Dozens of Canadian women travel to the U.S. every year for abortions paid for by their provincial governments, according to data obtained by Global News.
But as some states move to restrict and criminalize the medical procedure, experts say that could have a big impact on Canadian women by both limiting options for out-of-country care and potentially increasing wait times in Canada.
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“People who access abortion care, especially for later-term abortion care, they have to travel to the United States to do that,” said Frederique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.
“People go and seek them in the United States so if these services are not offered in the United States anymore, we’re going to see, effectively, a reduction in abortion access for Canadian people as well.”
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Neither Statistics Canada nor the Canadian Institute for Health Information maintains data on out-of-country abortions. Different provinces also have varying policies on whether they collect some, all or no information about such cases.
Ontario’s health ministry was the only province to provide Global News with detailed data on out-of-country abortions. The province covered abortion services in the U.S. for more than 100 women from 2014 to present. Those procedures added up to more than US$1.5 million.
This does not include women who go to the U.S. and pay the costs themselves.
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Under Ontario’s out-of-country medical program, abortion services are covered if the requested service is medically necessary, if the patient cannot get the procedure in Ontario or if waiting for the procedure in Ontario would result in death or irreversible harms.
A spokesperson for the Ontario health ministry said the fact that some women are being sent outside Canada for abortions does not mean there are gaps in abortion services in the province.
“There is no evidence that there are any system-wide issues with access to these procedures in the province,” spokesperson David Jensen wrote in an email. “The need for the province to fund out-of-country therapeutic abortions is limited, and the reasons for accessing this procedure out of country vary for each individual.“
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Yet experts disagree, saying the fact that even a small number of Canadian women have to go south of the border for abortions points to gaps in availability in the province.
Though the Ontario data does not break down the data based on the type of abortion, they are likely for third-trimester abortions.
“When women have abortions in the last trimester, it’s usually because of a very serious medical situation for the fetus or for themselves,” said Christabelle Sethna, a professor at the Institute of Feminist and Gender Studies at the University of Ottawa.
“What it means is that these women are not getting the kind of late-term abortion care in the province in which they reside.”
Sethna also said she was concerned about the out-of-pocket expenses these women would have to pay when accessing abortion services abroad, as the province covers only the medical procedure, not the extra expenses that come with it, such as accommodation, meals and time off from work.
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Sethna said the federal government has a responsibility to make sure provinces are providing the full spectrum of care and that Canadian women are not forced to go elsewhere for a legal medical procedure they should be able to obtain at home.
“It’s on the (Canadian) federal government to ensure that yes, the provinces are doing their duty and that access is actually access,” she said.
Part of the challenge is the restrictions and lack of access in Canada to late-term abortions, which the Canadian Medical Association defines as anything after 20 weeks of gestation, said Dr. Dustin Costescu, a family planning specialist with the Department of Obstetrics and Gynecology at McMaster University.
“When you’re talking about an abortion after 20 weeks, basically Vancouver, London, Ont., Toronto are the main centres that do these later abortions. A few smaller centres might do them, but they also wouldn’t advertise so it’s difficult for women to know where to access these services,” he said.
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While there is no legal limit on abortion access in Canada, hospitals do put their own regulations in place, which generally limit the procedure to being performed no later than 24 weeks, which is considered the point of viability.
Though performing an abortion after that is not illegal, ethical concerns and lack of physician training can make the procedure extremely difficult to access, Costescu said.
A spokesperson for the B.C. health ministry said that while the province does, in rare cases, refer women for abortions past 18 weeks to the U.S., it could not release those numbers for privacy reasons.
“There are rare situations where, on the advice of a physician or the Comprehensive, Abortion Reproductive Education (CARE) Program at B.C. Women’s Hospital, a patient may be referred for a medically necessary abortion. When a mother’s health is a concern, the physician may refer her to a medical clinic in Washington state for a late-term abortion,” said Stephen May, a spokesperson for the B.C. ministry.
“We are not able to provide the number of out-of-country referrals as the number is so small that there would be privacy concerns.”
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RAMQ, the Quebec health ministry, referred questions to the Centre intégré universitaire de santé et de services sociaux in Montreal, which then said it did not maintain data on Quebec women who go to the U.S. for abortions past 20 weeks of gestation.
Past reporting by the Montreal Gazette has suggested anywhere between 17 and 42 Quebec women go south for late-term abortions each year.
Neither department responded to followup requests to verify those reported numbers.
In Manitoba, a provincial spokesperson said it was “not possible” for the province to break down the numbers on residents accessing out-of-province or out-of-country care, noting residents do not need to notify the health ministry there to do so.
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The Saskatchewan Ministry of Health said it covers the cost of residents obtaining late-term abortions outside of Canada and that it has done so for fewer than five patients in total. Residents are referred for out-of-province care first before they would be referred to the U.S., and even then, the costs would only be covered in exceptional circumstances where late-term abortion is deemed medically necessary and is not available in Canada.
Nova Scotia, New Brunswick and Newfoundland do not cover the costs of out-of-country abortions and so do not maintain statistics on them.
Health PEI said it has not provided any referrals for out-of-country abortions.
Alberta’s health ministry did not respond to a request from Global News.