Andrew Steele is a vice-president at StrategyCorp.
If the leaked draft U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization reflects the final decision in late June, it will overturn Roe v. Wade and empower state legislatures to restrict medical and surgical abortions. While the American court will have no affect on the legality of reproductive choice in Canada, it could reduce access to local and safe abortions here.
Abortion rates are roughly the same in jurisdictions where it is legal and illegal. Restrictive laws do not stop abortions; they force women to seek clandestine abortions, often self-induced, in unsafe conditions or from unqualified practitioners.
If Roe v. Wade is overturned, abortion will be safe and legal in America’s Pacific and mid-Atlantic states, as well as in New England, and unsafe and illegal in the southern and plains states. Between the two coasts, Illinois, Minnesota, New Mexico and Colorado will be islands of legal reproductive choice.
Pills from mail-order prescribers could provide women in unsafe states with tenuous access to abortion for the first 11 weeks of pregnancy. After that, a pregnant woman in Louisiana will face a 1,000-kilometer journey, one-way, to a clinic in Illinois, the closest safe state. The longer the distance a woman must travel to get an abortion, the higher the risks become for an unsafe or late-term abortion, or carrying an unwanted pregnancy to term.
The Canadian government is open to American women seeking surgical abortions north of the border. Public Safety Minister Marco Mendicino ensured Canada Border Services Agency entry guidelines are clear, “so that women who may not be able to access health care including access to abortion are able to come to Canada.”
But legal does not mean accessible; pre-existing gaps in care and post-COVID waitlists are already creating a capacity crisis for abortion services in Canada. The availability of abortion here is highly dependent on where you live. In Ontario, there are little-to-no public hospitals or private clinics providing abortion services outside major city centres. Surgical abortion in Southwestern Ontario is only available at London Health Sciences Centre. Northern Ontario has no clinics at all. Note that these are the two regions of the province that directly border Michigan.
Critically, Michigan’s 1931 anti-abortion law was rendered moot by Roe v. Wade but never struck from state law. Last month, Democratic Governor Gretchen Whitmer asked the Michigan State Supreme Court to review the constitutionality of this archaic legislation, but she faces a Republican-controlled state legislature that is unlikely to repeal the law.
Barring a last-minute reprieve, safe and legal abortions will not be available in Michigan after June. Neigbouring states Indiana and Ohio are expected to enforce abortion bans as well, requiring women in Michigan to drive 400 kilometers one-way to Illinois, or across the bridge to Canada.
According to the Michigan Department of Health and Human Services, Michigan saw almost 30,000 abortion procedures in 2020 for its population of 10-million people. In comparison, Ontario’s 15-million residents received an estimated 20,000 abortions.
Almost half of Americans hold a passport. If even a fraction of Michigan women crossed the border at Windsor or Sarnia for abortion services, they could overload the only provider in Southwestern Ontario and compound delays in services across the province.
The desperate situation facing women in Northern Ontario will only get worse. For example, there is no Canadian abortion clinic within a six-hour drive of Sault Ste. Marie. But Planned Parenthood operates clinics just one hour away in northern Michigan. The fall of Roe v. Wade will close those Michigan clinics, require more pregnant women from the north to seek help in Toronto, and add stress to the capacity of providers there.
Even the abortion pill is no guarantee of access for those in rural and remote areas. A Globe and Mail investigation in 2019 found that many women travel hundreds of kilometres to an abortion clinic because they could not obtain a prescription for Mifegymiso from a physician in their community.
While we prepare for the potential fall of Roe v. Wade and the subsequent loss of abortion rights in some U.S. states, we must also improve access for Canadians. Remote prescribing and assistance for travel costs are quick ways to improve access for Canadian women.
Ultimately, Canadian provinces need more professionals providing abortion services. This will require increased training for physicians, allowing nurse practitioners to prescribe Mifegymiso, greater numbers of hospitals supporting clinics that provide abortions, and stronger anti-harassment laws to protect physicians who perform abortions, as well as their staff, families and patients.
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