Why Abortion Care Must Be Fully Funded

Anti-choice activists in Canada argue that abortion should be defunded and that women should pay out-of-pocket for abortion care.[1] But that is a right-wing ideological position that ignores evidence and human rights. Defunding abortion would be unconstitutional, discriminatory, and harmful to women. The following points explain why, followed by detailed arguments, evidence, and citations.

(A short version with only the 11 key points is available here. Aussi en français)

You can jump to the points using these links:

1. Women's lives and health are at stake.

2. Women’s liberty and conscience rights under the Charter require abortion to be funded.

3. Funding abortion is necessary to ensure women’s legal right to be free from discrimination.

4. Funding abortion is crucial to ensure fairness and equity, without discrimination on the basis of income.

5. Funding abortion is very cost-effective while unwanted pregnancies are costly.

6. Funding abortion serves to integrate abortion care into the healthcare system in general.

7. Funding abortion is the right thing to do, despite some peoples’ belief that abortion takes a human life.

8. Legal abortion is very safe for women, and generally beneficial.

9. Opinion polls showing that a majority of voters do not want to pay for abortion are misleading and not pertinent.

10. Abortion must be funded because it is not an elective procedure.

11. Women with unwanted pregnancies are not in a healthy place, and the argument that “pregnancy is not a disease” is invalid.

Sources / Endnotes

1.   Women’s lives and health are at stake. Funding abortion is necessary to guarantee women's right to life and security of the person under the Charter of Rights and Freedoms. The main reason the Supreme Court threw out the old abortion law in 1988 was because it arbitrarily increased the risk to women’s health and lives through unnecessary delays and obstructed access. Not funding abortion would have the same effect and the same constitutional problems as the old abortion law, and would put politics and ideology ahead of women’s lives and health.

Abortion services are a critical component of public health programs, since many women will otherwise risk their lives to obtain unsafe, illegal abortions.[2] Although no Canadian court has ever specifically ruled that abortion must be funded by taxpayers, if a legal challenge were made today, courts would likely uphold abortion funding as constitutional because it interferes with women’s equitable and unobstructed access to abortion in the same way that the old abortion law did, and therefore would negatively impact their right to life and security of the person. This was why the Supreme Court struck down the law in 1988 with the Morgentaler decision.[3]

The Charter protects the right to life and security of the person under s.7. The right to security of the person clearly entitles a woman to have control over her bodily integrity. This right is compromised without funding for abortion, since a right that becomes inaccessible or less accessible for some women due to government restrictions is a violated right. Further, Canada’s Supreme Court has agreed that funded healthcare is a s.7 right in Canada[4] (unlike in the United States where it is wrongly construed as a privilege). Canadians’ right to life cannot be upheld or protected without a universal healthcare system that funds medically required procedures for all Canadians on an equitable basis, and that includes abortion.

2.   Women’s liberty and conscience rights under the Charter require abortion to be funded. The government must not interfere with the deeply personal decision to bear a child or not, which is integral to women’s autonomy and privacy. Otherwise, the government would be co-opting women's right to choose by funding childbirth but not abortion, and paternalizing women with an official stance of moral disapproval of abortion.

It is difficult to conceive of a life decision more self-defining than whether or not to become a mother. Profoundly-held personal and religious beliefs guide a decision of this gravity, and the consequences of this decision will determine a woman’s perception of herself. The government must allow a woman to follow her conscience and beliefs in deciding whether or not to carry a fetus to term, and not constrain her choices by imposing restrictions such as a ban on funding.

In the 1988 Supreme Court Morgentaler decision,[5] Justice Bertha Wilson interpreted Charter rights more broadly than the other justices (who situated the right to abortion mainly in the “security of the person” clause). Wilson found that the criminalization of abortion also violated women’s fundamental rights and freedoms by denying women privacy and autonomy, and depriving them of their right to liberty. Wilson held that the right to liberty within s.7 “…guarantees to every individual a degree of personal autonomy over important intimately affecting their private lives” (Para 238) “without interference from the state.” (Para 228)

In addition, Justice Wilson affirmed broad definitions of freedom of conscience and religion in Morgentaler and held that personal morality that is not founded in religion was also protected by s.2(a). She held that “’freedom of conscience and religion’ should be broadly construed to extend to conscientiously-held beliefs, whether grounded in religion or in a secular morality.” (Para 251)

Subsequent rulings have suggested that the Supreme Court has adopted Wilson’s broad approach to Charter rights. [6] [7] [8] [9] [10] [11]  For example, the Supreme Court has recognized that s.7 generally includes the right to privacy.[12] Judicial intervention into women’s reproduction has been held to ignore the basic components of women’s fundamental human rights, including the right to privacy.[13] Specifically, the Supreme Court has rejected the restriction of conduct of pregnant women as an unacceptable intrusion into the privacy rights of women.[14] Following the legal principles set out in these subsequent rulings, abortion should be considered constitutionally protected under the rights to liberty, privacy, freedom of conscience and religion. Further, any legal restriction on abortion or government obstructions to access, including denial of funding, would violate these rights.

3.   Since only women need abortions, funding abortion is necessary to ensure women’s legal right to be free from discrimination. Restrictive policies and laws that apply to only one gender violate human rights codes that provide protection on the basis of sex. Further, women’s equality rights under the Charter cannot be realized without access to safe, legal, fully funded abortion—otherwise, women would be subordinated to their childbearing role in a way that men are not.

The Supreme Court in 1988 did not cite the Charter’s gender equality clause (Section 15), probably because it was not added to the Charter until 1985 and no jurisprudence existed for the clause until 1989. However, interpretation of this clause has gained strength in many subsequent court decisions,[15] including a Supreme Court decision stating that s.15 might be contravened if a pregnant woman owed a legal duty of care towards her fetus.[16]

A look at what happened in Saskatchewan in 1991 is instructive from the standpoint of women's legal equality and the issue of funding abortion. 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.[17]

Equality rights have been defined broadly by Canada’s Supreme Court. To determine whether someone is being discriminated against, courts must look not only at the legislation that has violated their equality rights by creating a distinction, but also the larger social, political, and legal context.[18] Further, it must be established whether the differential treatment has the effect of imposing a burden, obligation, or disadvantage not imposed upon others,[19] such as penalties or other restrictive conditions. If so, it is discriminatory.[20] This definition has been strongly affirmed by the Supreme Court as the proper approach to equality rights under the Charter.[21]

There have been attempts in Canadian law to characterize a woman’s pregnancy as a voluntary action, thus arguing that it is not the state that is imposing the burden of carrying the fetus to term, but her own actions. But this characterization has been repeatedly rejected by the Supreme Court, which said in one decision that characterizing pregnancy as a voluntary decision imposes unfair disadvantages on one group of people, from which all of society benefits.[22]  Further, most abortions are the result of unintended pregnancy, which is certainly not voluntary—it’s an accident. Medical treatment for other accidents is fully funded, so why not for pregnancy accidents? Also, men share responsibility for accidental pregnancy, so it would be discriminatory to place the burden of payment on women.

In addition, Justice Beverly McLaughlin stated in the Dobson decision:

To say women choose pregnancy is no answer. Pregnancy is essentially related to womanhood. It is an inexorable and essential fact of human history that women and only women become pregnant. Women should not be penalized because it is their sex that bears children: Brooks v. Canada Safeway Ltd, [1989] 1 S.C.R. 1219. To say that broad legal constraints on the conduct of pregnant women do not constitute unequal treatment because women choose to become pregnant is to reinforce inequality by the fiction of deemed consent and the denial of what it is to be a woman. (Para 87)

A woman’s equality rights are intrinsically tied to her right to determine whether she will carry a fetus to term. Anti-abortion restrictions—which by extension include lack of funding—compromise a woman’s bodily integrity and autonomy, thus imposing a burden not experienced by any other group of citizens. This conforms to the Supreme Court’s definition of discrimination that violates the Charter; therefore, defunding abortion would also be discriminatory and contrary to the constitution.

4.   Abortion funding is crucial to ensure fairness and equity, without discrimination on the basis of income. We must not compel low-income women and other disadvantaged women to continue an unwanted pregnancy due to lack of funding, or to delay care while they try to raise money. Any delay in abortion care raises the medical risks, especially when it extends into the second trimester. Delays are also a punitive burden that unnecessarily prolong stress and discomfort for women. Best medical practice should ensure that abortion takes place as early as possible in pregnancy, and this requires full funding.

Around the world, restricted access to abortion kills and injures the poor, not the rich, because better-off women have always been able to pay for safe abortions.[23] This inequity was one of the key reasons abortion was legalized decades ago in most western countries.

According to the Guttmacher Institute, in a report about the consequences of lack of funding for poor women:[24]

Research indicates that women who are economically disadvantaged are delayed at two key stages. Poor women typically take more time than better-off women to confirm a suspected pregnancy, which could be because of the cost of a home pregnancy test or the difficulty in getting a test from a clinic or doctor. In addition, they take several more days between making the decision to have an abortion and actually obtaining one. When asked why they were delayed at this stage, poor women are about twice as likely as more affluent women…to report having difficulties in arranging an abortion, usually because of the time needed to come up with the money. Moreover, other research shows that poor women who are able to raise the money needed for an abortion often do so at great sacrifice to themselves and their families. Studies indicate that many such women are forced to divert money meant for rent, utility bills, food or clothing for themselves and their children.

Up to a third of poor American women seeking an abortion are forced to continue their pregnancy because they can’t raise the money to pay for an abortion.[25] But governments are obligated to ensure that people can exercise their constitutional and human rights without undue hardship. There is no right to abortion without access to services, and funding is absolutely necessary to ensure reasonable access.

5.   Funding abortion is very cost-effective while unwanted pregnancies are costly. The medical costs of childbirth are about four times higher than the medical costs of abortion, and the social costs of forced motherhood and unwanted children are prohibitive. Further, the overall cost of abortion care to the taxpayer is a pittance relative to healthcare costs as a whole.

Although one of the main reasons cited by anti-choicers for defunding abortion in Canada is to save money,[27] this is ultimately a hypocrisy because they also want to make abortion illegal again. The cost of criminalization could rival the cost of safe, legal abortion, since women don’t stop having abortions when it’s illegal—they just have unsafe ones. In the developing world, treating complications from unsafe abortion costs hundreds of millions of dollars each year.[28]

6.   Funding abortion serves to integrate abortion care into the healthcare system in general, and ensure that reproductive healthcare is properly comprehensive. If abortions were not funded, it would ghettoize abortion care, as well as the women who need it and the healthcare professionals who deliver it. This would likely increase stigma, lead to other restrictions, further marginalize abortion care over time, and increase anti-choice harassment and violence. All of this occurred in the United States after abortion was defunded for poor women by the 1973 Hyde Amendment.

The Hyde Amendment was passed in 1977 to prohibit federal funding for abortion except in cases of rape, incest, and life endangerment. Since then, more than a million poor women—mostly women of colour—have been denied funds for abortion, severely limiting their right to reproductive healthcare.[29] Studies over the last two decades show that 18–35% of poor American women who would have had an abortion had to forfeit their right to abortion and continue unwanted pregnancies because their Medicaid funding was cut off.[30] 

A strong case can be made that lack of funding has contributed significantly to the marginalization and stigma of abortion, opened the door to more and more restrictions over time, and perpetuated or escalated violence against abortion providers. In the U.S., almost all abortions are now done by private clinics, isolating the service from the rest of the healthcare system. Part of the reason for this is that clinic costs are much lower than hospital costs.[31] Unfortunately, when hospitals do not offer abortion care, they are not teaching physicians how to provide safe abortions, or conducting research to advance quality abortion care. Further, abortion providers feel isolated and are often shamed and shunned by their colleagues in the medical profession, with negative consequences for their reputation and livelihoods.[32] States have enacted hundreds of abortion restrictions since 1973,[33] including a record 162 so far this year alone.[34]

Also, a heavily stigmatized atmosphere is decidedly not safe for providers. An epidemic of violence has occurred since 1977, committed by anti-choice radicals and terrorists—including 8 murders and 17 attempted murders of abortion providers, 41 clinic bombings, 175 arsons, 98 attempted bombings and arsons, 391 clinic invasions, 100 butyric acid attacks, 662 anthrax threats, 653 bomb threats, 188 cases of assault and battery against clinic staff or patients, 418 death threats, 523 stalking incidents, 1,451 cases of clinic vandalism, 154,000 pickets in front of clinics, and more.[35]

All of this would be much less likely to occur if abortion was funded and better integrated into mainstream healthcare. In Canada, the levels of stigma, marginalization, harassment, and violence are far less than in the U.S., which must be due at least in part to the fact that abortion is treated much more like a healthcare procedure in Canada, with full funding and about half of abortions done at hospitals. In addition, abortion funding likely enables increased opportunities and grants for research into improving abortion care and techniques, thereby enhancing the quality and safety of abortion care even more.

7.   Funding abortion is the right thing to do, despite some peoples’ belief that abortion takes a life. There is no social consensus on the moral status of the fetus, and our laws do not bestow legal personhood until birth. Regardless, most Canadians believe that the woman’s rights are paramount in all or most circumstances, because she is the one taking on the health risks of pregnancy, bearing a child is a major decision with significant lifelong consequences, and a woman should be able to direct her own life and pursue her own aspirations apart from motherhood.

There is a wide divergence of opinion on “when life begins” or what the moral value of a fetus should be. Biology, medicine, philosophy, and theology have no consensus on that issue. There will never be a consensus because of the subjective and unscientific nature of the claim. That's why we should give the benefit of the doubt to women, because they are indisputable human beings with rights.

The practice of abortion is unrelated to the status of the fetus anyway—it depends totally on the aspirations and needs of women. Women have abortions regardless of the law, regardless of the risk to their lives or health, regardless of the morality of abortion, and regardless of what the fetus may or may not be. For example, overall abortion rates do not differ much between countries where it's legal and countries where it's banned to "protect life." Of 41 million abortions a year in the world, 21 million are unsafe and mostly illegal. In the developing world, about 47,000 women die every year from unsafe abortion, and five million are hospitalized.[36]

This is not just a problem in developing countries. Because abortion is not funded in the U.S., many poor American women resort to cheap, illegal “do-it-yourself” abortions using the drug misoprostol, which can be unsafe without medical supervision.[37] Also, almost all U.S. clinics can anecdotally report that their patients frequently tried herbal remedies first, which are widely touted on the Internet[38] but are often ineffective or even unsafe. Abortion must be funded to ensure that women do not feel compelled or encouraged to take such risks.

Legally speaking, fetuses do not have rights in Canada. The Supreme Court has held that a fetus is not a legal person until it is born alive,[39] which is in line with the Criminal Code definition,[40] as well as Canadian civil law and international human rights codes. Further, in Dobson, the court ruled that a woman and her fetus are considered one person under the law, which essentially gives a woman absolute rights over her fetus: “A pregnant woman and her foetus are physically one, in the sense that she carries her foetus within herself. Virtually every aspect of her behaviour could foreseeably affect her foetus. … The physical unity of pregnant woman and foetus means that the imposition of a duty of care would amount to a profound compromise of her privacy and autonomy.”[41]  A denial of funding for abortion would amount to imposing such a duty of care on a pregnant woman, especially a poor woman.

In the Winnipeg decision, the Supreme Court stated that “recognizing a duty of care owed by a mother to her child for negligent prenatal behaviour may create a conflict between the pregnant woman as an autonomous decision-maker and her fetus.” The court approvingly cited this passage from the Royal Commission on New Reproductive Technologies in its final report, Proceed with Care (1993, vol.2 at pp. 957-58): “[Judicial intervention] also ignores basic components of women’s fundamental human rights – the right to bodily integrity, the right to equality, privacy, and dignity.”[42]

8.   Legal abortion is very safe for women and generally beneficial. The alleged medical and psychological “dangers” of abortion to women as described by anti-choice activists are either totally false or grossly overstated. Regardless, such arguments cannot support the defunding of abortion, since pregnancy and childbirth are far more medically risky, and many other funded medical treatments carry substantial risk. Access to legal, safe, fully funded abortion is also beneficial for women and families because it allows them to continue with their lives, and plan wanted children later when they are ready to care for them.

According to anti-choicers, the supposed risks of abortion for women include: breast cancer, infertility, pelvic inflammatory disease, subsequent premature birth and low birth weight, and "post-abortion syndrome", which includes depression, drug and alcohol abuse, suicide, and other mental health problems and negative psychological after-effects.

But most of the studies relied on by anti-choicers to prove their contention that abortion has such negative health risks or side-effects are flawed and essentially worthless, or have been misinterpreted. Unfortunately, the abortion issue has attracted more than its fair share of shoddy science, since anti-choice “researchers” themselves have been successful at getting many studies published in peer-reviewed scientific journals, despite serious methodological flaws in their work.[43] [44] The most common errors are recall bias, small or non-random samples, non-matching control groups, and wrong assumptions that correlation equals causation.

A good example that illustrates each of these errors is anti-choicers’ treatment of the alleged increased risk of breast cancer after abortion. They continue to tout this disproven link despite a comprehensive 2003 review of the evidence by the National Cancer Institute and over 100 of the world’s leading experts on pregnancy and breast cancer risk, which concluded that having an abortion or miscarriage does not increase a woman’s subsequent risk of breast cancer.[45] Reputable health agencies all continue to support this conclusion, including the World Health Organization,[46] American Cancer Society,[47] and Canadian Cancer Society.[48]

The recall bias error may occur when studies obtain women’s abortion history by interviewing them. But when women are asked to self-report their abortion, many won’t admit it. Various studies have shown that they under-report past abortions by 20 to 80 per cent, depending on the interview circumstances.[49] This has much to do with abortion stigma and fear of being judged by others, but under-reporting also skews the data. That’s because women with diseases that may be linked to past behaviours, such as breast cancer, are much more likely to admit to those past behaviours, as they’re anxious to find answers that may help with their treatment. Women acting as controls are not as inclined to admit to strangers that they’ve done something in the past that might be disapproved of, especially when they have no stake in the outcome. Conclusions from such flawed methodology are not justified.

One of the most ubiquitous flaws committed by anti-choice “researchers” is to confuse correlation with causation. When they find that women who had abortions suffer ill health more than women who carried to term, they tend to conclude that abortion was responsible.[50] But correlation does not equal causation, which means that some other factor could be causing the negative effect, not abortion. In fact, women with planned pregnancies tend to be in better physical or mental health compared to women who have abortions, and tend to have more stable lives. For example, married women are generally healthier than unmarried women, but most abortions are obtained by unmarried women. Also, women leading dysfunctional or unhealthy lives are much more likely to experience unintended pregnancy in the first place, and more likely to seek abortions.[51] Such disparities can lead to significant differences in outcome that should not be attributed to the birth or abortion itself. The American Psychological Association has concluded that mental health problems are not a direct result of choosing to have an abortion,[52] and a recent study confirms this.[53]

Some research done or cited by anti-choicers have relied on studies that look at small groups of women, or that use non-random samples for their study subject, which means that the findings are not statistically significant or may be invalid because the conclusions cannot be applied to women in general. Another common flaw is using an inappropriate control group for comparison purposes. For example, anti-choicers may mistakenly compare women with unplanned pregnancies to women with planned pregnancies or to women who had miscarriages, even though those groups have dissimilar characteristics. The best control group would be women who carried to term after being denied an abortion. Finding such a control group would not be impossible in western countries, because women are still frequently denied abortion due to various access barriers, particularly in the U.S. Most existing studies are older, and found that women denied abortion, along with their unwanted children, often experience significant long-lasting problems.[54] [55]

Legalized abortion has had many health benefits for women and their families. As shown in the U.S. after the Roe v. Wade decision legalized abortion in 1973, these include:[56]

• A dramatic decline in abortion deaths and complications.
• Increased proportion of abortions early in pregnancy when they are safer.
• A reduced incidence of major birth defects because of the availability of amniocentesis and legal abortion.
• A decline in birthrates and corresponding health improvements for women who bear the most negative consequences of unintended childbearing (teenagers, women over 35, and unmarried women).
• A lower infant mortality rate and healthier infants.
• Increased psychological, social, and economic well-being for mothers and their wanted children.

The last point reflects the fact that abortion is about good motherhood—women have abortions primarily so they can be better mothers to their existing or future children, which means that legal abortion helps strengthen families and keep them out of poverty. (It’s no coincidence that U.S. states with the strictest anti-abortion laws are the same states that have the worst records for the health and well-being of their women and children.[57]) Generally speaking, when abortion is legal and accessible in a country, so is contraception. When abortion is illegal, some forms of contraception may be illegal as well, or at least very difficult to access. The lack of access to these two services typically go hand in hand, probably because right-wing conservatives tend to equate contraception and abortion—or at least see both as immoral since they give women control over childbearing.

However, the evidence is very clear that contraception and family planning services are key to reducing unintended pregnancy, which is by far the main cause of abortion. [57a] In countries where abortion is legal and contraceptive use improves over time, abortion rates decline predictably and often dramatically. This pattern has repeated itself countless times around the world,[58] including in Canada, where our abortion rate has been in a more or less steady decline since 1997, especially amongst teenagers.[59] Therefore, the most effective way to reduce abortion is to advance women’s rights and equality so they are better-equipped to avoid unintended pregnancy, repeal all laws that restrict abortion, and ensure good access to family planning and reproductive health services. Good access entails full funding for not only abortion, but contraception as well.

Abortion is one of the most commonly performed clinical procedures in the world, including in Canada. About 31% of Canadian women will have at least one abortion by the time they’re 45.[60] If abortion was unsafe as anti-choicers claim, we’d be seeing an epidemic of illness, injury and death caused by abortion, but in fact, the mortality and morbidity rate from legal abortion is extremely low in Canada, compared to the tragic carnage we see in developing countries where abortion is illegal. In 1999, the mortality rate in Canada was estimated to be 0.1 deaths for every 100,000 abortions (and 0.6 deaths in the U.S.).[61] Compare that to sub-Saharan Africa, where the most recent estimated maternal mortality rate for unsafe illegal abortion is 90 deaths per 100,000 abortions. That’s 900 times the mortality rate in Canada. As for complications, 5 million women are hospitalized after unsafe abortion in developing countries while an estimated 3 million more never seek treatment.[62] This means that over a third of women resorting to unsafe abortion suffer serious complications. In the U.S. meanwhile, less than 0.3% of women suffer serious complications from legal abortion.[63] The Canadian Institute for Health Information (CIHI) reported that in 2010, the rate for complications was 2.4% - but only for hospitals.[64] The actual complication rate will be even lower because clinics do half of all abortions, almost all in the first trimester. Early abortions have a lower complication rate than for later abortions, especially when done under local anesthetic (most hospitals use general anesthetic). Statistics Canada reported that in 1995, less than 1% of abortions in Canada resulted in any complication at all, whether minor or more serious. [64]

These facts expose anti-choicers’ professed concern for women as a cruel hypocrisy. They limit their claims about the alleged dangers of abortion only to legal abortion but rarely talk about the well-proven and devastating impact of illegal abortion on women’s lives and health, even though that’s what they want to return all women to. They are indifferent not only to the serious endangerment of women’s lives and health through illegal abortion, but to the prospect of criminalizing one-third of Canadian women. In fact, some of them want to put women in jail.[65] It’s easy to conclude that anti-choicers are really more interested in punishing women for having abortions—including letting them die—than they are in protecting their health.

It’s not clear why Canadian mortality and morbidity rates from abortion are lower than in the U.S., but funding may help account for it. Although the vast majority of abortion clinics in the U.S. deliver excellent care despite the lack of government funding, a few outliers still exist—unscrupulous or incompetent providers who may take advantage of women for profit. The tragic situation discovered in Philadelphia in 2011 is a case in point—Dr. Kermit Gosnell performed cheap, illegal late-term abortions on vulnerable low-income women who could not afford to go to a reputable clinic. Gosnell was charged with 8 counts of murder for killing one woman and seven infants born alive. A second woman also died, and dozens suffered perforated bowels, cervixes and uteruses.[66] Unfortunately, when doctors make their money privately from abortion fees they collect directly from women, they become less accountable to the government, medical boards and organizations, and accrediting agencies. It’s reasonable to assume that the extra oversight that comes with government funding would decrease the risk of substandard treatment of women. Indeed, reports of bad providers are extremely rare and practically nonexistent in Canada, but surface from time to time in the U.S. Unfortunately, the occasional discovery of a bad provider is a field day for anti-choicers, who use it to reinforce abortion stigma and push for more stringent anti-choice laws—which incidentally have nothing to do with patient safety and may actually compromise it, such as laws that mandate waiting periods and increase delays, and laws that require clinics to do major and expensive renovations unrelated to patient health.

Finally, the overall rate of death from pregnancy-related causes is 7 deaths per 100,000 women in Canada, and 17 deaths per 100,000 women in the U.S.,[67] with abortion deaths a miniscule proportion of those. That means abortion is about 7 times safer than carrying a pregnancy to term in Canada, and 17 times safer than in the U.S. The risks of death and complications for teen pregnancy are even greater, for both the teen and her baby.[68]  Pregnancy can also aggravate or trigger various serious conditions, including heart disease, high blood pressure, cancer, diabetes, kidney disease, and autoimmune diseases.[69]  Nevertheless, the wide range of risks, complications, and side-effects of  pregnancy[70] are a topic that anti-choicers are completely silent on, despite their wish to forcibly subject women to those risks.

9.   Opinion polls showing that a majority of voters do not want to pay for abortion are misleading and not pertinent. Voter opinion on this issue has been shaped by anti-choice misinformation, as well as lingering prejudice about women who have abortions. Regardless, voters have no authority to dictate what medical treatments to fund, as this is the role of provinces and professional medical organizations. Women's basic rights and freedoms must not be subject to a majority vote.

All provinces and territories have deemed abortion to be medically required, which means they must fully fund the procedure under the Canada Health Act, whether it is performed in a hospital or private clinic.[71] The reason all abortions are medically required—not just the “hard cases” of life endangerment, rape, or incest—is because it became impossible and unconstitutional in 1988 (via the Morgentaler decision) for third parties to decide whether a woman should be able to obtain an abortion, based on her reasons for abortion. Ultimately, whether an abortion is "medically required" or not is a decision that only the pregnant woman has the right to make (with the assent of her doctor), not a medical organization and certainly not the government. Even if a particular pregnancy does not pose a serious risk to a woman’s physical health or life (but every pregnancy poses some medical risk), the World Health Organization’s definition of health includes “mental health”. In practical terms, this fits all abortions, since if a woman wants an abortion but can’t obtain one due to lack of funds, that would be very distressing or traumatic, and could have long-term negative psychological consequences for her.

Anti-choicers have claimed that provincial governments are exclusively responsible for deciding which services should be on the list of medically required services to be funded, and that courts have even said that a province could simply delist abortion. This is inaccurate or at least misleading, as there would be formidable obstacles to overcome. Provincial governments cannot make delisting decisions alone because they need to consult with doctors. As cited by anti-choicers themselves[72], the head of the Senate Standing Committee on Social Affairs said in 2001 that: "the determination of what services meet the requirement of medical necessity is made in each province by the provincial government in conjunction with the medical profession." In other words, the government consults with provincial medical associations and colleges of physicians and surgeons.

The lesson learned in Alberta was that these groups refuse to go along with the government when it tries to delist some or all abortions. In 1995, the federal government ordered Alberta to start funding all medically necessary services that were being performed in private clinics. Because Alberta had a large number of private clinics offering hospital services, the federal government began to withhold transfer payments to the tune of over $5 million a year. In an effort to declare at least some abortions as not medically necessary, the province asked the Alberta Medical Association and the College of Physicians and Surgeons to define "medically required" as it related to abortion services. Both refused to do so because it would interfere with doctors’ medical discretion. The Alberta government decided to continue insuring all abortions at hospitals, and soon began funding the private clinics in Calgary and Edmonton as well.

Taxpayer funding of healthcare works similarly to how citizens pay taxes in general. We cannot pick and choose which government services or initiatives we’re willing to pay taxes for and which we’re not. Otherwise, chaos would result and the government would not be able to function.

Finally, if a majority of taxpayers really don't want to fund abortion, that more likely indicates 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, and indicate the need for more public education.

10. Abortion must be funded because it is not an elective procedure, any more than childbirth is. Pregnancy outcomes are inescapable, meaning that a pregnant woman cannot simply cancel the outcome—once she is pregnant, she must decide to either give birth or have an abortion. To protect her health and rights, both outcomes need to be recognized as medically necessary and fully funded, on an equal basis.

Anti-choicers try to marginalize the medical necessity of abortion by labeling it as a “lifestyle” choice that women make for socio-economic reasons; therefore, it should not be funded. Although abortion is indeed often referred to as a choice, this is political rhetoric that cannot be used as an argument to deny abortion funding. Deciding to become pregnant and have a baby is also a choice, often a socio-economic one, but no-one would suggest defunding childbirth because it’s an elective procedure. Also, every medical procedure is essentially a choice—people have the right to opt out, even if it means choosing death instead. And as explained previously, funding childbirth while not funding abortion would be discriminatory and violate women’s constitutional rights.

11. Anti-choice activists often say that “pregnancy is not a disease” and therefore abortion should not be funded. But the same arguments can be made for childbirth, since there are no medical reasons for a woman to get pregnant and have a baby. More importantly, health is much more than the absence of disease – it’s about achieving a state of overall health and wellness. Women with unwanted pregnancies are not in a healthy place, so their abortion care should be funded.

The anti-choice position that “pregnancy is not a disease” implies that healthcare is about treating illness, but of course health is much more than simply the absence of sickness or injury, it’s about achieving a state that benefits a person and helps them get the most value out of their life. To quote feminist writer Amanda Marcotte:[73] “We don’t want women to be just “not sick.” We want them to be healthy. Not just healthy, but thriving.” She points out that the “pregnancy is not a disease” mindset sets up a minimalist view of what women need—as long as the body is functioning and can make babies, that’s all a woman needs. But women are not baby-making machines; they are far more than that. Besides, a woman with an unwanted pregnancy is not in a healthy place, either physically or mentally. Her body is out of her control, and she’s in a distressed state.

If anti-choicers think pregnancy is not a disease, then they should be consistent and oppose funded reproductive healthcare for all pregnant women, including any medical assistance in childbirth. Of course, this is absurd, but it effectively shows how the “choice” rhetoric is being inappropriately exploited in this context by anti-choicers to marginalize the medical necessity of abortion. Bearing children should not be constructed as a voluntary choice, as if it’s a frivolous activity like a hobby, because in order to survive and prosper, societies need most women to reproduce. This makes it essential for societies to protect women’s rights and ensure they have the supports they need to bear children when they are ready. That means providing access and funding for a wide range of reproductive health services, including abortion, in order to avoid the negative health and social consequences of forced motherhood and unwanted children. The opposite tactic of oppressing women and trying to force them into reproductive slavery simply does not work. It is also profoundly immoral and a serious violation of human rights.

Acknowledgment

I would like to thank Sarah Galeski, who supplied many of the arguments and citations provided for Points 2 and 3 in an unpublished 2007 article co-authored by her and Joyce Arthur, called The Case for Repealing Criminal Laws Against Abortion: Lessons from Canada.

Sources / Endnotes

Note: Portions of the following sources by the same author were excerpted or adapted for this article:

Arthur, Joyce. January 2011. Abortion Is a “Medically Required” Service and Cannot Be Delisted. Abortion Rights Coalition of Canada, Position Paper # 1. http://arcc-cdac.ca/postionpapers/01-Abortion-Medically-Required.pdf

Arthur, Joyce. Why Abortion Won’t Be Defunded in Canada. Pro-Choice Press. Autumn/Winter 2003. http://www.prochoiceactionnetwork-canada.org/articles/defunding.shtml

Arthur, Joyce. Can Abortion be De-funded in Canada? Pro-Choice Press. Spring 2002. http://www.prochoiceactionnetwork-canada.org/prochoicepress/02spring.shtml

Arthur, Joyce. March 1, 2010. Abortion Still Does Not Lead to an Increased Risk of Breast Cancer (or other health problems). Abortion Rights Coalition of Canada. http://www.arcc-cdac.ca/action/still-no-abc-link.html