The True Cost of an Abortion in Canada, According to an Expert

Abortion is typically covered by insurance for people with a Canadian health card, but there are additional costs that are often disregarded and can make the procedure inaccessible for some.

In 1988, abortion became legal in Canada, and today, new initiatives continue to be introduced to improve access to safe abortions for all citizens. Most recently, the Government of Canada committed to giving millions in funding for projects by Action Canada and National Abortion Federation Canada to offer financial assistance for people who need to travel for the procedure. But that’s still just one of many secondary costs that can be a barrier to abortion.

In most cases, the procedure itself—whether that be a surgical abortion or the abortion pill—in Canada is free for those with a Canadian health card. But then there’s the cost of taking time off work, child care, and travel and accommodation costs, if you live outside of a city centre where abortions aren’t available. That means for some people, an abortion in Canada can cost thousands of dollars.

We sat down with Action Canada’s director of health promotion Frédérique Chabot to learn more about the hidden costs around abortions in Canada.

First, can you share a bit about the two abortion options in Canada: a surgical abortion and the abortion pill?

The term “surgical abortion” is kind of a misnomer—it’s not actually surgery. Some people call it a procedural abortion, but people just know it as surgical abortion. Most of those abortions happen in the early stages of pregnancy, so before 12 weeks, which is when the majority (about 95 percent) of abortions are done. The way it works is you go for an appointment at a clinic or hospital. An instrument is inserted through the cervix and it aspirates the contents of the uterus. The procedure takes about 5-10 minutes. After the procedure, the patient goes to the recovery room for up to an hour, is usually given some pain management medication, and there’s some bleeding. Different procedures are used to terminate pregnancies at later gestational stages but it’s all with instruments through the cervix.

The abortion pill is usually called “medical abortion,” but a better name is “medication abortion.” People in Canada can access a medical abortion up until nine weeks; after that, a surgical abortion is the only option for ending pregnancy. A medical abortion is when an abortion happens through two medications. After talking to a doctor and getting a prescription, you take the first called Mifepristone, which is a progesterone blocker. Progesterone is the hormone that helps the pregnancy stick and continue to evolve—so if you block it, the pregnancy stops evolving. After 24 hours, you take Misoprostol, which is a medication that makes the uterus contract. The tissues are expelled; it’s basically a miscarriage. There will be cramping and bleeding. It takes two to three days to complete, and it can happen at home. There’s a follow-up appointment with a doctor by phone or in person to make sure that everything went well.

How much does a surgical abortion and a medical abortion cost in Canada?

Both surgical and medical abortions are insured medical procedures. This means all you have to do to get the procedure for free is show your health card at the clinic, hospital or pharmacy.

But, if you’re outside of your home province or territory, you can get coverage only for a surgical abortion—not the abortion pill. For example, if you’re from Ontario and visiting or living in Alberta, you’re entitled to getting an appointment with a doctor and your province will be billed for your surgical abortion—but there’s no such arrangement for medication. So if you need the medical abortion pill in another province you do not live in, you have to pay out of pocket, and the price can range from $350 to 450.

There’s also another potential cost, particularly if you are a resident of Ontario. New clinics in places like Brampton and Mississauga are charging people administrative fees. So, even though the medical procedure and the doctor fees are covered by the province, Ontarians are asked to pay out of pocket for the administrative fees, which can range from $50 to 400. This is in violation of the Canada Health Act. It’s a problem that can only be addressed by the provincial and the federal governments.

Is there anywhere else in Canada where people seeking an abortion are treated unfairly?

In New Brunswick, there’s an anti-choice regulation, which is also in violation of the Canada Health Act, because it restricts abortion care to hospitals—it can’t happen in a clinic. The government has funded three hospitals to offer abortion. Two of them are in Moncton, one of them is in Bathurst, and they have a very early gestational limit [14 weeks]. So when people need services beyond that time, or don’t have money to travel, people are asked to pay for a surgical abortion or medical abortion, ranging in price from $500 to 1000.

There’s also a possibility of a fee in Nunavut, because there’s no agreed universal cost coverage for the medical abortion pill. The appointment would be free, but there’s about 15 percent of the population that is not covered by a federal program to cover the cost of the pill.

How accessible is abortion in Nunavut and other remote places?

Outside of major cities, especially in the territories, there are fewer points of services, so people have to travel for health care. This means people seeking an abortion have to pay for travel and accommodation and everything else that comes with having to access an abortion that’s not in your community. It’s a very common medical procedure—one in three people that can be pregnant will have an abortion in their lifetime—but it’s not treated as such.

How much are the travel costs?

It’s a significant expense—plus, people have to take time off work, find childcare or eldercare, pay for transportation and accommodations. And it might require a few days. If the pregnancy is in its first few weeks, a procedure will be a day-long, but if it’s later in the pregnancy, the procedure can take three to five days.

Action Canada as well as the National Abortion Federation Canada have received funding that can cover travel, accommodations, and incidentals (taxis, food, etc.). A good portion of the funds goes to staffing costs for people who answer the phone lines and act as patient navigators. Another portion is reserved for financial aid that is available to anyone in Canada who is facing barriers to abortion. This past year, we have supported over 130 people with our donor-funded emergency fund. People who are not covered by the Health Canada fund are undocumented people or people without health insurance for some reason who need help with procedure costs and those who need the abortion pill and are not in their home province. We have another fund that we use to cover those costs, called the Norma Scarborough Emergency Fund and it is entirely funded through individual donations.

Are there other potential extra costs on top of travel?

There are all sorts of situations where people find themselves without insurance and no way to pay for an abortion, like not having health insurance or being out of province. And these procedures can cost between $500 to 3000, depending on where you’re getting it.

Plus, there’s the emotional and time burden. People have to figure out what to do by themselves. For example, say you needed a medical procedure because you have a heart murmur, you’d get a pathway to the service from your doctor. But when people need an abortion, in most cases, people have to go home, figure out where to go, wade through disinformation, and find a clinic. And then they have to make their way to that clinic themselves on their own dime.

Has the abortion pill made abortions more accessible, particularly for people in remote places?

In 2015, Health Canada approved the medication abortion, the gold standard from the World Health Organization that has been in use for over 30 years in 60 countries. So it’s new to Canada, but it’s not new at all. It’s finally easier to get abortion care outside of urban centres.

In most provinces, primary care providers can prescribe it. And the pandemic accelerated the process of doctors finally seeing the benefit of offering telemedicine. Now we have no-touch abortions, which means you can talk to your doctor from your home on Zoom, the prescription for the abortion pill can be faxed to the pharmacy, and then you can go pick it up and have your abortion managed at home. But it’s not always that easy. Some practitioners refuse to provide care on the basis of their own personal beliefs.

What can you do if your doctor won’t prescribe the abortion pill?

In those cases, you will have to find a public abortion provider (working from an abortion clinic, a hospital, or some health care center where primary care providers see the public). In some provinces, people can access an appointment for a medical abortion through telemedicine, which means that they can access it without having to travel outside of their community. This is what should be the case everywhere.

For more information or to find an abortion clinic, visit actioncanadashr.org.

This interview has been edited and condensed.

Next: Women’s Health Collective Canada Is Addressing the Gap in Women’s Health

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Originally Published in Best Health Canada