Abortion Is a “Medically Required” Service and Cannot be Delisted

The following arguments explain why all abortions are medically required and must be fully funded by provinces under the Canada Health Act, whether performed in hospitals or clinics.
What does “medically required” mean?
The federal government or the courts have never defined what “medically necessary” means, other than the circular definition in the Canada Health Act – “medically necessary is that which is physician performed”. The provinces decide what is medically necessary under the Act, by creating a list of insured services, which are then automatically deemed medically necessary. In practice, however, politicians alone do not decide what is medically necessary; listed services must be negotiated between physicians and government. So even if a province wanted to delist abortion, they would have to get the cooperation of a medical organization, usually the College of Physicians and Surgeons or the provincial chapter of the Canadian Medical Association.

Women’s lives and health are at stake
Abortion services are a critical component of public health programs, since many women will otherwise risk their lives to obtain unsafe, illegal abortions. Legal abortion literally saves women’s lives and protects their health, making the service an integral part of women’s reproductive health care. (No Choice: Canadian Women Tell Their Stories of Illegal Abortion. Edited/published by Childbirth by Choice Trust, 1998.)
Abortion is not an elective procedure
Pregnancy outcomes are inescapable and time-sensitive. Neither childbirth nor abortion are “elective” because unlike elective procedures, a pregnant woman cannot simply cancel the outcome, or wait till next year. Once a woman is pregnant, she must decide relatively quickly to either give birth or have an abortion. Abortion in particular is very time-sensitive. Even waiting a few weeks increases the medical risk of the procedure. Dr. Henry Morgentaler has said: “Every week of delay increases the medical risks to women by 20 percent.”

Access to abortion is a constitutional right
Abortion is unlike any other medical procedure-legal, accessible abortion is also a Charter right guaranteed to women to protect their liberty, equality, and bodily security, as per the Supreme Court’s Morgentaler decision in 1988, which struck down Canada’s old abortion law. Not funding abortions would infringe on that right and impair access. This is precisely why the court threw out the old law, because it obstructed access and treated women unfairly. Although the court did not address the funding of abortion specifically, if it ever becomes necessary, a strong legal argument can be made that defunding abortion would have the same effect and therefore the same constitutional problems as the old abortion law.

Significantly, the Charter guarantees equality for women, and this clause has played a role in several court decisions that have upheld the right to abortion. A look at what happened in Saskatchewan in 1991 is also instructive. The province held a referendum on abortion funding during the provincial election, and 63% voted to de-insure abortion services. The conservative government lost the election, however, and when the victorious NDP stepped in, they commissioned lawyers to review the referendum results and offer advice. The lawyers decided that defunding abortion would probably not survive a Charter challenge because it would discriminate on the basis of sex. That’s because only women can get pregnant and only women need abortions. The Saskatchewan government never acted on the referendum.

Defunding abortion discriminates against low-income women
Anti-choice people claim that if abortion services were defunded, it would not discriminate against poor women. They say that most women will find the money anyway, as has been shown in the United States, which banned Medicaid funding for low-income women in 1976 with the Hyde Amendment. But recent research in the U.S. shows that only 80% of poor American women who want an abortion actually get one. This discriminatory and tragic U.S. policy cannot be held up as a model for Canada. Women’s equality rights are enshrined in our constitution, unlike in the U.S. Plus, the values embodied in Canada’s universal healthcare system are very different from the U.S.’s profit-driven system. In Canada, funded healthcare is a right, not a privilege. And under the 1988 Morgentaler decision, all women-not just the well-off-must have the right to access abortion services in a fair and equitable manner.

All abortions are “medically required,” not just some
Everyone agrees that at least some abortions are medically required, i.e., those performed to save the woman’s life or health. That means the government and medical profession would be forced to decide which abortions are medically necessary and which are not, based on women’s reasons for abortion. This is an impossible task, and one that medical organizations have refused to do. The lesson learned in Alberta in 1995 was that these groups refuse to go along with the government when it tries to delist some or all abortions. Physician groups do not want to formally define any categories, because they believe such things should be left to the discretion of individual doctors. It’s a matter of professional medical judgment, based on the patient’s particular circumstances and needs. Regardless, the doctors who actually perform abortions would be the first to attest that all abortions are medically necessary. Health, after all, is defined broadly in our society. It encompasses not just physical health, but mental and emotional health as well. All abortions would qualify under such criteria.

All pregnancy outcomes must be funded equally
Anti-choice people often say that pregnancy is not a disease and that abortion is a lifestyle choice-therefore, it is not medically necessary. However, the same arguments can be made for childbirth. There are no medical reasons for a woman to get pregnant and have a baby. She does so because she chooses to, often for socio-economic reasons. Anti-choice people might protest that there are “two patients” in a pregnancy and that abortion harms at least one of them. But Canadian courts have ruled decisively that fetuses are not legal persons with rights. Also, if the government were to de-insure abortion without also de-insuring childbirth, it would in effect be making the “lifestyle choice” for women. But such a move would bring us right back to the 1988 Morgentaler decision and the issues of unequal access, arbitrary obstacles, and discrimination against women.

Also, the co-opting of the word “choice” by anti-abortionists to marginalize the medical necessity of abortion is inappropriate and irrelevant. Every medical procedure is essentially a choice-people have the right to opt out, even if it means choosing death instead.

Unwanted pregnancies are costly
If abortion were de-funded, more women would be forced to carry to term. But the medical costs of childbirth are at least three times higher than the medical costs of abortion, and the social costs of raising unwanted children are prohibitive. According to U.S. figures, for every $1 spent by government to pay for abortions for poor women, about $4 is saved in public medical and welfare expenditures resulting from the unintended birth. Known risks of unintended birth include inadequate prenatal care, smoking and drinking during pregnancy, low birth-weight babies, and increased medical risks and poor social outcomes for pregnant adolescents and their babies. (www.cbctrust.com/ECONOMIC.html). Compared to wanted children, unwanted children are up to four times more likely to have an adult criminal record, and up to six times more likely to receive welfare between ages 16 and 21 (www.prochoiceactionnetwork-canada.org/articles/civilize.shtml).

Opinion polls are not relevant to the abortion funding issue
Opinion polls commissioned by anti-abortion groups show that a majority of voters do not want to pay for abortion procedures. But if equitable access to legal, safe abortion is a constitutional right for women, and if provinces and medical groups are responsible for deciding which treatments will be funded as medically necessary, that means the public has no business voting to defund abortion. Women’s basic rights and doms must not be subjected to a vote by the electorate.

Further, if a majority of taxpayers really don’t want to fund abortion, that may just indicate a misunderstanding of the issue by the public, rather than an informed and reasonable perspective. The public has been subjected to relentless anti-choice propaganda for years. As a result, many misconceptions about abortion have made their way into the mainstream, such as the notion that women who have abortions are irresponsible and promiscuous. Such misconceptions contribute to the belief that abortion should not be funded.

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