Lack of open dialogue about abortion perpetuates stigma and barriers, Ontario researcher says

A leaked draft of the U.S. Supreme Court's opinion to overturn Roe v. Wade has sparked conversations about the barriers around abortion that still impact Canadians over 30 years after it was decriminalized here.

Just because abortion has been legal in Canada since 1988 doesn't mean the procedure is always readily accessible, says Jacqueline Potvin, a postdoctoral fellow at the University of Guelph in Ontario.

Potvin has conducted research into reproductive rights and justice globally that includes how society talks about abortion.

"There's often an assumption that we're good, we're fine, things that happen in other countries, things that happen in the U.S. are not going to happen here," said Potvin. "That's led to some complacency about being aware of that barriers that still exist."

Some of those barriers include differing services between provinces and lack of accessibility in rural areas, which Potvin said particularly impacts "people who are already marginalized" and may not have the means to travel.

If Roe v. Wade is overturned as federal law, some U.S. state legislation — known as "trigger laws" — would immediately take effect, outlawing abortion. In Michigan, which borders Windsor, Ont., the state's Republican-dominated legislature is unlikely to overturn that law and Democratic Gov. Gretchen Whitmer can't veto legislation already signed by another governor nearly a century ago.

Potvin said another challenge in efforts to access abortion can be the lack of open dialogue, and "that stigma and that silence that allows stereotypes and taboos to continue."

CBC News reached out to Windsor Regional Hospital (WRH), Bluewater Health in Sarnia and the Chatham-Kent Health Alliance (CKHA) to obtain data on how many abortions they perform, how many physicians assist and whether there are wait lists. All of them declined to discuss the topic of abortion or provide any data.

"We do not have any publicly available information on this," said Fannie Vavoulis, spokesperson for the CKHA.

"We aren't commenting on the issue at this time, most importantly for privacy and security of patients and our clinical staff," Steve Erwin, spokesperson for WRH, said in an email to CBC News. "For women seeking this procedure, it is a private matter that we can arrange with them privately or with the assistance of a family doctor referral."

Potvin said the reaction of the southwestern Ontario hospitals that CBC contacted "makes me really sad. That's really disappointing."

Institutions presumably do have good data and do have good insight into the [abortion] barriers that might exist, and without that kind of information and data being shared, we also can't understand how those barriers are being perpetuated.​​​​​- Jacqueline Potvin, University of Guelph researcher

On one hand, Potvin can understand a health-care provider's reluctance to discuss abortion as they can be targeted, sometimes with violence, for being associated with the procedure. Ontario law prohibits abortion protesters from being within up to 150 metres of an institution that performs the procedure or the homes of staff and physicians who assist women with terminating a pregnancy.

However, the lack of openness from some health-care providers can spark the fear of stigma or judgment, and could lead to a "shameful" experience, Potvin said. Lack of open and transparent discussions about abortion may also mean anyone seeking an abortion "won't even know where to start," she said.

"A lot of women feel like they're starting completely blind," said Potvin, adding it could stand in the way of a woman getting timely care. "That does make it less accessible."

There's also value in publicizing local data on abortions, she said.

"Institutions presumably do have good data and do have good insight into the barriers that might exist, and without that kind of information and data being shared, we also can't understand how those barriers are being perpetuated — how they're continuing, how we can make abortion accessible [and] a more positive experience for people."

Without sharing the data, there's a risk of perpetuating the "stigma and that silence that allows stereotypes and taboos to continue."

While the southwestern Ontario hospital bodies contacted wouldn't release numbers, the Canadian Institute for Health Information (CIHI) has annual data on abortions conducted across the country. In 2020, there were more than 21,000 in Ontario, compared to nearly 45,000 in 2012.

Ontario has 38 abortion providers, the second highest number in Canada behind Quebec, according to the latest data from the charitable organization Action Canada for Sexual Health and Rights.

A Ministry of Health spokesperson told CBC News that more abortion services, both medical and surgical, are provided in non-hospital settings.

Abortion bans 'create inequality': researcher

The Canadian government has said Americans would be able to access abortions here in the event Roe v. Wade is overturned.

"Abortion bans don't stop abortion, but they do create inequality in who has access to abortion," said Potvin, referencing the means or resources someone would need to cross state lines or international borders.

Hospitals are considered independent corporations, governed by a board of directors, and independently handle billing for uninsured individuals, according to the Ontario government.

"Some hospitals work out payment plans so that bills can be paid over time and some hospitals will absorb a portion of the costs, enabling the patient to contribute what they can," said Ministry of Health spokesperson Bill Campbell.

Windsor Regional Hospital declined to comment about if and how American women could access an abortion here and the associated cost if they are uninsured.

Local supports for those considering abortion

The Windsor Essex Community Health Centre provides supports for people with questions about abortion, but declined to speak with CBC News.

However, the Windsor-Essex County Health Unit (WECHU) said they offer counselling services, provided by a public health nurse, for individuals looking to end a pregnancy. After those discussions about how a pregnant person is feeling, risks and where to access abortion services, the health unit refers them to Windsor Regional Hospital's pregnancy hotline (519-985-2662) for further assistance.

"It's not just a personal health care [decision] — it's a difficult one," said Felicia Lawal, WECHU's chief nursing officer and director of public health programs.

Lawal acknowledges stigma on any issue, including abortion, can be harmful, and WECHU tries to help "support and advocate to break down the barriers."

"Anything that would help destigmatize an issue is always beneficial. So yes, if there is an opportunity for more open dialogue, we would definitely advocate and support that."