“Honestly when you called me I said, ‘Why, you know, why write about abortion, why write about it in Quebec?’” said France Desilets, director of Montreal’s Morgentaler Clinic. “We don’t want to focus on it, in the sense that access has been achieved in reproductive choices, but we still need to talk about it. I mean, we can’t make it a taboo subject.”
Abortion is a divisive topic, often caught between two passionate crusades. Consequently, it can sometimes be difficult to find space to talk about the issue, but university students and young people are in a unique position to change the conversation. With International Women’s Day on March 8, there are opportunities to be involved with the celebration and reflect on the state of women’s rights and reproductive choice. This year’s theme, #BeBoldForChange, emphasizes the importance of change for forging a more inclusive and equal future.
“This day is a great opportunity for university students to engage in an inclusive dialogue about the right to abortion access for people of all genders and orientations,” said Dr. Sarah Munro, a post doctoral fellow in the Department of Family Practice at the University of British Columbia (UBC).
Historically, university students have played an important role in leading conversations about abortion in Canada. In 1968, McGill undergraduate students Allan Feingold and Donna Cherniak illegally produced and published the seminal “Birth Control Handbook,” as a result of a motion passed by the Students' Society of McGill University (SSMU). Distributed on college campuses across North America, the handbook provided answers on sex education and reproductive health—including information about abortions—for an information-starved audience.
Access to information and discussion are key components in reproductive health. However, as one of his first executive orders, U.S. President Donald Trump reinstated and expanded a controversial global gag rule eliminating funding for global organizations that provide information about abortions. The gag rule has been criticized by many worldwide, who think that impoverished women will face the brunt of the policy’s impact. In response, on March 2, Canada pledged to donate $21 million to international organizations to fund reproductive health services, including abortion.
Presumably, Trump’s policy was put in place to limit the number of abortions. The truth of the matter is that in order to decrease the number of abortion, conversations about abortions and why women get them, need to continue. Not talking about abortions doesn’t mean they won’t happen.
“In abortion literature, there’s something they call ‘decision certainty,’” McGill Department of Epidemiology PhD candidate Nichole Austin explained. “If a woman is pregnant and decides to terminate the pregnancy, she will typically find a way to do it [….] These women will always seek abortions out if they need them, it’s not a question of getting rid of that need.”
In order to reduce the number of abortions, it’s necessary to decrease the number of unwanted pregnancies. This requires widespread open knowledge of and access to contraception.
“I think people often focus on abortions and how many abortions there are, but they don’t consider why there are so many unplanned pregnancies,” said Desilets.
Unless contraceptive measures are available and accessible, unwanted pregnancies—and abortions by extension—will continue to occur. Trump’s global gag rule is antithetical to this strategy of contraception access. Not only will the policy reduce funding to family planning non-governmental organizations, it will decrease funding for all global health organizations that receive any U.S. funding. This includes organizations that aim to bolster contraceptive access and information.
While Canada’s southern neighbour has been embroiled in a high-profile and relentless fight over freedom of choice, the issue of abortion in Canada has not made nearly the same number of media headlines. However, while the battle scars may not be as fresh, that’s not to say the struggle for abortion rights wasn’t hard-fought.
In Canada, abortions—along with the sale, distribution, and advertisement of contraceptives—were illegal under the Criminal Code until 1969, when the former prime minister Pierre Trudeau’s Liberal government amended the code to decriminalize contraception and legalize abortion under strict provisions. At this point, abortions were illegal except in cases when pregnancy endangered the life of the pregnant woman. Moreover, these provisions meant the procedure could only be performed in hospitals, and only if the woman received approval from a Therapeutic Abortion Committee (TAC). These tribunals required three medical doctors—nearly always men—to decide whether the abortion was justified or not.
The TACs led to unequal access to abortion across Canada as hospitals were not required to have these committees on hand. By the mid-1970s, only 20 per cent of hospitals had formed a TAC, hindering the possibility of a legal abortion for the majority of Canadians.
Enter Dr. Henry Morgentaler, the namesake for the Morgentaler Clinic. After immigrating to Canada from Poland following the Second World War, Morgentaler opened a medical practice in the east-end of Montreal.
There, he became one of the first doctors to perform vasectomies, insert intra-uterine devices (IUDs), and provide birth control pills—even to unmarried women, something that was unheard of at the time. For Morgentaler, a survivor of the Dachau concentration camp, anti-abortion laws were unjust because they placed unnecessary burden and suffering on women seeking abortions. After illegally opening an abortion clinic in Montreal in 1969, Morgentaler faced multiple legal charges and was jailed three times between 1970 and 1984.
Across Canada, abortion became part of a larger public conversation over reproductive health and women’s rights. By 1983, public opinion was shifting: Seventy-two per cent of Canadians believed the pregnant woman and her doctor should have the sole responsibility for deciding whether the pregnancy should be terminated.
In 1988, the Supreme Court of Canada struck down the restrictions on abortions, including the TACs, in its R v. Morgentaler decision. With the decriminalization of abortion, Canada is one of the only countries in the world without a law restricting the procedure.
“There isn’t a law in Canada. Since the R v. Morgentaler [decision], there is no legal document surrounding abortion saying when can a woman abort—there’s nothing like that. It’s between a woman and her doctor,” Desilets said. “You know, it didn’t happen overnight. There were fights and there were struggles, but for a long time now it has been accessible for women in most provinces, particularly in Quebec, which has, I would say, the most points of access in the entire world.”
In addition to being Morgentaler’s home base, Quebec also had a powerful feminist movement and political support in the ‘70s and ‘80s. Today, there are over 50 points of service in the province, according to Desilets, largely as a result of these factors. However, like many services in Canada, there still exists an accessibility gap between urban and rural regions. Moreover, issues of misinformation and procedure choice in Canada are still germane.
“I think a lot of people, when they first start learning about abortion trends, are surprised to learn how common it is,” Austin said.
While abortion rates are declining in the U.S., according the Guttmacher Institute, an estimated 30 per cent of American women will have an abortion by age 45. Yet, it is difficult to make these kinds of statements in the Canadian context, as the States has much more robust data collection requirements.
Munro works on the national Contraception and Abortion Research Team (CART) at UBC, in Vancouver, and uses data on abortion rates for her research on patient-centred interventions.
“Approximately 31 per cent of Canadians will have an abortion in their lifetime,” Munro said. “This data comes from Statistics Canada, but the estimate may be low for two reasons. First, people may underreport their personal history of abortion at the time they are seeking one. Second, Statistics Canada does not capture data for approximately 10 per cent of abortions.”
Not all abortions are reported in official data collection. Clinics, as opposed to hospitals, are not required to disclose the number of abortions they perform. In Quebec, the majority of abortions are performed in freestanding clinics, or CLSCs. As a result, the statistics gathered by the Canadian Institute for Health Information (CIHI) are woefully inaccurate. Moreover, medical abortions are not included in CIHI’s official data count.
Medical abortions refer to a combination of medications a person can take to terminate a pregnancy. While medical abortions are available in over 60 countries worldwide, Myfegymiso (mifepristone), also known as RU-486, has only recently been approved by Health Canada, after spending nearly three years in the approval process. As of January 2017, Myfegymiso is available in only a few provinces—not including Quebec, despite its listing on the World Health Organization’s index of essential medicines.
“I think women need to know that it’s not just a pill that magically makes a pregnancy go away,” Desilets cautioned. “[But] it’s going to help women all over Canada in terms of access, especially in the rural regions and it’s going to provide women with another option.”
While many women experience considerable side-effects after taking the “abortion pill,” it is a vital service—especially for women who are in the early stages of pregnancy or women who have difficulties accessing a clinic.
Many medical professionals and consumers have criticized Canada’s slow adoption of the drug and its uncoordinated efforts to release it.
“Governments can support abortion access by making it easy for family physicians to offer medical abortion,” Munro said. “The way the drug has been rolled out has caused confusion in the medical community about where to get the training, how to order the drug from the manufacturer, and how the drug is covered by health care plans.”
Melissa Fuller, founding member of the newly-formed Montreal Abortion Access Project (MAAP), explained that while abortion may be accessible on an institutional level, there is still room for improvement when it comes to enhancing an individual’s experience and access to information.
“While abortion is accessible in the sense that it is covered by RAMQ [Quebec Health Insurance Plan], and there are several public and private sites in the city, there are many misconceptions about access and abortion procedures,” Fuller explained. “Too much [responsibility] is put on the individual to inform themselves.”
Without a centralized resource, public information can be hard to find, making it difficult for women to make an informed decision on where to go and what to expect. Furthermore, for individuals who are in Quebec, but aren’t covered by RAMQ, Fuller explained that it can be really difficult to locate the needed resources. MAAP seeks to address these issues by offering education and information on rights to access, abortion providers and procedures, and support before, during, and after an abortion at no cost.
Fuller highlights that it is easy to lose sight of the individual in these discussions. Listening to people’s experiences and finding space to talk about abortion is critical for furthering the dialogue and promoting a culture for freedom of choice.
“Conversations about abortions tend to get stuck in the hypothetical, which often means failing to see or make space for the people who have direct experience with abortion,” Fuller said. “I think a great place to start is working on the stigma that continues to be associated with abortion.”
Despite these challenges, the state of abortion access in Canada does not face the same kind of existential threat that is prevalent in the U.S..
“I don’t see how we could go back in terms of access and in terms of care,” Desilets said. “So, issues surrounding abortions are going to pop up, but I think we have the political, institutional, and societal support to make sure that nothing makes us regress with the rights that we have achieved.”
Nevertheless, the dialogue on abortion, in the context of women’s health and right to choose, has many opportunities to evolve. While Quebec has made a lot of progress, it can continue to serve as a model by pushing past decriminalization and onto the equally difficult process destigmatization.
If you are interested in learning more about local resources contact:
The Montreal Abortion Access Project at [email protected]
The Union for Gender Empowerment, at their office in the SSMU building, has a resource library on abortion services on campus.