical barriers to abortion care. Since the expansion of our services, both of our organizations have experienced an overall rise in the number of people we support through our financial assistance programs. For Action Canada, we can report an overall 184% rise compared to 2021, with the numbers for the months of August (933%), September (320%), and October (266%), demonstrating that this trend is accelerating. For NAF Canada we can report an overall a 175% increase in demand from the same period in 2021. When we look at the complexity of requests for support, we saw a 1,175% increase in travel support, a 100% increase in people needing support with later abortion care, and a 211% increase in support for care out of province or country.

Both Action Canada and the National Abortion Federation Canada were well aware that we did not know the scope of the unmet need when it came to people in Canada facing barriers to abortion care. With the increased awareness of available supports, though neither of our programs has been publicly advertised yet, it is therefore not a surprise that we are seeing a sharp surge in requests for assistance. Every call we get gives us important information about what barriers to abortion look like and these barriers impact a significant number of people in Canada.

Here are some important observations from our work on the frontline this past year:

Since the beginning of the pandemic, Action Canada, NAF Canada, and our partners in clinics and hospitals have all observed a rapidly rising need for abortion care at later gestations. Generally, the data available in Canada show that the vast majority of abortions take place in the first trimester of pregnancy. In the last couple of years, we have witnessed a sharp increase in people seeking care beyond the first trimester. While we already had extensive experience supporting people accessing abortion later in their pregnancies, there are implications for a higher number of people needing care later in their pregnancies. Those trends not only impact the landscape of abortion access in Canada, they also impact our ability to offer support to people facing barriers to abortion.

• Several factors could explain this sudden upward trend in the need for abortion services at later gestations. The COVID-19 pandemic has had impacts on key areas of people’s lives, ranging from their health status to their finances, their relationships, family status, stress levels and mental health. These impacts may factor in pregnancy options decisions and in people’s ability to access health care in a timely manner. Since 2020, both Action Canada and NAF Canada have observed a significant increase in the number of anxious callers and in the complexity of the cases we take on. What used to be simple calls to navigate now demands increased logistical and wrap-around support and a lot more staff time. We have observed a reduced ability to cope with the demands of navigating health situations and health systems. This has translated in more people coming to us later in their pregnancies for support in accessing abortion care.
• Abortion services are unevenly distributed across Canada. In some regions, services are only available until approximately 12 weeks, and so, needing abortion care beyond then means travelling outside of one’s community. Procedures offered later in the pregnancy are often scheduled over several days which means needing to take more time off work, arranging care for children and other dependents, and bringing on more logistical and financial hurdles.
• Not all abortion providers offer care beyond the first trimester and their numbers decrease for those who perform abortion care beyond 19 weeks. This past year, we have seen a sharp increase in wait times at several key points of services which have then created complex scenarios where people have to travel increasingly farther to get the care they need. For example, if a person living in Cape Breton, Nova Scotia, needs an abortion beyond 16 weeks, they would usually travel to Quebec or Ontario, but we have had to expand the search for available providers to as far as British Columbia.
• Because of longer wait times, there is an increased risk of people exceeding the gestational limits of the abortion facilities not only in their province but in Canada. We are currently seeing a rise in people needing to travel to the United States for abortion care at a time when access to abortion care in the U.S. is jeopardized by the reversal of Roe. V. Wade. Canadians accessing care in the U.S. travel to states that are now considered Safe Haven states for Americans living in states that have now severely restricted or banned abortion. This has also increased wait times and the accessibility of those services for both American and Canadian patients. There are many people in Canada who are unable to travel to the U.S. for abortion care, for example, people who are undocumented, people without I.D., those in situations of intimate partner violence where freedom of movement is compromised and many others in vulnerable situations. When services are rendered unavailable in Canada there are people, effectively, denied care.
• There are very few hospitals offering abortion care beyond 24 weeks in Canada. While the province of Quebec has instituted a program to ensure access to those services for Quebec residents, in the rest of Canada, only two hospitals have been offering those services on an ad-hoc basis. This has caused immense strain on the providers and teams offering those services and created situations where wait times can be weeks-long. It has also meant that travelling to the United States remains the most viable option for most, at great cost to charities supporting travel and accommodations and provinces paying for Out of Country procedure costs.
• In the last several years, on average, close to 40% of the people Action Canada and NAF Canada support through our financial assistance program are uninsured or need assistance to pay for the abortion pill or for procedure costs because of barriers they face. For example, reciprocal billing between provinces does not cover the cost of medication otherwise universally covered for those with provincial health insurance, or trans people who have changed their gender markers cannot use their health card to access coverage for the abortion pill and in some places the physician fees for the abortion procedure. The majority of the people who need support with procedure costs are undocumented or migrants without access to the coverage they need. As we see a rise in the number of people we support overall, this has meant a much higher number of people needing support with procedure costs. While travel costs, accommodations, and incidentals are now funded through Health Canada’s new Sexual and Reproductive Health Fund, medical expenses such as procedural or in-clinic abortions, ultrasound, and medication, among other medical costs can only be covered through funds registered charities raise with individual donors. The trend of an increased number of people needing care later in pregnancy has also held true for people who are uninsured. The demand for support exceeds the funds that registered charities like Action Canada and NAF Canada can raise, putting charities at risk of having to turn away people, a decision with devastating human costs. An alternative is focusing all fundraising efforts on supporting access to abortion at the cost of other vital programs which would effectively destabilize two of the main national reproductive rights organizations in Canada, Abortion care remains a highly stigmatized form of health care both with the general public and within the health care communities. Many people who access abortion care internalize that stigma and are unable to make public their needs and barriers. Action Canada and the National Abortion Federation Canada are too well aware of the dire consequences of turning people away from abortions they want and need and so, we are sounding the alarm.

Our recommendations

Reproductive rights are human rights, including the right to access abortion. Canada has the obligation to provide women, girls, and other pregnant people with access to safe and legal abortion as part of their core human rights responsibilities. In Canada, the issue is that access is still compromised for many people. It is imperative that we work together to address persistent barriers so that all people in Canada can have timely access to abortion care. This will continue to strengthen Canada’s role as a champion of SRHR on the global stage, an important role as we face global attacks on sexual and reproductive health, gender equality and democratic institutions. In this spirit, Action Canada for Sexual Health and Rights and the National Abortion Federation Canada make the following recommendations:

1. The Federal Government must make the new Health Canada Sexual and Reproductive Health Fund permanent. This new fund rolled out in 2022 has permitted organizations across the country to work on enhancing the accessibility to sexual and reproductive health services in their communities. To improve access to abortion care, this fund covers travel, accommodation, and incidental costs for people in Canada who must leave their communities to access abortion. Since its inception, we have seen a dramatic increase in demand for support. When this program sunsets in 2024, there will be a cliff in service provision that will have grave impacts on the people who face barriers to abortion care. These supports must remain in place until abortion is accessible to all people in Canada equitably. This fund also invests in the SRHR sector including feminist, 2SLGBTQIA+ and social justice civil society organizations to enable their participation in SRHR policy development and their ability to increase access to sexual and reproductive health care for all.
2. We must strengthen all available means to support the provinces and territories to uphold the tenets of the Canada Health Act in regard to sexual and reproductive health care and especially abortion care. Canada has a law that governs access to abortion for its citizens and it is the Canada Health Act. The five principles of the Act provide solid grounds on which we can articulate what we want to see in Canada when it comes to access to abortion.
3. The Federal Government must create a permanent Sexual Health Transfer following the model of Canada’s Mental Health Transfer to assist jurisdictions to expand the delivery of high-quality and accessible sexual and reproductive health services, including abortion care. Through the Canada Health Act and the federal health care transfer system, the federal government can incentivize provincial action in support of greater abortion care, as well as penalize provinces that do not meet the standards of accessibility defined by the Act. Existing penalties have been insufficient to remedy existing access issues and so, we recommend strengthening measures to enforce the Canada Health Act. Moreover, the government should follow the model it has established for mental health transfers, and assign a ring-fenced sexual health transfer, appropriate to regional needs and in negotiation with the provinces and territories, to provide regular increased financial support to ensure all jurisdictions have the capacity to scale up sexual health service provision to meet the needs of their populations, including abortion services.
4. Regularize all undocumented migrants and establish permanent resident status for all 1.7 million people without it, recognizing that precarious immigration status is an ongoing barrier to abortion access.