Question Period Note: Access to sexual and reproductive halth care information and services

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• Currently, women, youth, 2SLGBTQI+ people, racialized Canadians, and Indigenous populations face the highest sexual and reproductive health risks and the greatest barriers to accessing support, information, and services. Too often, they do not receive the same quality of care, particularly if they are from marginalized communitiesAll Canadians should have access to a full suite of sexual and reproductive health resources and services, no matter where they live.
• We are funding community-based organizations to provide training and to increase knowledge and capacity among sexual and reproductive health care providers, develop and implement best practices, carry out public awareness activities, and provide travel and logistical support to access abortion care.
• Budget 2021 committed $45 million to advancing sexual and reproductive health. To date, $24.9 million has been allocated. Nine projects, valued at $15.3 million, are underway. Of these nine projects, two address access to abortion, five address 2SLGBTQI+ communities, two address youth. Two of the nine projects include components focusing on Indigenous peoples. In addition, per capita funding of $9.7M has been allocated to the Province of Québec to support community-based organizations located in Québec.

IF PRESSED ON DATA…
• We are also investing $7.6 million over five years for Statistics Canada to collect data that will fill existing information gaps and help us target appropriate sexual and reproductive health supports for Canadians.

IF PRESSED ON ABORTION SERVICES…
• Our Government believes that Canadians should have access to the full range of reproductive health services, including abortion services.
• This Government will uphold the Canada Health Act to help ensure that patients do not face barriers when accessing medically necessary health care.
• Of the $45 Million committed in Budget 2021, the Government of Canada has invested $3.6M to date to support access to abortion for people in Canada who face the greatest barriers to care. In the first six months of funding Action Canada provided 234% greater levels of financial support, and for a 208% increase in number of people supported, as compared to the same period in 2021.

IF PRESSED ON WHETHER THE GOVERNMENT WILL PROVIDE FUNDING TO ORGANIZATIONS OFFERING ALTERNATIVES TO ABORTION (I.E. CONTINUING THE PREGNANCY) …

• This fund is specifically designed to help women access abortion and it will not support initiatives that discourage or are opposed to freedom of choice or attempt to override the individual’s right to make decisions about their own body.

The Government of Canada has made strong commitments to gender equality, using a feminist lens, and realizing and protecting sexual and reproductive health rights.

Key barriers and challenges related to inequitable and variable access to sexual and reproductive health services remain. Women, members of 2SLGBTQI+ communities, youth, racialized Canadians and Indigenous peoples face the highest sexual and reproductive health risks and the greatest barriers to accessing support, information, and services.

An initial targeted call for proposals inviting select organizations to submit applications for funding was launched on July 29th, 2021 and closed October 4, 2021. Nine contribution agreements have been signed. A second targeted Call for Proposals was launched on July 12, 2022 and closed on September 16th. Further funding decisions will be made in the coming months.

Canada’s current national-level data on sexual and reproductive health is limited to a narrow range of indicators. There is insufficient data available to support understanding and evidence-based decision-making to address a full range of key indicators of sexual and reproductive health, including prevalence of sexually transmitted infections, contraception use, pregnancy intention, and sexual knowledge and behaviours.

Patient charges for abortion services
Although access to abortion services in Canada has been improved by the approval and roll-out of Mifegymiso for medical abortion, 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 both New Brunswick and Ontario. Patient charges for abortion services received in private clinics are considered user charges under the Canada Health Act.

In New Brunswick, Regulation 84-20 of the NB Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals (three NB hospitals currently offer the service – two in Moncton and one in Bathurst). 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. Patient charges for abortion services received in private clinics are considered user charges under the Canada Health Act and raise concerns under the accessibility and comprehensiveness criteria of the Act. Since March 2020, deductions totaling $269,916 have been levied against the NB’s Canada Health Transfer (CHT) payments in respect of patient charges for surgical abortion services. The lack of coverage for abortions performed in private clinics has been discussed bilaterally with NB since 1995, without resolution. Currently, Clinic 554 appears to be operating one day per week, offering only surgical abortion services.

In summer 2019, media stories in Ontario revealed fees charged to individuals to access surgical abortion services in some private clinics. Health Canada followed up on these reports by analyzing clinic websites, and by making phone or email inquiries to clinics of concern. While the Ontario Health Insurance Plan provides coverage for physicians' fees related to abortion services in all private clinics, the province only covers facility fees in the four private abortion clinics licensed as Independent Health Facilities (IHF). Evidence gathered confirmed that some private non-IHF abortion clinics charged fees for uninsured services, while not consistently informing patients these fees were optional, with respect to accessing insured surgical abortion services.

When the Ontario Health Ministry conducted further investigations the patient charges discovered were reported to Health Canada. These charges formed the basis of Ontario’s March 2021 and March 2022 deductions (totaling $20,465). In December 2021, Ontario submitted a Reimbursement Action Plan to Health Canada, and has committed to revisit the current framework for the funding of insured surgical abortion services in the province. Health Canada continues to engage with Ontario as it works to implement its action plan and eliminate patient charges for access to abortion services and the province will provide an updated status report in the coming months, which will be published in the Canada Health Act Annual Report for 2021-2022.

Dobbs v Jackson Women’s Health Organization in the United States
The U.S. Supreme Court, in rendering their decision in the case Dobbs v. Jackson Women’s Health Organization, held that the Constitution of the United States does not confer any right to abortion, overruling the decisions in Roe v. Wade (1973) and Planned Parenthood v. Casey (1993) that prohibit U.S. states from passing legislation criminalizing abortion. This decision will make it possible for states to criminalize abortion at their discretion.

There has been concern in Canada about Americans coming to Canada seeking abortion care, potentially overwhelming limited Canadian resources. Since many states, including several on the U.S.-Canadian border, have announced their intention to protect abortion services, a large influx of American patients seems unlikely. Similar to other health care services, Americans coming to Canada would be able to obtain safe abortion care in Canada, but would have to pay for the service out-of-pocket. Media articles have reported an increase in phone enquiries from Americans seeking information since the decision, but no increase in the booking of appointments.

Because of differences between the American and Canadian legislative and judicial systems, the Canadian legal context for abortion is distinct. In Canada, following the Supreme Court of Canada’s decision in R. v. Morgentaler (1988), abortion was decriminalized in Canada. There is therefore no regulation at the federal level regarding abortion. As with other health care, abortion service delivery is managed at the provincial or territorial level.

• Canadians, especially those from underserved populations (including women, members of 2SLGBTQI+ communities, Indigenous and racialized people, and youth), continue to face barriers to access abortion services which includes a lack of availability, a lack of financial and logistical resources required to travel to access abortion care, and lack of culturally-safe, stigma-free sexual and reproductive health services. Health Canada’s Sexual and Reproductive Health Fund was created to advance mandate commitments relating to sexual and reproductive health and to strengthen the healthcare system and public health supports for vulnerable members of our communities, and those who have faced discrimination by the very system that is meant to heal.