By Nancy Janovicek, Christabelle Sethna, Beth Palmer, and Katrina Ackerman
International Travel and Access to Abortion
Travelling to the Montreal Morgentaler Clinic
Defending access in rural communities
Anti-Abortion Campaigns in New Brunswick
Access to Abortion Services Today
On July 18th, the Morgentaler Clinic in Fredericton performed its last abortion. Without government funding, and the generous support of Dr. Henry Morgentaler, the clinic is no longer sustainable financially. The closure of this clinic is a reminder that although abortion is legal in Canada, there are still significant disparities in timely access to abortion services. The closure of the clinic is part of a long history of women’s access to abortion services at the local level before and after the legalization of abortion in 1969 and the decriminalization of abortion in 1988. The lack of access at the local level has a major impact on obtaining an abortion in much wider contexts because women have tended to travel to other jurisdictions for pregnancy termination. Travel is one of the main barriers to access to abortion. Yet travel is often the only way women can access abortion services. In this essay, we use four responses drawn from an article we published in Labour/Le Travail that examines Canadian women’s transnational travel for abortion services as well as their attempts to defend access in their home communities.
In the 1960s, various Western nations began liberalizing their own abortion laws. At the same time, the expansion of airline companies, cheaper international flights and middle class disposable incomes made international organized tourism affordable for those living in the West. Canadian women who could manage the cost travelled alongside tourists to countries like Britain, Japan, Mexico, and Sweden to access abortion services abroad because they were illegal in the country. The Canadian Liberal government finally legalized abortion in 1969. But under the new law, which went into effect that August, legal abortions could take place only under strict conditions. A physician had to refer a woman seeking an abortion to a Therapeutic Abortion Committee (TAC) based in an accredited hospital. Composed of three to five doctors, the TAC determined on a case-by-case basis whether the continuation of a woman’s pregnancy constituted a threat to her life or health. However, hospitals were not obligated to strike TACs, the word “health” was never defined, and most of the hospitals with TACs were concentrated in urban centres. TAC approval proved to be such a time-consuming, arbitrary and demeaning process that even after the legalization of abortion in Canada, women continued to travel to other countries to access abortion services.
In 1977, the Badgley Report, which investigated the operation of Canada’s 1969 abortion law, found that the number of deaths caused by abortion had decreased. However, only 20.1 percent of Canada’s public hospitals had established TACs, creating significant regional disparities in access to abortion services. Wait times for a TAC-approved abortion averaged eight weeks, thereby increasing the medical risks associated with later-term abortions. The report conceded that Canadian women’s visits overseas slowed after 1969 due to the emergence of “abortion referral pathways” to the United States. These pathways were deployed when physicians refused to refer women to TACs, women could not satisfy TAC requirements, or when TACs deluged with abortion requests could not meet the demand.
Women’s ability to successfully navigate the restrictions created by the 1969 law were hampered by factors such as their socioeconomic statuses, racial and ethnic backgrounds, marital statuses and regional locations. Within Canada, women who lived on the margins were less likely to receive TAC approval for an abortion. Even the number of children a woman already had could affect the decision of a TAC. In response, women’s groups took up the daunting task of abortion referrals. They coached women through TAC requirements at individual hospitals, or contacted cross-border organizations, networking women through abortion services in the United States, or sending them to domestic physicians such as Dr. Henry Morgentaler, who provided abortions at his Montreal clinic. When Morgentaler came out publicly in favour of abortion in 1967, he was besieged with requests from desperate women seeking abortion services. The abortions he provided were illegal according to the 1969 abortion law because they were neither TAC-approved nor performed in an accredited hospital. Despite the illegal status of Morgentaler’s abortion services, his clinic was popular. The examination and abortion were often done on the same day under hygienic circumstances and in a non-judgmental fashion that made the women feel safe and comfortable.
As it became increasingly clear that abortion services were inaccessible to many women, grassroots networks and women’s groups assisted women seeking abortion services. This assistance grew organically, as was the case in Kingston, Ontario. A street health clinic began running an ad-hoc abortion service. Marginalized women were most reliant on this service. For example, a woman incarcerated at the Kingston Penitentiary was pregnant and wanted an abortion. She contacted the street health clinic, which set up an appointment with the Morgentaler clinic in Montreal when she was able to get a day pass. Volunteers then picked her up at the penitentiary, drove her to Montreal, and then drove her back to the penitentiary before curfew. The urgency of this woman’s situation was compounded by the fact that she was in prison. Like other women who used grassroots services, she too had few social and personal support systems. Clients of the shuttle service believed that a TAC would deny them a legal abortion or that they would be unable to go through the process required for TAC approval.
Over the decades, Morgentaler established abortion clinics in cities across the countries and challenged laws that restricted access to abortion services. Nevertheless, access to abortion services in clinics and hospitals remained a challenge because of the rise of anti-abortion activism. Anti-abortion activists harassed clinic staff and patients and sometimes resorted to violence. Another tactic anti-abortionists used to restrict access to abortion at the local level was to elect anti-abortion candidates to hospital boards with the goal of dismantling TACs. As the Badgely Report found, women living in rural communities faced the most significant barriers to accessing abortion services because many hospitals in their communities refused to establish TACs. Women in rural areas were, therefore, compelled to travel long distances to the larger cities within their provinces for abortion services. Some women decided to go to freestanding abortion clinics in the United States because they were closer to home. In rural southeastern British Columbia, feminists joined forces with traditional women’s services to defend successfully abortion services at the Kootenay Lake District Hospital (KLDH) in Nelson from anti-abortion activists.
In the mid-1980s, an anti-abortion activist group, Nelson Future Life, ran a slate of candidates against experienced pro-choice board members at the hospital association’s AGM. Pro-choice activists were caught off-guard when three anti-abortion activists were elected. Anti-abortion activists were not a majority on the board, but pro-choice forces worried that they would be successful in the next election. They were also concerned about the harassment of women seeking abortion services at the hospital. Before this election, someone had leaked the names of women scheduled for an abortion to anti-abortion activists. Pro-choice activists founded the Nelson and District Pro-Choice group to maintain control of the hospital board. They established a travel fund for women who needed abortions in case they lost local services. In an attempt to win a majority on the hospital board, anti-abortion activists tried to prevent feminists, who had recently moved to the region as part of a back-to-the-land movement, from having a voice in the governance of the hospital. They also prevented hospital auxiliary women, who had volunteered in the hospital and held countless bazaars and bake sales to raise money, from representation on the board. Hospital auxiliary women agreed to cooperate with the Nelson and District Pro-Choice group so that they could elect pro-choice trustees to the hospital board and regain their voting privileges on the hospital board. The campaign worked. Ultimately, anti-abortion activists’ tactics did not significantly interrupt abortion services at the Nelson hospital because a coalition of pro-choice individuals and groups prevented them from gaining influential decision-making positions.
Throughout this campaign, pro-choice activists insisted that women living in rural areas had a right to access medically insured abortion services in their own communities. While pro-choice activists were able to defend access to abortion by mobilizing regional networks, they were aware that this localized attempt to restrict abortion services was informed by an international anti-abortion movement that was chipping away at women’s hard won reproductive rights.
In New Brunswick, it has long been difficult for women to obtain abortion services in public hospitals. Hoping to improve hospital abortion services, the province’s pro-choice forces were active in Planned Parenthood New Brunswick and the New Brunswick Advisory Council on the Status of Women in the 1970s and 1980s. However, anti-abortion activists lobbying the Progressive Conservative government to restrict abortion services proved to be more influential than feminist campaigns. They scored a victory early in the abortion debate when the Moncton Hospital, which performed two-thirds of the province’s abortions, responded to anti-abortion activism by placing a moratorium on abortion for six months in 1982.The Moncton Hospital re-established abortion services at the end of that year with the support of the Society of Obstetricians and Gynaecologists of Canada.
In 1985, the abortion debate intensified when Morgentaler publicly declared his intent to open a freestanding abortion clinic under New Brunswick Medicare. He laid out the advantages of a freestanding abortion clinic in the region, indicating that it would offer cost-efficiency to taxpayers and more accessibility for Maritime women. Premier Richard Hatfield rejected Morgentaler’s request and the government quickly passed Bill 92 to make abortions performed in non-hospital settings illegal. The passage of this legislation, which was deemed unconstitutional in 1994, was an unmistakable rout of pro-choice forces.
In New Brunswick, anti-abortion activism was motivated by an absolute conviction that life begins at conception. To attract the attention of both secular and religious-minded citizens, activists used controversial scientific evidence as well as human rights discourses to highlight the inhumane nature of abortion. Some members of the New Brunswick medical community sided with anti-abortion activists. While there are discrepancies in the abortion statistics compiled throughout the 1980s, the numbers indicate that abortion provision decreased substantially after the 1982 moratorium on abortions at the Moncton Hospital. In 1980, seven of the province’s thirty-four general hospitals had TACs and performed abortions. By 1984, Chaleur Hospital in Bathurst had stopped performing abortions and the Soldier’s Memorial Hospital in Campbellton had abolished its TAC. Between 1984 and 1987, New Brunswick women could obtain abortions at Dr. Everett Chalmers Hospital in Fredericton, Moncton Hospital, Oromocto Hospital, and Saint John Regional Hospital. According to statistics compiled before the New Brunswick government passed Bill 92, there were 449 abortions performed in 1980, 430 in 1981, 223 in 1982, 263 in 1983, and 267 in 1984. In addition to the decline in abortions provision, the government funded fewer out-of-province abortions throughout the 1980s.
The southern New Brunswick regions, where all legal abortions were performed, had the most out-of-province abortions between 1980 and 1985, meaning that women living in these regions were most likely to travel outside the province to access abortion services. Out-of-province abortions paid for by provincial Medicare occurred primarily in the United States and in the neighbouring province of Nova Scotia. New Brunswick hospitals denied at least 299 women therapeutic abortions between 1982 and 1986. In February 1988, the newly elected Liberal Government of Premier Frank McKenna conducted a preliminary report on the abortion issue and revealed that the majority of the women seeking abortion services in the province were single and aged between 15 and 24. The report indicated that the family planning clinics originally supported by the Hatfield government were ineffective at decreasing the need for abortion services.
Despite the fact that the Supreme Court of Canada struck down the abortion law in 1988, and abortion is considered a medically necessary procedure under the Canada Health Act, access to abortion services remains uneven throughout the country. A recent study mapping women’s travel to abortion clinics reveals that women in Atlantic Canada “have the lowest access to abortion services in the country.” Morgentaler opened the Fredericton Clinic in 1994 because Prince Edward Island (PEI) and New Brunswick place severe restrictions on women’s access to abortion services. Since it opened, the Fredericton Clinic has provided safe and timely abortion services for 10, 000 women from PEI and New Brunswick. Despite an active campaign led by young feminists, there are no abortion services on Prince Edward Island and its provincial government will pay only for abortion services provided in a Halifax hospital if the woman has a referral from a family physician.
The New Brunswick government has refused to cover abortions for women living in the province if they are performed at the Fredericton Morgentaler Clinic. Regulation 84-20 Schedule 2 (a. 1) of the Medical Services Payment Act states that provincial Medicare will only cover abortions provided in a hospital by a specialist in obstetrics or gynecology. More distressing is the stipulation that two doctors must certify in writing that the abortion is medically necessary, a restriction that is unconstitutional under the 1988 Supreme Court decision. Long wait lists for abortion services in publically funded hospitals in the province complicate matters. Women are faced with the option of travelling to Quebec, Ontario, or Maine for the procedure. However, women must pay for abortion services obtained outside the province because New Brunswick does not include abortion in its interprovincial reciprocal billing agreements. Morgentaler was involved in a decade-long court case against the government of New Brunswick to demand provincial health care coverage for clinic abortions but the case has been inactive since his death in May 2013.
News of the impending closure of the Fredericton Morgentaler Clinic mobilized pro-choice activists around the country to demand the removal of all barriers to abortion services. In April, Reproductive Justice NB launched the #SaveTheClinic campaign and slogan: “We have the law / We need the access.” The campaign has two goals: to repeal Regulation 84-20 and re-open the clinic. Social media has become an important tool for mobilizing national support to save the clinic. Insisting that all people have a right to autonomy over their body, activists sent tweets to MLAs who attended the anti-abortion New Brunswick March for Life Rally on May 15. Reproductive Justice New Brunswick organized a crowdsourcing campaign with the goal of raising $100,000 to secure the lease for the clinic while they explore other options to provide full reproductive services for women in the province. Within two weeks, they had reached their goal. They now hope to double the amount raised so that they can purchase the equipment in the clinic. The Fredericton Youth Feminists, a group of high school and university women, also organized a Pro-Choice Gala on July 25th to fundraise for the initiative. Sorcha Beirne, the Grade 11 president explains: “By Canadian law, we have the right to an abortion, and abortion is an important medical service, and if we don’t have the access to abortion, then we’re not getting the services we need.”
History has shown that women who are blocked from accessing abortion services at the local level will travel to other jurisdictions, often far away from their home communities. Therefore, inadequate access to abortion services in one region cannot be viewed in isolation as it impinges directly upon the availability of abortion services intra-regionally. Prime Minister Stephen Harper continues to insist that he will not reopen the abortion debate, although in 2010, Canada’s G8 global initiative on maternal and child health excluded funding for abortion. Politicians who give voice to anti-abortion sentiments compound the ongoing unevenness in abortion access. Member of Parliament Stephen Woodworth attempted in 2012 to introduce into Parliament a debate about the origins of fetal life. In the most recent example, the recently appointed Dennis Savoie as Canada’s envoy to the Holy See, who is a former executive from New Brunswick Power and a top official in the Knights of Columbus, compared the 3,000 deaths resulting from a terrorist attack in New York on September 11, 2001 to the number of abortions performed every day in North America. The closure of the Morgentaler clinic in New Brunswick should signal to the rest of Canada that access to abortion services should not be taken for granted anywhere in the country.
Nancy Janovicek is Associate Professor of history at the University of Calgary. Her research focuses on community politics, principally in rural areas. Her current SSHRC-funded research examines the back-to-the-land movement in the West Kootenays, British Columbia.
Dr. Christabelle Sethna is a historian and an Associate Professor in the Institute of Feminist and Gender Studies and the Faculty of Health Sciences, University of Ottawa. She does research in the history of sex education, contraception and abortion. With Dr. Marion Doull, she tracked and mapped the journeys women undertake to abortion services in Canada. This first time study, which involved women’s travel to Canadian abortion clinics, was funded by the Social Sciences and Humanities Research Council of Canada.
Beth Palmer’s PhD explored the pro-choice movement in Canada from 1969 to 1988. She now lives in Ottawa, where she works in politics and is the Vice President of Planned Parenthood Ottawa.
Katrina Ackerman is a doctoral candidate in history at the University of Waterloo. A portion of this piece was based on her Master’s research and published in the article “’Not in the Atlantic Provinces’: The Abortion Debate in New Brunswick, 1980-1987,” Acadiensis 41, 1 (Winter/Spring 2012).
Katrina R. Ackerman, “‘Not in the Atlantic Provinces’: The Abortion Debate in New Brunswick, 1980-1987,” Acadiensis, XLI, 1 (Winter/Spring – Hiver/Printemps 2012): 75 – 101.
Joyce Arthur, Exposing Crisis Pregnancy Centres in British Columbia. Vancouver: Abortion Rights Coalition of Canada (ARCC), 2009.
Janine Brodie, Shelley A.M. Gavigan and Jane Jenson, The Politics of Abortion. Toronto: Oxford University Press, 1992.
Canadian Abortion Rights Action League (CARAL), Protecting Abortion Rights in Canada: A Special Report to Celebrate the 15th Anniversary of the Decriminalization of Abortion: Full Report. Ottawa: CARAL, 2003.
Catherine Dunphy, Morgentaler: A Difficult Hero. Toronto: Random House of Canada, 1996.
Nancy Janovicek, “Protecting Access to Abortion Services in Rural Canada: A Case Study of the West Kootenays, British Columbia.” Magazine of Women’s History 73. Special Issue on Abortion. (Autumn 2013): 19-28.
Beth Palmer, “‘Lonely, tragic, but legally necessary pilgrimages’: Transnational Abortion Travel in the 1970s,” Canadian Historical Review, 92, 4 (December 2011), 637 – 664.
Angus McLaren and Arlene Tigar McLaren, The Bedroom and the State: The Changing Practices and Politics of Contraception and Abortion in Canada, 1880-1997. Toronto: Oxford University Press, 1997.
Christabelle Sethna and Marion Doull, “Spatial Disparities and Travel to Freestanding Abortion Clinics in Canada.” International Women¹s Studies Forum 38 (2013): 52 – 62.
Christabelle Sethna, “All Aboard? Canadian Women¹s Abortion Tourism, 1960-1980,” In Gender, Health and Popular Culture, ed. Cheryl Krasnick Warsh. Waterloo: Wilfred Laurier University Press, 2011: 89 – 108.
Jessica Shaw, Reality Check: A close look at accessing abortion services in Canadian hospitals. Ottawa: Canadians for Choice, 2007.
A longer version of this article was published as: Christabelle Sethna, Beth Palmer, Katrina Ackerman, and Nancy Janovicek, “Choice, Interrupted: Travel and Inequality of Access to Abortion Services since the 1960s,” Labour/Le Travail 71 (Spring 2013), 29-48. We thank journal editors Bryan Palmer and Alvin Finkel for granting us permission to republish some of this article in this piece.
Christabelle Sethna and Marion Doull, “Spatial Disparities and Travel to Freestanding Abortion Clinics in Canada,” International Women’s Studies Forum38 (2013), p. 59.
For more information, read the Fact Sheet on Access to Abortion in NB.