Is Canada too 'smug' about abortion? These doulas say access is worse than you think
Canadian women face many barriers to abortion access, including money and geography
A pair of abortion doulas in southwestern Ontario say Canadians shouldn't take access to safe, legal abortions for granted because there are still barriers to care that are difficult to overcome, including time off work, a lack of financial resources and the distance from urban-centred clinics.
Christal Malone of London and Jennifer Surerus of St. Thomas help make access to safe abortions as seamless and easy as possible for people across the country.
Unlike doctors or nurses, their roles stop short of medical care. Instead, they provide physical and emotional support that runs the gamut from picking someone up from the airport to holding a thermometer in their mouth, even just giving someone a shoulder to cry on.
"We are trying to support people to make the choices they need, and we are not trying to persuade people to do anything," said Surerus. "Often people don't have [support] from family and friends."
Abortion is legal, but access a problem
Unlike the United States, where the legal landscape of abortion is undergoing a radical shift following the landmark Supreme Court ruling that struck down a constitutional right to abortion for the first time in 50 years, Canada has no laws restricting access to the procedure.
In this country, abortion is legal, regardless of the reason. The procedure is also publicly paid for through a combination of the federal and provincial health systems, but just because it's not illegal in Canada doesn't mean Canadians should take it for granted, Surerus said.
"I think we're a little too smug here. Transportation, child care, being able to get time off work — that all plays into the access equation."
It's a problem all over the country, but perhaps the most acutely felt in Canada's Atlantic region, where restrictions to abortions are the highest, and the federal government has withheld health-care funding to provinces that didn't provide adequate access.
In Ontario, 21,428 abortions were performed in 2020, according to the Abortion Rights Coalition of Canada. More than 15,000 of them were done at private clinics, while just over 5,000 were at the province's hospitals.
Urban and rural divide
Despite the number of procedures, disparities exist between urban and rural areas in Ontario, Alberta, Saskatchewan and Manitoba, where abortion services are only in urban settings, despite 35 to 40 per cent of the population living in rural or remote communities.
The charity says more than half of its callers need help with costs of flights, accommodations and other travel expenses, citing the place where they live as the biggest barrier to accessing safe care.
"It's pretty dire," said Malone. "It is very hard to access an abortion if you live in a rural area, and it is very time-consuming and expensive to access certain types of abortions."
Even in Malone's hometown of London, a city of more than 400,000, there is only one clinic. It serves a huge catchment in southwestern Ontario as well as people as far away as Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick — provinces where access to abortion is the most restricted.
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When a patient does get to the London clinic, the person must attend a minimum of three appointments before health-care workers will agree to perform the procedure.
"It can be really challenging to get the time off work, or to get transportation, and a lot of them start early in the morning. So if the person is not local, they have to come the day before to access the service," Malone said.
Pro-choice charities such as Action Canada step in to help fill the financial gap and help connect people seeking an abortion with doulas like Surerus and Malone.
In Ontario, there are nearly double the number of crisis pregnancy centres. at 77, compared to 38 hospitals and clinics that provide abortion access, according to Action Canada.
"The anti-choice is strong here, and there is a political component to it," Surerus said.
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