Question Period Note: Abortion Access

• The availability of surgical abortion varies both between provinces and territories and nationally. Health Canada is aware of coverage issues resulting in patient charges for surgical abortion services in a limited number of private clinics in Ontario (5). The one private clinic that had been charging patients in New Brunswick closed in February 2024. These patient charges are considered user charges under the Canada Health Act.

• This Government is committed to upholding the fundamental right to choose and believes that no one should be forced to carry an unwanted or unsafe pregnancy.
• Health Canada has taken action under the Canada Health Act to combat patient charges for access to insured surgical abortion services by levying deductions to Ontario and to New Brunswick’s Canada Health Transfers.
• In recognition of actions taken to eliminate these patient charges, Ontario has also received partial reimbursement of its Canada Health Transfer deductions under the CHA Reimbursement Policy.
• In addition, this Government has invested $8 million to date under the Sexual and Reproductive Health Fund to support access to abortion.
IF PRESSED ON FURTHER COMPLIANCE ACTION UNDER THE CANADA HEALTH ACT

• While abortion services are insured in all provinces and territories there is still work to be done to improve access in many areas of the country.
• Health Canada continues to engage with Ontario as they work to implement their action plan, which is expected to eliminate patient charges for access to abortion services.
• Though the one private clinic in New Brunswick closed in February 2024, New Brunswick will still face deductions for patient charges levied through 2023-2024 for refusing to provide coverage for these services.
IF PRESSED ON THE SEXUAL AND REPRODUCTIVE HEALTH FUND

• This Government is committed to making sexual and reproductive health (SRH) care, information, and services more accessible for populations facing the highest risks and greatest barriers to SRH.
• Through Budget 2021 and 2023, $81 million has been committed to the Sexual and Reproductive Health Fund over 6 years.
• The Sexual and Reproductive Health Fund supports community-based organizations that help make access to abortion, and other sexual and reproductive health care information and services more accessible for Indigenous, racialized, 2SLGBTQI+ populations, newcomers, people living with disabilities (including chronic conditions), as well as women and youth from underserved populations.
IF PRESSED ON THE MARCH 21 RELEASE OF THE SURVEY ENTITLED INDUCED ABORTIONS REPORTED IN CANADA IN 2022 BY THE CANADIAN INSTITUTE FOR HEALTH INFORMATION

• CIHI released 2022 data on abortions in Canada on March 21, 2024.
• Access to abortion appears to be improving in Canada. There were an estimated 97,211 reported induced abortions in Canada in 2022. This is a 11% increase from the 87,485 induced abortions reported in 2021.
• The data also indicates a 3% increase in medical abortions, and an increased proportion occurring outside of hospitals. This points towards increased access to abortion earlier in gestation, and less need for travel for people living in underserved communities.
• HC uses this data to inform CHA deductions to NB, due to the province’s refusal to cover these medically necessary services when provided outside the hospital setting, or to report on them when they occur

The aim of the Canada Health Act is to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital, physician, and surgical-dental services that require a hospital setting on a prepaid basis, without charges related to the provision of insured health care services.

Health Canada’s top priority is to protect the health and safety of people in Canada, including those who choose to end their pregnancy. Abortion services are deemed medically necessary and are insured in all provinces and territories. Individuals should not face charges when seeking these insured services, regardless of where the services are provided.

Access to Abortion in Ontario
In summer 2019, evidence in Ontario confirmed that some private abortion clinics charged fees for uninsured services, while not consistently informing patients these fees were optional, with respect to accessing insured surgical abortion services. Since March 2021, deductions totaling $86,065 have been levied against the ON’s Canada Health Transfer (CHT) payments in respect of patient charges for surgical abortion services.

Under the Canada Health Act Reimbursement Policy provinces and territories that face mandatory deductions have the opportunity to be reimbursed if they work with Health Canada to develop a plan to eliminate patient charges for medically necessary services, and the circumstances that led to them within a specified timeframe. Ontario is in the process of implementing its Reimbursement Action Plan, including the introduction of regulations under legislation that was passed in 2023, which is expected to eliminate patient charges for access to abortion services. In recognition of actions taken by Ontario to eliminate these patient charges, per the Reimbursement Policy, partial reimbursements of its 2022, 2023 and 2024 deductions totaling $43,296 have been authorized to date.

Access to Abortion in New Brunswick
In New Brunswick, Regulation 84-20 of the Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals. This means that individuals who receive these services at the private clinic in Fredericton are required to pay out-of-pocket. New Brunswick is the only province with a private abortion clinic (Clinic 554) where the province does not provide coverage for services. In December 2022, the Government of NB passed legislation allowing for some insured surgeries to occur in private clinics (including cataracts) as a means of reducing surgical waitlists. However, this new legislation does not extend to surgical abortion services in private clinics. Since March 2020, deductions totaling $444,041 have been levied against the NB’s CHT payments in respect of patient charges for surgical abortion services. Though Clinic 554 closed in February 2024, given the retrospective nature of reporting patient charges under the Canada Health Act, New Brunswick will face additional deductions for patient charges levied in fiscal 2022-2023 and 2023-2024.

On January 6, 2021, the Canadian Civil Liberties Association (CCLA) filed a statement of claim in the NB courts, as part of a Charter challenge against NB’s restrictive Regulation 84-20 and was granted standing on June 2, 2021. The group argues that the regulation is inconsistent with and in violation of the Canada Health Act. The case is currently in the discovery phase and the CCLA is awaiting information from the province, which was requested in January 2022. A trial date has yet to be set.

• Abortion services are deemed medically necessary and are insured in all provinces and territories.
• Patient charges for medically necessary surgical abortion services in private clinics have resulted in mandatory Canada Health Transfer (CHT) deductions to Ontario ($86,065 since March 2021) and to New Brunswick ($444,041 since March 2020).
• In recognition of actions taken to eliminate these patient charges, such as the introduction of new legislation in 2023, Ontario has received partial reimbursement of its CHT deductions under the CHA Reimbursement Policy totaling $43,296 to date.
• Though the one private clinic in New Brunswick closed in February 2024, the retrospective nature of reporting under the Canada Health Act means New Brunswick will still face deductions for patient charges levied in fiscal 2022-2023 and 2023-2024