When there are no abortion laws: A case study of Canada

Abstract

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political and policy events prior to and since decriminalization. We explore implications for clinical care, health service and systems decisions, health policy and the epidemiology of abortion in the absence of criminal legislation. Since the criminal abortion law was struck down dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

Leadership for success in transforming medical abortion policy in Canada

“…In Canada, abortion was decriminalized in 1988, and it remains the only country in the world to have fully enacted decriminalization. [1,2] There are currently no Canadian criminal laws restricting abortion access. For example, this includes that Canada has no criminal law stipulating restrictions on gestational age and there are no criminal laws which require authorization from a medical board, or a specified number or type of physician, prior to obtaining a procedure.…”

“…For example, this includes that Canada has no criminal law stipulating restrictions on gestational age and there are no criminal laws which require authorization from a medical board, or a specified number or type of physician, prior to obtaining a procedure. [2] In Canada, abortion care is regulated as any other medical service; governed by provincial health professional regulators and health system authorities. Following decriminalization there was an attempt to restrict access through provincial channels, but currently the only regulations that exist are designed to improve access to abortion services.…”

“…Following decriminalization there was an attempt to restrict access through provincial channels, but currently the only regulations that exist are designed to improve access to abortion services. [2] Despite this, The UN Human Rights Commissioner's report identified that access to abortion in Canada is known to be unequally distributed. [3] This inequity is caused by the monetary cost of some abortion services, the challenges with awareness of how to access services and the geography of providers.…”

“…[3] This inequity is caused by the monetary cost of some abortion services, the challenges with awareness of how to access services and the geography of providers. [2] The majority of providers are located in urban centres and there is minimal provision in rural and remote locations. [4] Due to this clustering of providers, individuals seeking abortion care who do not reside in these urban centres must travel to access care, resulting in increased time away from work, family obligations, social supports, as well as substantial monetary costs for travel and accommodation.…”

Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

“…Abortion health services are safe, common, and legal in Canada [1]. The rate of induced abortion is approximately 14-15/1000 females aged 15-44, annually [2,3]. In Canada, abortion is a publicly funded service.…”