Reproductive Health

In Gruben’s chapter, what were the barriers to accessing abortion?

• Reduced/uneven public funding of abortion 

• Limited number of facilities offer abortion services

• Hospital and Clinic abortion services are concentrated in Urban centres

• Concerns regarding privacy and confidentiality 

• Conscientious objection policies

Barrier to abortion access: Reduced/uneven public funding of abortion

• Funding varies across the country, insurance often does not cover clinic abortions.

• Exclusion of abortion care from interprovincial reciprocal billing agreement (now includes only hospitals, not clinics)

Barrier to abortion access: Limited number of facilities offer abortion services

• Lack of facilities = greater wait times, travel and cost.

 

Ex. only 16% of hospitals in Canada provide abortion services (and decreasing)

Barrier to abortion access: Hospital and Clinic abortion services are concentrated in Urban centres

• Those living in rural or remote areas need to travel

• Longer wait times = stress and possibility of exceeding gestational limits.

Barrier to abortion access: Concerns regarding privacy and confidentiality

• Anti-choice harassment and violence on both patients and doctors.

• Shortage of health care professionals who provide abortion services.

• Difficultly in getting a referral.

Barrier to abortion access: Conscientious objection policies

• Providers may decline to provide services like abortion and contraception (on religious, ethical or moral grounds)

• Does not require a doctor to refer the patient to someone else (that wont object)

• Deep ideological divisions

How do barriers to accessing abortion disproportionately impact Indigenous women?

• traveling (3x more likely)

• Often lack access to confidential and unbiased abortion care.

• Often live in communities characterized by disadvantageous socioeconomic conditions.

To promote true access to abortion services for indigenous women, the social context in which indigenous women operate must be addressed, including:

Legacy of colonialism, oppression, and attempts at assimilation (i.e. residential schools, forced sterilization, sixties scoop)

Medical abortion

early abortion through the use of a prescription drug (i.e. mifepristone)

What are the barriers to medical abortion?

• Health Canada only authorizes the use of mifepristone only where it is prescribed and dispensed by registered physicians who have successfully completed an education program.

• Provincial governments have been slow to create billing codes for medical abortion.

• Most provincial drug plans do not cover the cost of the pill.

How can we improve access to abortion

• Governments must dismantle existing restrictions on abortion services and adopt positive measures (i.e. funding)

 

• Additionally, federal governments could withhold funding from provincial governments in order to get them in line.

Low rates of contraception use are seen among:

youth, those living in rural and remote territories, recent immigrants, and those of lower socioeconomic status.

• These low rates result from federal regulatory processes, high cost and limited access to knowledeable skilled healthcare providers.

What are the barriers to accessing contraception?

1. Health Canada's process for approving contraceptives has been less efficient than other classes of drugs. = Fewer contraceptive options

 2. Cost

• Health care system does not cover the cost of contraception.

 

3. Healthcare providers act as a barrier in accessing

• Those living in remote areas have limited access to providers authorized to prescribe contraception or provide services (i.e. IUD).

• Block access by applying inappropriate contraindications, delaying initiation, selective prescribing, lack of training or comfort, or by applying their own personal beliefs to patients.

In what ways are Indigenous women disproportionately affected by barriers to accessing contraception?

• Jurisdictional conflict

• Lack of access to confidential and unbiased primary care providers.

• Mistrust in contraception (i.e. history of sterilization)

How can we improve access to abortion?

• Amending laws and policies to expand the scope of practice

• Training of nurses and midwives.

• Authorizing other medical staff to prescribe contraceptives and perform IUD insertions.

• Universal contraception subsidy.

The law itself is a determinant of health, for example:

• can positively uphold rights to wellbeing

• can position some people as citizens/rights bearers

• can place people into a negative relationship with the law -- where health can be undermined from either rules or the stress created (ex. experiences of discrimination through the legal system)

 

Sexual Sterilization Act (Alberta), 1928-1972.

Made it legal for a board to decide if sterilization would be forced onto those who were then released from a mental hospital based on whether they were deemed medically incompetent to make a decision on their reproductive future (i.e. unable to consent)

During Alberta’s Sexual Sterilization Act, 1928-1972, what was the social climate at the time? who was targeted?

• During a time where same-sex sex was considered a mental illness.

• Those targeted by these laws included teenagers, Indigenous people, racialized people, people living in poverty, people with disabilities, people with mental illness.

• These targeted individuals would be framed by people in power as being "less competent," and unfit parents.

When people started to challenge these sterilization laws in Alberta, there was a

 

surge in the number of sterilizations on Indigenous women. (i.e. targeted once there was a concern the law would be removed)

Sexual Sterilization Act (BC), 1933-1973.

• There was a eugenics board that consisted of a court judge, a psychiatrist, and social worker.

• Those who were released from mental hospitals and industrial schools were subjected by a review from the eugenics board

"Over 1000 Indigenous women were also sterilized in the North in federally operated "________" across Canada between the early 1960s to the late 1970s."

Indian hospitals

These forced sterilizations were part of broader __________

eugenics movement

Eugenics movement

The idea that some people are unfit to be reproducing, so there is an attempt to create a society based on those deemed to be the strongest and most competent (i.e., meaning rich heterosexual able-bodied white people).

In Canada, how was the eugenics movement operationalized?

In Canada, this was done through accessing people as mentally unfit, having low IQ, and therefore not able to contribute to Canadian society.

• Included biased tests, and often targeted Indigenous people.

In 1951, Changes to the Indian Act that gave provinces the power to

define mental competence.

• Being deemed mentally incompetence led to forced sterilizations, removed property rights, and inability to consent.

 

Ex. Sterilizations happened more when people were in contact with mental health institutions.

Leilani Muir case

• Sterilized on the basis of an IQ tests, and notioned that she wasn't competent

• Underwent childhood abuse and did not receive proper education

So many sterilization cases like this occurred that Alberta had to do a  ________

group settlement

• 1998 (500 people) 

• Accepted a settlement that totaled 48 million dollars.

• There were remaining plaintants that went through the courts and received a settlement from Alberta and were issued an "expression of regret."

What were some issues with the group settlements alberta carried out?

• Restrictions on how long someone could take to file a claim.

• Individual cases need to be funded (not accessible process)

• Indigenous people got lumped in with everyone (ignores the context of targeting indigenous women)

Stote (and others) frame these practices of sterilization against Indigenous people as _______.

genocide

UH hospital in Saskatoon; currently a class action lawsuit by Indigenous women who have experienced coerced sterilizations since the 1970s.

There were concerns raised by indigenous women in that they were coerced into sterilization, for example:

• Not being provided adequate information

• Not being provided accurate information

• Being pressured to agree to sterilization while under duress.

"Medical authorities in Canada’s Northwest Territories sanctioned a doctor in May for forcibly sterilizing an Indigenous woman, according to documents obtained by the AP. Dr. Andrew Kotaska performed the 2019 operation to relieve an Indigenous woman’s abdominal pain. He had her written consent to _________."

remove her right fallopian tube but not her left one, which would leave her sterile

Selling and advertising birth control was not legal in Canada until _____.

1969

In regards to contraception, how did power influence its use?

• Indigenous people were pressured to take forms of birth control

• Government took an active role in promoting birth control to indigenous women (to keep families small, and motivated by eugenics)

 

Ex. Cash incentives to men to get vasectomies.

Shifts to “_________” discourses was used to target particular groups/mask eugenics based approaches (Stote).

family planning

One example of the harmful and coercive use of birth control was the criminalization of ________

midwifery

• Everything related to birth was only supposed to be done by medical doctors (and therefore the main government institutions)

Abortion was criminalized in the Criminal Code in ______.

1892

• A doctor or someone assisting an abortion could be charged, as well as the patient themselves.

• However, some doctors still preformed or assisted abortions.

“Therapeutic abortion” was legalized in Canada in _____, along with

1969

birth control; anal sex

Even as it was legalized, what were the restrictions in place for abortions in 1969?

• allowed abortions to take place in hospitals provided that the pregnancy posed a danger to the health of the woman as determined by a 3 doctor therapeutic abortion committee.

• “Section 251 of the Criminal Code, as it then was in 1969, authorized a physician to carry out an abortion provided that the woman received the approval of a therapeutic abortion committee at an ‘accredited or approved hospital.'"

The __________ in 1977 assessed how the change in abortion laws were functioning/going in practice.

Badgley report

• Led by Dr. Robin Badgley appointed by the federal government, chaired this committee that was creating this report on abortion laws.

What were the findings of the Badgley report in 1977?

Raised concerns about barriers and delays in accessing abortions (ex. travelling to hospitals, waiting for approval from committees, access, improper functioning)

R v Morgentaler, 1988, struck down …

s.251 (abortion laws) as unconstitutional.

R v Morgentaler, 1988

• Prior to this decision, Dr. Morgentaler set up a free standing abortion clinic in Quebec. This clinic ran without the therapeutic committee approval for abortions, and he was arrested.

• After being acquitted, he continued opening up clinics in other provinces, and he was charged again.

• Went to the supreme court, where the lawyers challenged the charge with the constitution.

 

• Stated that the abortion laws are interfering with a woman's body.

 

"section 251 violated women's right to security of the person because it created delays and frustrated access in ways that threatened women's health"

One year after morgentaler, there were attempts to

recriminalize abortion (through bill c-43 introduced in 1989), though they were not successful.

• 1990 --> Proposed recriminalization passed at the house of commons

• 1991 --> Went through the senate, was not passed (43 to 43 --> negative)

After R v Morgentaler, provinces attempted to introduce

their own restrictions on abortion access (ex. decreasing funding), though these were deemed unconstitutional.

In 2023, the federal government provided added

additional charges for expungement and destruction from criminal record.

Through what case did the supreme court overturn Roe v. Wade?

Dobbs v. Jackson Women's Health organization

What change was made to US abortion laws in 2022?

• The decision meant that individual states could create their own regulations regarding the legality of abortion access. (i.e., ended the constitutional right to an abortion)

 

• People will often travel to protected states to get an abortion; with this there are barriers in terms of travel and cost.

 

• Additionally, there is a fear of punishment for travelling for abortions.

3 years out from the Dobbs case; even though states have had bans, the number of abortions each year

remains steady, with other data suggesting abortions have increased by 10% since 2020.