The cost of laws that restrict abortion rights, in Canada and around the world

Editor’s note: This is a translation and update of the original two-part article written in French and published by the NB Media Coop.

Nowadays, abortion debates still often lead to moral, religious or ethical considerations. These ideological positions totally overlook the social and economic dimensions prompted by the question of pregnant people’s right to control their fertility.

Access to abortion is an issue of general interest. Forbidding anyone with a capacity for pregnancy to abort not only has consequences on the individuals but also harms society as a whole.

While abortion is now permitted in most Western countries, inequalities in access to healthcare services are rife and abortion laws are more precarious than they seem. In June 2022, the U.S. Supreme Court’s decision to overturn Roe v. Wade, which protected the right to abortion in the U.S. constitution, came as a thunderbolt to women around the world. It reminded us that the right to abortion remains highly dependent on political institutions, which are still often predominantly directed by men.

In Europe, France is working to enshrine abortion rights in its constitution, in response to Roe v. Wade’s overturning. However, every country on the continent is not going down this road. As a matter of fact, some even seem to have declared war against abortion. In Hungary, it is increasingly restricted, while in Poland it has become almost illegal, and, in Malta, an island where institutions are deeply infused by the Catholic religion, abortion is totally prohibited and penalized (the only country in Europe to do this).

Canada’s persistent territorial disparities

In Canada, the issue remains a subject of debate. Abortion became legal in 1988 with the Morgentaler decision and is financed by the state, in theory. However, there is no law ensuring its access on a national scale, a situation that fosters inequalities particularly affecting poor, racialized and trans people across the country.

In P.E.I., the Sexual Health, Options & Reproductive Services provides procedural abortions up to 13 weeks and 6 days. Only in Alberta, Ontario, Quebec and British Columbia is abortion accessible up to 20 weeks. Reimbursement is also not the same depending on where you are in the country. In some provinces, there is sometimes no facility within a hundred kilometre radius. New Brunswick and Nunavut will only reimburse procedures performed in a hospital.

In New Brunswick, a historically Christian province, the poorest in the country, only 3 hospitals, in Moncton and Bathurst, provide abortions. This is a backdoor way to restrict its access. As explained by Dr. Adrian Edgar, founder of Fredericton’s Clinic 554, in an interview with the Tribune in June 2022, “People who want to terminate their pregnancy will always find a way to do it. But it’s not going to be done in a safe way (…) It’s insane to witness this kind of situation in a country like Canada. It creates an environment where women feel judged. And alone. It’s very violent”.

To date, Dr. Edgar’s clinic is the only private facility in New Brunswick that performs abortions at a cost of $700 (or $850 for over 14 weeks), a sum that is not reimbursed by the government health care system. Because of the pro-life movement’s influence and a lack of government funding, the clinic was recently forced to reduce its activities.

In Canada, anti-abortion lobbies and activists are indeed legion. Some do not hesitate to put signs that compare abortion to the Holocaust or the Rwandan genocide in public spaces and on university campuses. Throughout the country, the number of Crisis Pregnancy Centres (CPCs) exceeds the number of health care centres that perform abortions. These facilities, which are not regulated by the authorities, receive people who wish to have an abortion and use massive misinformation to convince them to carry their pregnancy to term. There are currently 165 CPCs in the country, as compared to 147 facilities that perform abortions.

This lack of political will continues to penalize individuals and hinder progress as well as social justice. It also leaves the field open to the pro-life movement, for which, obviously, all lives are not equal. They defend the life of the fetus more ardently than that of pregnant people.

No gender equality without abortion rights

“Controlling when and if [or] how many children somebody has is sort of the absolute demonstration of patriarchy. Because controlling people’s fertility can affect what education they can get and what career they can have and how far they can go in life,” states American gynecologist Colleen MacNicholas in the documentary Roe v. Wade: The True Story of Abortion.

This injustice is all the more blatant as it’s still the people who can get pregnant that take on most of the contraceptive workload, as explained by French sociologist Marie Mathieu in an academic article. She adds that “no method of contraception is foolproof, not even those which are perceived as the most reliable” and that “abortion remains a frequent episode in the lives of people that can get pregnant.” In North America, for example, one in four women will have at least one abortion by the age of 45.

So, it goes without saying that access to abortion is an essential component of gender equality. In today’s world and in the absence of comprehensive family policies that guarantee gender equality in all spheres of society, women continue to put their studies and careers on hold to care for children, while men are often able to continue their professional careers without interruption.

In Canada, despite a decline in the gender wage gap in recent years, inequalities persist. In 2021, the Organisation for Economic Co-operation and Development reported that there is a 16.1 per cent difference between annual median earnings of women and men, making Canada one of the most unequal countries in the study in terms of gender pay equity.

Even though women now tend to go to college more than men, the gendered division of domestic labor, increased by the birth of children, still strongly impacts women’s professional careers. In 2018, a U.S. study revealed that women who had children between 25 and 35 years old suffer more severely from wage inequality. Throughout their careers, wage inequalities between women and men tend to increase.

No ecological transition without gender equality

Since we are faced with an unprecedented ecological crisis, several levers need to be activated to help societies evolve towards virtuous and sustainable models. Achieving gender equality is undeniably one of them.

According to scientists, gender equality should be regarded as a top priority goal to help curb the climate crisis. In many parts of the world, climate change impacts women more than men. Having less access to health care and natural resources to feed their families, women are more exposed to the risk of maternal mortality and often are the primary caregivers for their children whose health is particularly at risk in parts of the world affected by climate and environmental hazards.

On the other hand, women also tend to lead the way in instilling ecological values, being globally more concerned about environmental issues than their male peers. When it comes to agroecology for example, they play a major role in reinventing practices, managing to match priorities of food safety, environment, health and links to the land.

Women’s leadership qualities to tackle climate change and other crises have also been investigated. One study shows that they are particularly capable of making concerted decisions, motivating their teams and weaving links between individuals which are much needed assets to cope with crisis situations and draw the contours of more equal societies. When it comes to women’s political representation, a 2019 study reveals that increasing the number of women in national parliaments led to the adoption of more clear-cut policies to fight climate change.

But, if women cannot regulate their fertility, how can they fully invest in tomorrow’s world? Allowing them to have an abortion in the best possible conditions, at any age and whatever their motivation, is a decisive factor to build greener, more egalitarian, inclusive and sustainable societies. It could also be a step forward to helping stop the systemic social and racial inequalities that continue to affect society.

Restricting abortion means perpetuating racial inequalities

In the U.S., the Supreme Court’s reversal of Roe v. Wade illustrates how inequalities in reproductive rights still overwhelmingly affect racialized women.

In that respect, an article of the New England Journal of Medicine that investigates the fundamental link between abortion access and racial justice reads: “Decisions regarding the legal status of abortion and other reproductive health services reflect the status of civil rights for anyone with the capacity for pregnancy, but they have a particular resonance for Black and Indigenous people living in the United States, who have experienced reproductive oppression for centuries.”

In the U.S., Black and Indigenous women are 2 to 4 times more likely to die during pregnancy or childbirth than white women, due to profound inequalities in access to healthcare. They also have limited access to contraception and family planning services, a situation that feeds a never-ending reproduction of inequalities.

In Canada, reproductive rights and access to sexual health services are still threatened by racial inequalities that affect Black, Indigenous and people of color. Across the country, particularly within provinces that restrict access to abortion, racialized people have less access to contraception and abortion than their white peers. On a day-to-day basis, they still face higher rates of unemployment, wage inequality and less access to higher education. For many, travelling long distances to be taken care of in medical facilities that provide abortion services or having to fund the full cost of treatments is not even an option.

These inequalities in access to health care, education, and employment are extremely costly to the individuals. A study by Citigroup Bank in the U.S. estimated that discriminatory practices against racialized people, essentially women, cost the GDP US$16 trillion over 20 years.

We can no longer accept the human cost of laws that restrict abortion

Confronted to anti-abortion laws and a lack of access to sexual and reproductive health services, women have always been forced to find ways to terminate their pregnancy. Today, they continue to abort, in every country of the world, whether it is legal or not.

Overall, nearly half of all pregnancies throughout the world are unintended.

Deprived of a supervised medical intervention, people who wish to abort in countries that prohibit abortion resort to plants, pills, needles and other blunt instruments, acidic substances or street drugs. Each year, 25 million unsafe abortions – 45 per cent of all abortions performed worldwide – are performed, mostly in Africa, Asia or South America. The abortion stigma is such that the tragedies caused by unsafe abortions are usually kept secret.

In Europe too, some terminate their pregnancies without any medical supervision. In Poland, 200,000 women a year resort to illegal abortion pills and other more dangerous methods, some without medical supervision. In Malta, women who can afford it travel to clinics abroad, while others buy abortion pills online for use at home. Every year, 300 to 400 underground abortions take place in the country.

A high price to pay for the healthcare systems and the economy

According to the WHO, the complications faced by women after an unsafe abortion cost healthcare systems in developing countries $553 million per year. These problems include life-long injuries, severe disability, heavy bleeding, damage to internal organs, losing the ability to become pregnant in future and death. In 2018, 6.9 million women were treated for complications from unsafe abortion within countries where abortion is prohibited. Long-term disabilities that can occur after unsafe abortion cost households an estimated US$922 million. Treating these complications also come at a price for these already fragile health systems.

Yet, abortion treatments are less costly than treating complications. In Canada, the abortion pill costs between $300 and $450 to the health care system or the uninsured patient. This pill can be used to terminate a pregnancy in the first trimester. A surgical abortion costs about $800 in the first trimester and up to $2,500 if the operation is performed in the second trimester in a hospital setting.

The entire community pays the price for the restrictions around the right of abortion. In the U.S., a study indicates that in states where access to abortion is not restricted, 505,000 additional women participate in the workforce, which generates US$3 billion in income. This is a significant generation of wealth for the states’ economies that is lost in areas that do not make abortion access a public health priority.

For an unconditional control on our own fertility

Abortion is part of people’s lives, whether we like it or not. Prohibiting it, restricting its access and bringing up the issue through the prism of morality is a direct attack on women and anyone with a capacity of pregnancy. It threatens the possibility of living the life they want, it limits their life opportunities and those of their family. But, it also deprives society of an essential factor of social progress.

In Fredericton, Dr. Edgar continues to fight for the people of New Brunswick. “When I realized that it should not be taboo, I decided to talk about it. I am not ashamed. Everyone should be able to choose for themselves, without anyone interfering,” he explained in his interview with the Tribune. In November 2022, he published an open letter asking New Brunswick’s Minister of Health Bruce Fitch, to extend the reimbursement of abortions to those performed outside of hospitals.

Hélène Bourelle is a freelance journalist who writes about society, gender and the environment and also works as an editorial manager for different companies.