As an abortion care provider in Canada, I know anti-abortion politics in the U.S. can cause fear and confusion here, often resulting in delays and barriers to care. Unlike in the U.S., access to abortion in Canada has improved significantly in recent years. Abortion was completely decriminalized in 1988 and is publicly funded as a regular part of health care, and the introduction of mifepristone for medication abortion in 2015 vastly improved access. But because abortion is not openly talked about, what it involves and how to get care may not be commonly known.
Here’s everything you need to know about abortion care in Canada, and how to access an abortion in every province and territory.
What is a medication abortion?
A pregnancy can be terminated by medication or aspiration (also referred to as surgical abortion). Medication abortion involves two medications: one 200 mg mifepristone pill (taken orally) and four 200 mcg misoprostol pills (in the form of vaginal suppositories or oral tablets), taken 24 to 48 hours apart. Mifepristone causes hormonal changes incompatible with pregnancy, effectively “stopping” the pregnancy; misoprostol causes the uterus to contract, expelling blood and tissue. The medications can take a few days to work and can involve very heavy bleeding and cramping. Mifepristone is approved by Health Canada for use for up to nine weeks of pregnancy.
With the exception of Quebec, primary care providers—including family doctors, nurse practitioners, and some midwives—are authorized to prescribe mifepristone. The cost is covered by provincial and territorial health insurance, and pills are typically picked up by the patient at their pharmacy. During COVID-19, many prescribers became familiar with using telemedicine in their practice, and so some are comfortable prescribing a medication abortion without requiring an ultrasound, blood work or physical assessment.
What is an aspiration abortion?
Aspiration abortion is performed by obstetricians and family doctors in freestanding clinics or hospitals. More than 90 percent of aspiration abortions in Canada are completed in the first trimester (up to 16 weeks). Patients may opt for pain medications and/or mild sedation during the procedure.
An aspiration abortion takes about 10 minutes: First, a health care practitioner assesses the uterus in a manual exam. After that, the cervix is frozen with regional anesthetic. Then, dilators are used to gently open the cervix. A small tube called a vacurette is inserted through the open cervix into the uterus. Finally, suction is used to remove the tissue. In the second trimester and beyond, the procedure usually requires at least two in-person appointments, and care providers require different training and clinical infrastructure. As a result, this care is available in fewer locations.
When both aspiration and medication services are available, your preferences and circumstances will govern how you choose to proceed. Some patients prefer to experience the abortion at home, whereas for others, home is not a safe option.
How does abortion care differ among provinces and territories?
Care practices and access challenges vary by province and territory. Rural patients in the Prairies may travel very long distances for aspiration services. Atlantic Canada only has elective aspiration abortion care for up to 16 weeks of pregnancy. (If the pregnancy needs to be terminated for a clinical reason related to fetal or maternal health, abortion care is availale up to 24 weeks.) Quebec limits who can prescribe medication abortion. Although most aspiration abortion providers will also prescribe medication abortion, uptake of telemedicine is spotty, and many prescribers still require patients visit them in person.
In response to the overturning of Roe v. Wade, it is possible Americans will start travelling to Canada for care. We must ensure our access is as strong as possible, and that Canadians also have the information they need to access abortion.
Here’s how to access care in your province or territory.
Nova Scotia has a centralized self-referral program. Patients call 1-833-352-0719 and leave a message. A nurse will call back to conduct an intake and arrange care as close to home as possible. There are four aspiration abortion sites in the province and dozens of medication abortion prescribers. Counselling is also available. The greatest challenges? Currently, aspiration providers cannot provide care after 16 weeks, and there are no aspiration services on Cape Breton.
Prince Edward Island
After the Women’s Legal Education and Action Fund led a successful legal challenge against the province for lack of services, P.E.I. opened a comprehensive abortion program in 2017, with two physical locations in Summerside and Charlottetown. Patients call 1-844-365-8258 ext 1 to speak with a nurse for intake, or email [email protected] More than half of P.E.I. abortions are through medication, and there are about 200 abortions in total every year. P.E.I. offers aspiration abortion for up to 12 weeks of pregnancy.
Newfoundland and Labrador
The freestanding Athena clinic in downtown St. John’s, owned and operated by two sisters, provides most abortion care for the province. Aspiration abortion is available onsite up to 15 weeks, and staff travel to Cornerbrook and the Central region once a month to provide aspiration services. Medication abortion is available through telemedicine for patients across the province, including Labrador. Self-refer to Athena by calling 709-754-3572.
The Health Sciences Centre hospital in St. John’s provides elective abortion care with a referral, and patients must be at least eight weeks pregnant.
Prescriptions for mifepristone must go through private insurance first, and the province picks up the remaining cost. This may pose a problem for patients who need to hide their prescription from unsupportive parents or spouses.
New Brunswick notoriously refuses to publicly fund aspiration abortion care conducted in freestanding clinics. There are self-refer aspiration abortion services available up to 14 to 15 weeks at three hospitals: Chaleur Regional Hospital Bathurst (506-544-4150), Dr. Georges-L.-Dumont Moncton (506-869-2770), and Moncton Hospital (1-844-806-9205). Medication abortion is also available at several sexual health centres and in some individual primary care offices.
There are approximately 49 aspiration abortion facilities (clinics and hospitals) in Quebec, more than in any other province, and with some providers offering aspiration abortion up to 24 weeks and beyond. Quebec is the only province where family doctors and nurse practitioners are not generally authorized to prescribe medication abortion, as it is considered a specialized service. Abortion services are individually listed here.
There are aspiration and medication services available in Brampton, London, Kingston, Kitchener-Waterloo, Mississauga, Ottawa and Toronto. (Services up to 24 weeks and beyond are available only in Toronto and London.) There are clinics providing medication abortion prescriptions in Barrie, Hamilton, Oshawa, Penetanguishene Midland, Scarborough, Sudbury and Thunder Bay. The SHORE Centre in Kitchener operates an online app called Choice Connect to direct patients to the nearest appropriate provider and also operates a telemedicine medication abortion service for anyone across the province, with booking available through their website.
Patients anywhere in the province can self-refer to the Women’s Health Clinic in Winnipeg for help organizing care: 1-866-947-1517. The clinic provides aspiration abortion up to 16 weeks and connects patients for medication abortion in Dawson and Steinbach and to aspiration services at the Brandon Regional Health Centre (up to 12 weeks). Additionally, the Winnipeg Health Sciences Centre (204-787-1980) provides elective abortion up to 20 weeks.
Patients anywhere in the province can self-refer to the Regina Women’s Health Centre (306-766-0586) for onsite aspiration abortion care up to 19 weeks and medication abortion through telemedicine anywhere in the province. There are also aspiration services available up to 12 weeks at the Women’s Health Centre at the Saskatoon City Hospital, but a referral is required.
Aspiration services are limited to Edmonton and Calgary. The Edmonton Women’s Health Options Clinic provides aspiration services up to 20 weeks (patients can self-refer to 780-484-1124). The clinic will only prescribe medication abortion to patients who live in Edmonton.
In Calgary, the Kensington Clinic (403-283-9117) provides aspiration up to 20 weeks; beyond 20 weeks, patients can seek care from the Peter Lougheed Centre (403-943-5716). Kensington can refer patients to a physician who will provide telemedicine prescriptions for medication abortion anywhere in the province.
There are clinics providing aspiration services in Cranbrook, Kelowna, Nanaimo, Nelson, Vancouver, and Victoria. Patients may self-refer to the CARE clinic at BC Women’s Hospital in Vancouver for later term procedures (24 weeks and beyond): call 604-875-2022 or book online. There are also many medication prescribers across the province. For help navigating, patients can the provincial Pregnancy Options Line (604-875-3163) or the Options for Sexual Health “Sex Sense” information line at 1-800-739-7367.
Northwest Territories and Nunavut
Patients can call the Northern Options for Women program at 1-888-873-5710. A service of N.W.T.’s Health and Social Services Authority, the program provides care for residents of both N.W.T. and Kitikmeot (Western Nunavut). The headquarters is in Yellowknife and offers aspiration abortion from 14 to 20 weeks.
Medication abortion is available in Rankin Inlet, Cambridge Bay and Iqaluit, and aspiration abortion is available at the Qikiqtani hospital in Iqaluit, up to 13 weeks. The hospital number is 867-975-8600.
The Opal Clinic in Whitehorse provides surgical abortion up to 15 weeks. Patients can leave a message at 867-393-6635. There are also Opal-affiliated prescribers of medication abortion in Dawson City and elsewhere in the territory.
For information about services anywhere in the country, or for support to pay for travel for care, patients can call Action Canada (1-888-642-2725) or the National Abortion Federation Hotline (1-800-772-9100).
Where we go from here
As an abortion care provider, I believe we can improve access significantly by increasing health professional engagement in this work. We need health professional schools to routinely teach about abortion, for more health professionals to become prescribers/providers of abortion, and for prescribers and providers to increase their use of telemedicine and other approaches that expand accessibility.
The general public can make a huge difference by sharing information about abortion services, and talking openly about the importance of abortion as a normal part of sexual and reproductive health.