by Ilakkiah Chandran

Graphic design by Josip Petrusa

Imagine being wheelchair-bound inside a burning building. As smoke starts to fill the air, you and others in the building rush to the brightly lit emergency exit. When you get to it, you discover that the only way to reach the door is by climbing a steep staircase. There is no ramp, no elevator and no alternate route. As people rush past you and exit out this door to safety, you become aware of the barrier in front of you, as, despite the door not being locked or blocked, you physically can’t access it. As the smoke grows thicker, even with the legal right to escape, and the door being right in front of you, the barrier of the stairs makes safety impossible for you.

With abortion existing within policy, but missing in practice, the inability to reach the emergency exist, is what access to abortion services feels like for many Canadians, with care being too far, the wait being too long, and the system being too hard to navigate. This gap reflects the limitations of our healthcare system, impacting those of marginalized communities to an even greater degree.

In Canada, abortion has been legal for over 55 years, meaning that at the federal level, there are no laws restricting a Canadian’s legal right to abortion access.¹ However, the availability of abortion services is often impacted by geographic distance, longstanding medical discrimination, and policy gaps. In urban regions across Canada, accessing abortion services is typically straightforward, but this isn’t the case in rural areas. For example, a Canada-wide national survey conducted in 2012 identified that, with the exception of Quebec and British Columbia, abortion services were largely concentrated within cities.² Furthermore, even in the absence of geographic barriers, practitioners in rural regions of Canada were far more likely to describe hesitation from their colleagues that impacted their ability to provide surgical abortions.³ This means that individuals living in remote or rural areas are faced with the choice of experiencing stigma or ambiguity from their care team when seeking abortion services, or taking time off work, arranging travel, finding childcare, and navigating unfamiliar healthcare facilities—all while managing an experience that is overwhelming both physically and emotionally.

This issue goes beyond inconvenience; it is a growing public health concern that has been overlooked for decades. Limited availability of abortion care leads to increased wait times and delays in receiving medical attention. Delays in abortion care increase the physical and emotional toll on patients.⁴ In some cases, this may also lead to some people being forced to carry pregnancies they did not choose, which is associated with poor mental and physical health outcomes, increased exposure to domestic violence, and long-term financial insecurity.^4–6

Although the impact of restricted abortion services on marginalized populations is better explored in the United States, investigations of reproductive health in Canada suggest similar findings, with Indigenous women, racialized individuals, people with disabilities, individuals from the 2SLGBTQIA+ community, and immigrants facing disproportionate barriers to all forms of reproductive care, including abortion. With higher rates of medical discrimination and stigma experienced by these individuals when seeking healthcare, the impacts are compounded when receiving abortion services.^7,8 For example, in Indigenous communities, abortion must be understood within the context of ongoing reproductive injustice. The legacy of forced sterilizations, persistent failures in culturally safe care with prioritization of Westernized practices, and the lack of post-abortion support has eroded trust in health institutions. This history limits not only the availability of abortion services but also affects individuals’ willingness to seek out and trust the care they are offered, especially when faced with dismissal or stigma.^9,10  Immigrant women face similar challenges, encountering a lack of culturally affirming care and often having to choose between Westernized practices or their own cultural values and beliefs when making decisions about their reproductive health.⁸ Furthermore, their experiences are often impacted by the lack of support available in their native languages, and restrictions based on their citizenship status.⁸ Moreover, many non-binary Canadians report feeling pressured to conceal their gender identities when navigating reproductive care, to avoid denial and refusal in receiving medical attention.¹¹ Labelling abortion facilities as “women-only spaces” can create significant barriers to transgender inclusivity—frequently excluding trans women and girls, and trans men and boys who wish to use available services as a result of discrimination and stigma.¹²

Despite the long history of medical discrimination and its impacts on health outcomes, abortion continues to be treated as a politically sensitive topic rather than a medical necessity. This framing not only perpetuates limited access to services but also restricts the public’s exposure to accurate information, contributing to the growing infodemic of abortion misinformation.¹³ The exacerbation of misinformation—like that abortions exacerbate cancer risk or infertility, and pose psychological risks—underscores the importance of acting now.^14,15

Abortion should be treated like any other essential healthcare service to be safe, evidence-based, timely, and accessible. Strategies explored in the US, such as dispensing mifepristone—a common medication used for abortion—through telemedicine and by pharmacists, have been associated with an increase in efficient and patient-oriented abortion care.¹⁶

In other cases, engaging directly with communities, expanding education on traditional and Westernized practices of abortion care within medical teams, and acknowledging the role of remote abortion clinics can help address limited access while ensuring sensitivity around the topic. Moreover, recognizing that abortions are not simply a one-time procedure but one that requires follow-up care can support those accessing services in navigating their physical and mental health throughout the process.

There is no single solution that will fix every barrier. However, we need to stop pretending that legality is equivalent to accessibility. We need to recognize that abortion services in Canada are not equally distributed, with individuals who are already experiencing marginalization by other structures within Canada also being more likely to experience barriers limiting their ability to use abortion services.

Abortion is not just a private matter, nor is it an issue that only affects some individuals. Abortion services are integral to health and require consideration of health and equity, to ensure that every Canadian can receive the care they need.  

References

1.    Public Health Agency of Canada. Abortion in Canada. Government of Canada (2024).

2.    Norman, W. V et al. Abortion health services in Canada: Results of a 2012 national survey. Can Fam Physician 62, e209–e217 (2016).

3.    Norman, W. V., Soon, J. A., Maughn, N. & Dressler, J. Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS). PLoS One 8, e67023 (2013).

4.    Wasser, O., Ralph, L. J., Kaller, S. & Biggs, M. A. Experiences of delay-causing obstacles and mental health at the time of abortion seeking. Contracept X 6, 100105 (2024).

5.    Wallace, M. E., Stoecker, C., Sauter, S. & Vilda, D. States’ Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20. Health Aff (Millwood) 43, 682–690 (2024).

6.    Wisner, K. L. & Appelbaum, P. S. Abortion Restriction and Mental Health. JAMA Psychiatry 80, 285 (2023).

7.    Coen-Sanchez, K. et al. Reproductive justice in patient care: tackling systemic racism and health inequities in sexual and reproductive health and rights in Canada. Reprod Health 19, 44 (2022).

8.    Machado, S., Wiedmeyer, M., Watt, S., Servin, A. E. & Goldenberg, S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008–2018). J Immigr Minor Health 24, 256–299 (2022).

9.    Monchalin, R. et al. “I would love for there not to be so many hoops … ”: recommendations to improve abortion service access and experiences made by Indigenous women and 2SLGTBQIA+ people in Canada. Sex Reprod Health Matters 31, (2023).

10.  Monchalin, R. et al. A qualitative study exploring access barriers to abortion services among Indigenous Peoples in Canada. Contraception 124, 110056 (2023).

11.  Lowik, A. J. “I Gender Normed as Much as I Could”: Exploring Nonbinary People’s Identity Disclosure and Concealment Strategies in Reproductive Health Care Spaces. Women’s Reproductive Health 10, 531–549 (2023).

12.  Prince Edward Island Abortion Rights Network. Trans-Inclusive Abortion Services Manual . (2021).

13.  Pagoto, S. L., Palmer, L. & Horwitz-Willis, N. The Next Infodemic: Abortion Misinformation. J Med Internet Res 25, e42582 (2023).

14.  Berglas, N. F. et al. State-Mandated (Mis)Information and Women’s Endorsement of Common Abortion Myths. Women’s Health Issues 27, 129–135 (2017).

15.  Gill, R. & Norman, W. V. Telemedicine and medical abortion: dispelling safety myths, with facts. Mhealth 4, 3 (2018).

16.  Rasmussen, K. N., Janiak, E., Cottrill, A. A. & Stulberg, D. B. Expanding access to medication abortion through pharmacy dispensing of mifepristone: Primary care perspectives from Illinois. Contraception 104, 98–103 (2021).