As a U.S. president tries to blur the border between Canada and the U.S., the distinction between the two countries could not be more stark when it comes to reproductive health and rights.
Abortion access in Canada has expanded dramatically in recent years. A new UBC study finds huge gains in availability of abortion services in Ontario, where 91 per cent of residents now live near abortion services, since mifepristone-the abortion medication-became available in 2017.
Dr. Laura Schummers, assistant professor in UBC's faculty of pharmaceutical sciences and lead author of two Ontario-focused studies published this month in JAMA Open and the Canadian Medical Association Journal , says her team's findings reflect Canada's position as a global leader in evidence-based reproductive health policy. We spoke with Dr. Schummers about what sets Canada apart.
How does the abortion trend in Canada differ from other countries?
Between 2020 and 2023, several jurisdictions around the world saw a real spike in abortion rates. For example, in Scotland in 2022, the abortion rate increased to 16.1 abortions per thousand women from about 13.5 in 2021, and then increased again to 17.6 in 2023. That's their highest since abortion surveillance began in that country. Similar trends occurred in England and Wales.
In contrast, what we found in Ontario is that abortion rates have risen slightly and without the dramatic post-2020 spike seen in other countries.
Why are those big increases happening elsewhere?
You can't really separate the frequency of abortions from the provision of contraception services. The pandemic created a real struggle to consistently provide excellent primary care services, where contraception is usually provided.
There has also been an increase in misinformation and disinformation about contraception through social media, giving people the sense that contraception is unsafe-that it might make you fat, or have unwanted side effects. In the U.K., there have been reports of increased concern about side effects, leading to lower use.
Why aren't we seeing a spike in Canada?
Canada is a leader in prioritizing sexual and reproductive health and rights. Starting in 1988, Canada became one of the first countries to legally define abortion like any other health service. We have no criminal laws to protect or restrict abortion. It's the same as having your hypertension managed, having an infection treated, or having surgery.
When we introduced mifepristone, our policy was unprecedented in that we made it available just like any antibiotic or blood-pressure medication. Any licensed prescriber can prescribe it, any pharmacist can dispense it, and you take the pills home and take them yourself.
Many settings have restrictions on mifepristone use that are not based in science, but come from an ideological position about who should have abortions and why. We don't have that.
If we make abortion so easy, why does our abortion rate rise more slowly?
When people are supported by the health system to make choices that best fit their needs and reproductive goals, we tend to see gradual declines in abortion rates. There will always be pregnancies that need abortion services, but we will see a tempering of the abortion rate when services are provided in a way that is not encumbered by ideology.
Many Americans think Canada is just like the U.S. What would you say to them?
When it comes to reproductive health and rights, Canada could not be further from the "51st state."
We're seeing lawsuits in the U.S. which suggest mifepristone shouldn't have been approved and call into question the safety data that supported its approval back in 2000. Other legal battles are looking at the availability of medication abortion by mail. Some states are trying to restrict abortion to within a six-week limit on gestational age-often before somebody is even aware of their pregnancy.
In Canada, we are culturally distinct for reproductive rights and freedoms. Our policymakers listen to and collaborate with leaders in health care and research. We still struggle to provide services for our geographically distributed population, and we have persistently poor access in some jurisdictions. But we have a foundation of leadership federally that aims to continuously improve access and improve service provision, following the best available evidence.
