As Roe v. Wade draft ruling draws Canadian fire, has Trudeau lived up to his promises?

Canadian politicians who support reproductive rights have wasted no time in stepping into the outcry boiling over following news that the U.S. Supreme Court appears poised to overturn the landmark Roe v. Wade ruling that enshrined abortion as a constitutional right.

Prime Minister Justin Trudeau vowed his government will “never back down from protecting and promoting women’s rights in Canada and around the world” on Tuesday.

Women and Gender Equality Minister Marci Ien said people in Canada “cannot afford to be bystanders when it comes to protecting reproductive rights” while Health Minister Jean-Yves Duclos retweeted a tweet from Foreign Affairs Minister Melanie Joly defending reproductive rights as “rights that our government will continue to uphold.”

Yet the most recent federal budget contained no mention of reproductive rights or abortion, nor did the government’s fiscal update provided last fall after the election campaign.

That’s in comparison to 26 references to reproductive rights and abortion in the 2021 budget, and 16 references in the 2021 Liberal campaign platform.

While the U.S. Supreme Court draft ruling is not yet law, experts say overturning Roe v. Wade would cause spillover effects for Canadian women and pregnant people in a number of ways if access is not rapidly improved here at home.

“I think this would be a mistake to think that there will be no impacts for people in Canada,” said Frederique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.

Chabot said as state bans roll out following an overturning of Roe v. Wade, her organization anticipates restrictions will “severely curtail Canadian people’s ability to access care there.”

“That will, of course, put pressure on an already overburdened health system here in our own country.”

Abortion is legal at all stages of pregnancy in Canada, where there are no laws regulating or restricting care. But legal and accessible are two very different issues when it comes to abortion in Canada, and pregnant people are regularly referred to the U.S. for more complex abortions they cannot get here.

So are the Liberals living up to their promises?

For years, Trudeau has been vocal in emphasizing that both he and his government are pro-choice, and that anyone running for the Liberals must commit to voting in support of reproductive rights in the House of Commons.

He has been critical of efforts under the former Trump administration to restrict abortion access in the U.S. and has also criticized Canadian provinces for failing to make abortion easily accessible.

To be clear — most of the hands-on power to improve abortion access in Canada lies with provinces through their authority on providing health care to their residents and ensuring their doctors are properly trained to provide that health care.

But Trudeau has made clear he views a role for the federal government in doing what it can to improve access both by withholding money from provinces that do not fund abortion adequately, and working through other legislative powers to support the front line groups providing reproductive care.

In the most recent Liberal campaign platform, Trudeau made four key promises.

Those were updating the Canada Health Act to more clearly define the requirement on provinces to provide publicly funded abortions; providing up to $10 million to Health Canada to create a reproductive health portal, including a section countering abortion misinformation; and providing up to $10 million over three years to “youth-led grassroots organizations that respond to the unique sexual and reproductive health needs of young people.”

The fourth promise was to “no longer provide charity status to anti-abortion organizations (for example, Crisis Pregnancy Centres) that provide dishonest counseling to women about their rights and about the options available to them at all stages of the pregnancy.”

Both followed promises in the 2021 budget to provide $45 million to community-based organizations making sexual and reproductive information more accessible, including groups that help people who have to travel in order to get abortion care.

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The 2021 budget also vowed $7.6 million to set up a national survey on sexual and reproductive health — information not typically included in other Canadian surveys, which the government said leaves officials blind on where they might be best able to target support.

A spokesperson for Duclos said on Wednesday the promised $45 million will be rolled out over three years, and $15.5 million of that is being given so far through nine contribution agreements.

“Of the 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,” said Marie-France Proulx, press secretary for Duclos, in an email. “In addition, per capita funding of $9.7M will be provided to the Province of Québec to support community-based organizations located in Québec.”

Duclos said earlier on Wednesday that work on the promised information portal “is progressing” and the government will make further details public “soon” given the current concerns about abortion rights.

He said the latter was not in the latest budget because the funding was “already there,” but did not explain where that money was specifically coming from.

The government did not provide the names of the nine organizations with which it has signed contribution agreements to support access to reproductive care services.

Officials also did not provide a timeline when asked about the promised national survey, and also did not answer when pressed for details on the promise to update the Canada Health Act.

They also did not provide an answer when asked for the status of the promise to revoke the charitable status of so-called crisis pregnancy centres that provide false or misleading information about abortion.

Minister of Families, Children and Social Development Karina Gould had referenced that promise during comments to journalists when she was pressed on the government’s progress on protecting abortion.

“We are looking at making sure that abortion is accessible in every province or territory through the Canada Health Act. That means making sure that the Canada Health Act provides for access to abortion across this country,” she said.

Gould added that updating the Canada Health Act is in the mandate letters of both Duclos and Ien.

“They are working on this issue right now,” Gould said.

She also highlighted the legislation implemented last year to prohibit the obstruction or intimidation of people or patients at health-care facilities, a move that followed widely condemned protests at hospitals by anti-vaccine demonstrators.

That legislation also applies to those receiving and providing abortions.

The Canada Health Act is the federal legislation that outlines essential health-care services that all provinces must provide to their citizens. Abortion is one of those.

Provinces that refuse to provide services outlined in the Canada Health Act can see their health transfers withheld until they fix the problem. While the federal government has done that over recent years, the actual amount of money withheld is small: $140,200 withheld twice in the case of New Brunswick.

Campaign sources told Global News in the fall that the government’s aim in updating the Canada Health Act was to create clear definitions and standards for what level of equitable access to abortion provinces are required to provide.

Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, also urged the government to consider attaching strings to health-care spending boosts for abortion and sexual health care.

“The federal government is fond of saying that health care is a provincial jurisdiction, which is true, but it’s not true, because we have to remember, the federal government does supply about 30 per cent of the health-care funding to the provinces,” Arthur said.

“They could choose to increase that. They can also choose to attach strings to certain portions of the health-care transfer, for example, the way they’ve done with mental health care. They can do the same with sexual health care.”

The Liberals have several times now offered up health-care funding boosts to the provinces while requiring the cash on offer to be put to use for specific measures, such as improving mental health funding or addressing surgical backlogs caused by the COVID-19 pandemic.

As well, recent years have seen strong growth in the availability of the abortion pill throughout Canada, which experts say fills a key gap in making early abortion more easily available for people.

But not all pharmacies stock the combination of pills required, and there’s no national database of reliable, accurate information on how to access the abortion pill across the country.

Any conversation about abortion access would also be incomplete without also talking about birth control access, which remains a challenge for many where cost or permission may be a barrier.

Canadian provinces do not universally cover the full range of birth control options in their provincial health insurance plans, and some of the most effective options like IUDs or the arm implant are not covered by all provincial plans and can cost hundreds of dollars each without coverage.

Private plans, as well, do not universally cover all birth control options in their most affordable plans.

Federally regulated insurance companies are regulated under the federal Insurance Companies Act.

There’s also growing calls from sexual health advocates for Health Canada to reclassify birth control pills — in particular, the mini-pill –so that they can be made available over-the-counter.

The United Kingdom authorized the mini-pill for over-the-counter use last year.

According to a 2015 study in the Journal of Obstetrics and Gynaecology Canada, the cost of the 180,700 unintended pregnancies each year in Canada is roughly $320 million.

In contrast, the cost of universal national coverage for hormonal birth control is estimated at $157 million, according to an article in the Canadian Medical Association Journal (CMAJ).

NDP Leader Jagmeet Singh urged the government to include hormonal contraceptives in the pharmacare deal it has vowed to implement under its governance deal with the party.

Trudeau did not answer when asked if he would do so in question period.