Abortion barriers in Canada are back in spotlight following passage of abortion bans in U.S.

While abortion remains legal in Canada, some abortion rights advocates saywomen continue to face hurdles in accessing the procedure.

Funding, distance to medical facilities and a patchwork of provincial laws all mean an abortion is not as easy to obtain in Canada as some may think.

"People often conflate the two, thinking that because it's decriminalized, it's very easy to access in our country and it's not the case," saidFrdrique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.

"There's been very little progress done to make sure that abortion is actually, in fact, accessible to everyone in Canada equally."

The controversial issue has gained renewed focus following thepassage of abortion bans in the U.S.

Several states have in the last yearpassed so-called heartbeat bills,which ban abortionas soon as a heartbeat can be detected which could be as early assix weeks into pregnancy. Just this week, Alabama madeit illegal for doctors to perform abortions.

None have taken effect yet, and they're expected to be tied up in legal wrangling for a while. But they could make their way tothe U.S. Supreme Court, where anti-abortion activists hope the new conservative majority might be inclined to overturn or drastically diminish the court's landmark abortion-rights precedent set in the Roe vs. Wade case in 1973.

Meanwhile in Canada, federal Liberals have accused the Conservatives of wanting toreopen the abortion debatesomething party leader Andrew Scheer has insisted he will not do.

'Becomes really tricky'

Abortion has been legalin Canada since 1988 when the Supreme Court of Canada struck downlaws against it. Butfor women living outside of big urban centres like Toronto, Montreal and Vancouver, accessing the procedure "becomes really tricky," Chabot said.

Some of those barriers include funding. Under the Canada Health Act, abortionservices are insured in all provinces and territories. Butsome provinces have placed limits on funding for the procedure.

Ontario does not fund abortions at every clinic, while New Brunswick does not fund abortions at clinics at all, only in hospitals. In its 2016-2017 annual report, Health Canada said New Brunswick's lack of coverage"remains a concern."

The Abortion Rights Coalition of Canada (ARCC) says that's not good enough. In its interpretation of the Canada Health Act, abortion services across the country must be fully funded.

And in the case of New Brunswick, the "federal government has failed to penalize the province by withholding transfer payments."

Distance to abortion services can also be a barrier.In many remote communities, specificallynorthern communities, there areno abortion clinics in townand no hospitals that performthe procedure.

"So that imposes significant travel costs, you know, loss of work time, for women to get to a place where they can actually access it," said Karen Segal, staff lawyer for thethe Women's Legal Education and Action Fund (LEAF).

In some regions, she said, there are only a couple of points of access. For example, in Alberta there are only two clinics: one in Edmonton and one in Calgary.

Requirements for a hospital abortion alsodiffer across jurisdictions; provinces enforce their own health care legislation,whichcould includerequiring a doctor's referral or gestational limits. Hospitals alsooften have long waiting lists.

Prince Edward Island was the last holdout, refusing to provide any abortion service on the island until, followinga long legal battle, the province agreed in 2016to open an abortion clinic. Before that, women had to travel to Halifax or Moncton, N.B., with the province paying medical costs, but not travel expenses.

P.E.I. restricts medical abortions to the first nine weeks of pregnancy and surgical abortions to 12 weeks andsix days, though women still have the option of a later abortion by travelling to another province.

Long wait lists

"What we've heard anecdotally is that their wait lists are so long," Segal said. "Women face wait listsoffive, six weeks which, if you don't know you're pregnant right away, can mean that by the time you have your appointment, you're ineligible for abortion in the province."

Segal acknowledged that access to medical carein general can be a challenge for those living in rural and northern communities. But she believes the lack of access to abortion reflects, at least in part, an ideological opposition.

If a medical practitioner hasa religious objection to providing abortion, they don't have to carry it out. So, for example,a doctor may be willing and capable of providing an abortion at a local hospital, but an anaesthetist mayhave a conscientious objection andrefuse to assist.

"So, practically speaking, it's very hard to actually do it, because the staff don't agree and won't participatein providing the service," Segal said.

Otheranti-abortion doctors have refused tomake referrals for a doctor who will provide an abortion.

But the Ontario Court of Appeal ruled just this week thatdoctors in the province must give referrals for medical services that clash with their religious beliefs, including abortion.

Nova Scotia has found its own way around reluctant doctors. Instead of a referral, womencan call an access-to-abortion helplinethat's run by the provincial health-care system.

Sarah Baddeley, chair of the Halifax chapter of LEAF, told CBC Radio'sInformation Morning that there has been some improvementin the region when it comes to access, thanks to the helpline and other changes, like better access to ultrasounds and dropping the mandatory requirement to have an ultrasound.

Meanwhile, the availability of Mifegymisothe so-called abortion pill that was first made commercially available inCanada in 2017has also helped with access issues, Chabot said.

The drug can be taken up to nine weeks into a pregnancy,and Health Canada recently dropped a requirement that women undergo an ultrasound before being prescribed Mifegymiso.

"Thatmeans that people might not have to leave their communities to get an abortion and it's starting to be realized," Chabot said.

But Chabot said thatSaskatchewan and Manitoba remainthe only two provinces that do not provide universal coverage for the pill. As well,many pharmacies across Saskatchewan do notstockthe drug.

In Manitoba, women can get the abortion pill for free at three health centres, otherwise they must cover the costaround $350themselves.