In an office in Canada the nurse calls from outside the abortion procedure room. Standing by a counter. the products of conception are in a glass dish. The dish reveals a small pinkish liquid swirl. The nurse pulls down her surgical mask, using a latex gloved finger points at a miniscule, feathery item. “That is what we look for, that little bit of fluff.”

 

An abortion may be done utilizing local anesthetic in less than 10 minutes. It is safe, requires very little recovery time and almost no medication. In fact it is many times safer than being pregnant, and is the safest procedure done by doctors. Less than 3 per 100,000 have an difficulty. To place in perspective, the chance of dying from anesthesia in a hospital is 30x that. Most abortions are not done in hospitals, simply in doctor’s offices.

 

Statistics Canada Abortion reports 100,039 Canadian women had an abortion in 2004, the last year for which statistics are available. Another 337,072 did not have an abortion.

 

According to the Guttmacher Institute and the World Health Organization, about 40% of pregnancies in development countries — including Canada — are unintended. Both organizations say 28% of all unintended pregnancies in developed countries end in abortion.

 

What follows here is not a debate about whether it is right or wrong. Not a discourse on whether the nurse at Toronto’s Morgentaler clinic was pointing at the byproduct of social evil or choice.

 

Twenty years ago next month, on Jan. 28, 1988, the Supreme Court of Canada ruled in favour of a case brought years earlier by Dr. Henry Morgentaler.

 

COMMITTEE DECISION

 

His lawyers argued a situation in place since 1969, where a woman seeking an abortion had to find and convince a three-member therapeutic abortion committee it was medically necessary to protect her health, violated the Charter of Rights and Freedoms.

 

From then on, it would be a woman’s choice to terminate or continue her pregnancy. There are no limits on when. Abortion is treated like any other medical service. Except it is most definitely not. We don’t talk about abortion in Canada because for the most part, we don’t want to.

 

One 27-year-old Ottawa woman, who has had two abortions, tries to explain why. She’s comfortable with her decisions but knows others, including a close friend, would not be.

 

“People are judgmental and they look at you differently. For sure. Even if they agree with it,” she said, “she (her friend) looks at me as a lesser person because I did that. And so would other people.”

 

The country’s right-to-life movement has worked tirelessly to keep its cause alive since 1988.

 

“People are coming up who have lived with the Morgentaler decision a long time,” says Mary Ellen Douglas, national organizer of Campaign Life Coalition. “They don’t come to the issue with the same feeling we did. I think our attitude was ‘let’s stop the horrible killing.’ I think the feeling was we’d be able to do this in five years and go back to our families.”

 

Past serious challenges to the Supreme Court ruling failed and there aren’t any on the horizon in Canada, certainly nothing like what is happening in the United States, next month also marking an anniversary, the 35th, of 1973’s abortion-legalizing decision, Roe v. Wade. But there is a movement afoot here to implement certain gestational limits.

 

“I personally don’t think we should have a prohibition on early abortion, because I think if you can’t enforce it, then overall it does more harm than good,” said Margaret Somerville, founding director of the Centre for Medicine, Ethics and Law at McGill University.

 

“But Canada is unique in the Western world for having no prohibition on abortion at all. You can have an abortion the day before you give birth in Canada and that is perfectly legal.”

 

Morgentaler, now 84, says the fight is far from over.

 

“I think the way people think, it’s other people’s problem, and as long as it doesn’t affect them personally, there’s not much action on that,” he said. “Also, Canadians mostly believe the issue has been solved.”

 

Morgentaler warns while abortion may be legal in Canada, a variety of factors are at work to limit access. Those problems were reflected in a major survey of abortion access released this year by Canadians For Choice (CFC), an Ottawa-based group created after the Canadian Abortion Rights Action League (CARAL) dissolved in 2004.

 

Building on a 2003 CARAL study, CFC research co-ordinator Jessica Shaw contacted 791 hospitals, posing as an out-of-province 22-year-old, 10 weeks pregnant, without a family doctor or any nearby family and friends, seeking an abortion.

 

AMONG HER FINDINGS:

 

– Abortion services are available in one of every six Canadian hospitals; a percentage that has dropped to 15.9% from 17.8% in 2003.

 

– In three out of four calls, hospital staff did not know if their facility offered abortions.

 

– The average waiting time for an abortion is two weeks, but can be four and as much as six. Until new funding came through, that was the length of the wait in Ottawa, proving access problems are not limited to small towns.

 

– Limits on when abortions can be performed vary widely among hospital and facilities — from 10 weeks to 22 weeks.

 

– Travel time and expenses are an issue. Shaw also encountered hospital staffers who tried to mislead or ridicule her.

 

“One nurse, in Central Canada, said ‘well, if you are thinking about having an abortion, you might want to first consider checking yourself into the inpatient psychiatric ward at the mental hospital,'” recalls Shaw, “‘because obviously you are not in a good frame of mind.'”

 

CFC executive director Patricia LaRue says after 20 years, the study shows women are still having to fight to have an abortion.

 

“We think if we ever need it, it’s going to be there,” she said, “but we don’t need to take a position on it until we ever need it.”

 

The way Canada’s health care system is structured can explain some of the obstacles to access. Health care is a provincial responsibility and subject to political will. In the months after the Supreme Court decision, many provinces moved to restrict abortion funding.

 

In New Brunswick, Morgentaler is suing the province over its policies, which funds hospital abortions only under restrictions he says violate the Canada Health Act. And not all provinces include abortion in their reciprocal billing agreements.

 

“There’s very clearly a two-tier system at work,” said Christabelle Sethna, an associate professor at the University of Ottawa Institute of Women’s Studies.

 

“Women are sort of ping-pong balls between provinces and different health care levels and facilities.”

 

Sethna is studying the explosion of privately operated abortion clinics in Canada since the Morgentaler decision: 45% of abortions are now done in clinics, compared to 7% in 1988. And while it is considered both “appalling” and “urgent” whenever news surfaces of Canadians who have to travel or pay for CAT scans or MRIs, said Sethna, “none of the discussion that is taking place about wait times and access to medical procedures like cancer treatments or hip replacements is going on about abortion.”

 

In the August edition of the Journal of Obstetrics and Gynaecology of Canada, Sethna reported on how access issues affect low-income women. In a survey done at the Toronto Morgentaler Clinic, she found women with incomes of less than $30,000 were more likely than wealthier women to have travelled between 200 to 1,000 km to have their abortion.

 

Vicki Saporta, executive director of the National Abortion Federation, agreed the access issue may not be a problem for women with money and means to travel.

 

“But it is a problem for many low-income women or immigrants or students who may not have access to the services they need,” she says.

 

Joyce Arthur, co-ordinator of the Abortion Rights Coalition of Canada (ARCC), says because abortion is an unpopular topic, federal governments tend to have a “hands-off approach.”

 

“And if no one is doing anything to improve access,” she says, “it’s probably going to decrease.”

 

OTHER FACTORS

 

There are other factors at work. Medical schools in Canada provide little instruction on abortion. More than half of Canada’s abortion providers are near retirement age. The doctor shortage, size of the country and anti-abortion doctors who may conscientiously object to providing the service or information about it are also factors.

 

Pro-abortion and anti-abortion groups agree it still needs to be an issue.

 

On one side, LifeCanada president Joanne Byfield says the goal is to get people outraged.

 

“You don’t decide who is a human being by listening to a judge or a government,” she said. “These are inalienable human rights.”

 

On the other hand, the Morgentaler decision may have protected the right to choose an abortion, but it didn’t ensure abortion services will be available, says Joanna Erdman, adjunct professor at the University of Toronto’s International Reproductive and Sexual Health Law Programme.