Originally published in the Montreal Gazette
It’s not a good year to have a uterus in Quebec. Setbacks to reproductive health care in the province continue to be rolled out one after another. Bill 20 is putting reproductive options under fire, weakening service availability in Quebec by limiting physician time allocations for sexual and reproductive health, including abortion care, contraception counselling and STI screening.
Abortion has been recognized as a human right in Canada for over 30 years and an essential medical procedure since 1995, requiring that abortion services be fully accessible and financially covered by provincial and territorial health insurance plans under the Canada Health Act.
These austerity measures chip away at hard fought-for reproductive rights. Despite Health Minister Gaétan Barrette’s insistence that the abortion debate is not being reopened, as it stands, Bill 20 promises to severely impact people’s ability to access abortion services in a timely and cost-effective way. There is no concrete evidence demonstrating how the government will ensure such services are protected from proposed quotas and heavier loads, especially in the case of physicians performing abortions while carrying a patient load.
Quebec is considered a champion of reproductive health care and is host to about 50 per cent of the country’s abortion-care facilities. Our provinces and territories need to uphold the standards set by leaders like Quebec, not see them watered down. Without clearly defined protections on access to abortion, Bill 20 could have serious implications and could have more than just an effect on access for the Quebec population. Regions like the Maritimes where access is limited – or non-existent – still see residents traveling to urban centres in Quebec to access abortion.
Universal access to health care is part of the Canadian landscape. It’s also Canada’s obligation under international human rights law. The UN Committee on Economic, Social and Cultural Rights explicitly includes the right to control one’s health and body in its legal definition and calls on State parties, including Canada, to implement measures to improve maternal health and sexual and reproductive health services. At a time where the UN Committee is already questioning Canada’s existing record on access to abortion, we need to see explicit protections in Bill 20.
In Canada and globally, we have known and fought for years for the recognition of women’s right to health and the removal of barriers that challenge access to essential health services. Despite Barrette’s best assurances, without explicit written protections, Bill 20 could negatively impact access to abortion and related services currently offered by a limited number of physicians. If physicians are in fact offered exemptions from Bill 20’s caps – as suggested by Barrette – we are still faced with the reality of who offers abortion care in Quebec, how the procedure is integrated into their practice, and the shrinking number of physicians trained to perform abortions as many approach retirement.
In Quebec, upward of 80 per cent of all abortions are performed by an already small pool of physicians. Seemingly, the due diligence requirement Bill 20 proposes could bottleneck access to services by penalizing family physicians whose patients opt to seek abortion care directly without seeking a referral through their practice. This could effectively add weeks of wait time for a procedure that is already time-sensitive. It could also jeopardize confidentiality, a crucial element in access to reproductive health care, could cut access to specialized family planning clinics, privatize essential health services, and potentially expose people to anti-choice or unsympathetic practitioners acting as so-called gatekeepers and further delay access to abortion services rather than facilitate access to care.
Bill 20 threatens a serious setback to sexual and reproductive rights and women’s rights. The government of Quebec must explicitly and formally guarantee and protect access to comprehensive sexual and reproductive health care, as it has done for so many years.