The number of Canadian women going south of the border to receive medically necessary abortions has dropped during the COVID-19 pandemic, according to data from the Ontario government and a sexual health expert who says her organization has seen a drop.
Over the last five years, dozens of Canadian women primarily from Ontario have been referred each year to doctors and clinics in the United States to receive medically necessary abortions they cannot access at home, which are covered under their provincial health-care plans.
But between March 15, 2020, and April 31, 2021, just 11 Ontario women were approved through the out-of-country medical program to receive medically necessary abortions in the U.S. — a drop of roughly half compared to the annual numbers for each of the previous five years.
Ontario does not collect data on the reason but experts say these numbers typically represent the rare cases where late-term abortion is needed due to a serious medical situation for the mother or the fetus.
The overwhelming majority of abortions take place during the first trimester, before the 12-week mark, according to annual data collected from hospitals and clinics by the Abortion Rights Coalition of Canada.
Frédérique Chabot, director of health promotion with Action Canada for Sexual Health and Rights, said the pandemic has made it more challenging for Canadian women who have to travel to access abortion.
She said that challenge extends to women having to travel between provinces as well.
“There’s a few centres in Canada that have later care — Vancouver, Toronto, Montreal, London, Ont. — and we’ve seen fluctuating rules in terms of who’s allowed to access care there,” she said, pointing to provincial travel restrictions and health-care systems already straining to care for COVID-19 patients.
“For those who need to travel to the United States, we’ve seen less people able to do so.”
Between June 1, 2019, and April 30, 2021, Ontario’s out-of-country medical program covered 36 out-of-country abortions — 25 of those in the 10 months prior to the pandemic-associated travel restrictions imposed during the week of March 15, 2020.
One Ontario government official told Global News that the COVID-19 pandemic has caused a drop in applications for all categories of out-of-country health services, but that they could not say with certainty whether drops in applications for specific services were due to the pandemic or other possible reasons.
The number of applications for out-of-country abortions in the 10 months prior to the pandemic appears to suggest that the numbers have been largely consistent up until COVID-19 hit.
Ontario has covered the medical expenses for more than 100 women who meet the criteria for medically necessary abortions in the United States since 2014: 33 in 2014-15, 26 in 2015-16, 20 in 2016-17, 25 in 2017-18 and 26 in 2018-19.
Ontario is the only province that maintains detailed data on out-of-country medically necessary abortions. Quebec, Manitoba, Nova Scotia, New Brunswick and Newfoundland do not track that data.
A spokesperson for the B.C. health ministry did not respond to a request for comment by publication.
Prince Edward Island has not had patients requiring referral to the U.S. during the pandemic, but has referred “a very limited number” to other provinces during that time without issue, said Janice Skeffington, program director for the province’s women’s wellness program.
Chabot noted that while out-of-country or out-of-province health programs pay the cost of the procedure in cases of medically necessary abortions, the cost of getting to the other province or the U.S. is on the patient — or, often, charities that help.
“Even when borders are not closed, there’s challenges in terms of travel. Financially, people have to arrange their own travel, pay for their own travel and take several days off work to be able to move across provinces, across borders to access care,” she said.
“People are having a really hard time to do that this year, more so than in other years. And also, the simple logistics of travelling right now are incredibly difficult.”
She added the costs of helping women in Canada travel to access abortions, both interprovincially and into the United States, typically add up to roughly $50,000 each year for groups like Action Canada.
Canadian provinces and territories confirmed abortion remains and will be treated as an essential service throughout the pandemic at the outset last spring.
Since then, access has remained a longstanding challenge, particularly for women in remote or rural communities and those who want or require a surgical abortion, as noted in the journal Canadian Family Physician, published by the College of Family Physicians of Canada.
At the same time, virtual and telemedicine have made it easier for some to access the abortion pill, which is a combination of two drugs marketed in Canada under the brand name Mifegymiso.
The Society of Obstetricians and Gynecologists of Canada also rolled out new protocol in April 2020 specifically about best practices for prescribing the abortion pill through telemedicine during “pandemics and periods of social disruption.”
Lack of access to abortion and the financial costs of having to travel to obtain abortions were both among priorities outlined by the federal government in Budget 2021.
The government committed $45 million over three years to community organizations working to increase access to sexual health care, and specifically included those groups “providing travel and logistical support to individuals who have to go long distances to access abortion care.”
The budget also included $7.6 million over five years for Statistics Canada to develop and roll out a national survey on sexual and reproductive health, aimed at gathering information about what other support is needed to ensure access to care and services.
Chabot said that leaves her feeling “optimistic.”