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Accidental Tourists: Canadian
Women, Abortion Tourism, and
University of Ottawa
University of British Columbia
Available online: 23 Apr 2012
To cite this article: CHRISTABELLE SETHNA & MARION DOULL (2012): Accidental
Tourists: Canadian Women, Abortion Tourism, and Travel, Women's Studies: An inter-
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Women’s Studies, 41:457–475, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0049-7878 print / 1547-7045 online
DOI: 10.1080/00497878.2012.663260
University of Ottawa and University of British Columbia
“Medical tourism” is fast becoming a subject of major research
interest. It is usually understood to be a twenty-first centur y man-
ifestation of health tourism and refers to travel to access a range
of elective or obligatory medical services. Medical tourism is pop-
ularly characterized as the solution to rising domestic health care
costs and patient wait times in a globalized world that encourages
consumer choice (Gray and Poland 2; Cortez 72; Turner 1639).
Yet medical tourism is a very complex phenomenon. The term
itself is contested; sometimes emphasizing foreign, cross-border
or regional travel, travel from wealthy countries to poor countries
or travel that combines access to medical services with tourism
(Hall 5; Johnston 24; Hopkins 185). The word “tourism” can be
misleading (Hannah). Tourism can occur for “non-leisure pur-
poses” involving “the consumption of goods and services” during
the period of travel. These goods and services can include medical
services (Martin 251) and their consumption is seen as addressing
or exacerbating prevailing economic inequities because medical
tourism is a global industry worth billions (Vijaya 55; Godwin
3981). Even when individuals travel to access medical services for
reasons that have little to do with choice, tourism signifies indi-
vidual agency, freedom, and mobility (Gilmartin and White 276).
These characteristics are often linked to medical tourism despite
the fact that legal and extra-legal impediments blocking access to
medical services compel individuals to travel (Smith-Morris and
Manderson 334).
Address correspondence to Christabelle Sethna, Institute of Women’s Studies,
University of Ottawa, 30 Stewart St., Ottawa, Ontario, K1N 6N5, Canada. E-mail:
Downloaded by [Marion Doull] at 08:46 30 April 2012
458 Christabelle Sethna and Marion Doull
Women’s access to medical services within a medical tourism
framework needs to be investigated because women’s choices, espe-
cially in regard to reproduction, are limited by gendered structural
constraints and globally stratified inequities based on race, class,
disability, sexuality, nationality, and age (Colen 380; Lippman 282;
Smith 120). Notably, one type of medical tourism that is unique
to women is “abortion tourism.” The term has an anti-choice
slant although it is used generically to indicate the travel women
undertake to access abortion services. This kind of travel, which is
likened to the Underground Railroad, diaspora, or exile (Nathan;
Rossiter), is most familiar to Ireland, where abortion is illegal.
Thousands of Irish women travel to Britain annually for abortion
services (Human Rights Watch 2). Medical tourism and abortion
tourism are profoundly interconnected because they both involve
travel to circumvent similar legal and extra-legal impediments to
medical and abortion services. However, abortion tourism is rarely
acknowledged as part of the broad spectrum of medical tourism
(Behrmann and Smith 85). This omission may occur because atten-
tion paid to women participating in medical tourism is focused
mostly on the use of assisted reproductive technologies (ARTs) in
“reproductive tourism,” “fertility tourism,” or “cross-border repro-
ductive care” intended to induce pregnancy and promote gestation
to term (Jones and Keith; Bergmann; Whittaker and Speier). It may
also occur because of a general disinterest in women’s reproduc-
tive health issues (Cook, Dickens, and Fathalla), because abortion
is a stigmatized medical procedure (Feldt), or because only travel
across international borders is viewed as medical tourism (Johnston
24; Hopkins 186; Smith-Morris and Manderson 331) whereas travel
across domestic borders is ignored.
In this article we trace Canadian women’s abortion tourism,
use government reports documenting its existence, and then turn
to studies of non-governmental organizations on abortion access.
We argue that travel to access abortion services is a widespread
transnational phenomenon in which Canadian women have par-
ticipated; that it predates the current trend of Canadian medical
tourism; and that it must be considered a type of medical tourism
whether or not Canadian women’s travel to access abortion ser-
vices occurs across international or domestic borders (Palmer;
Sethna and Doull, “Journeys of Choice”; Sethna and Doull, “Far
From Home”).
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Canadian Women, Abortion Tourism, and Travel 459
Abor tion as a Medical Procedure
Abortion is recognized as a vital, time-sensitive health service that
is also a remarkably common medical procedure. Still, it remains
a contentious practice for many (D. Shaw 634). “Unsafe abortion,”
defined as “a procedure for terminating an unwanted pregnancy
either by persons lacking the necessary skills or in an environ-
ment lacking the minimal medical standards or both” (World
Health Organization), is a leading cause of maternal mortality and
morbidity (Grimes et al., “The Preventable Pandemic” 3). While
abortion rates are similar in the developing and developed worlds,
the vast majority of unsafe abortions occur in the developing world
(Sedgh 90). Safe abortion in the first trimester leads to far bet-
ter health outcomes than does late term abortion (Kiley 446).
After 20 weeks of gestation abortion is generally classified as late
term and is rare (Centers for Disease Control and Prevention).
Abortion rates remain fairly stable regardless of the legal status
of abortion. Legal abortion results in significant improvements
to women’s health (Grimes, “The Silent Scourge” 101). Despite
the importance of legal abortion, abortion does not have to be
illegal in order to be inaccessible. As the grounds for legal abor-
tion vary widely around the world, access to abortion can easily be
compromised (Singh 5).
Women who travel to access abortion services do so because
of the illegality of abortion and/or because extra-legal impedi-
ments restrict access to abortion services. Extra-legal impediments
may include the geographical distance to abortion services, the
costs of the procedure, the wait times involved, complicated
referral or approval policies, gestational limits, inappropriate or
limited facilities, uncooperative or untrained medical person-
nel, anti-choice harassment, confidentiality issues, and HIV status
(J. Shaw; Henshaw). Extra-legal impediments restrict access to
abortion even in sectors where abortion is legal (International
Sexual and Reproductive Health Law Program).
Therefore, women travel, often over long distances and
under trying conditions, to access abortion services across inter-
national and domestic borders. The further a woman has to travel
to access abortion, the less likely she is to obtain one and the
more likely she is to be young and underprivileged (Jewell and
Brown 118; Lichter, McLaughlin, and Ribar 285; Shelton, Bran,
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460 Christabelle Sethna and Marion Doull
and Schultz 262). Travel can skew abortion data, making it diffi-
cult to establish the need for abortion services in different sectors
(Strauss). Indeed, abortion rates fluctuate geographically because
of the concentration of abortion services in certain jurisdictions
(Gober 230). Birth and abortion rates rise and fall based on the
feasibility of travel from regions where abortion access is impos-
sible or difficult to regions where abortion access is available
(Harper, Henderson, and Darney 507). Even internet search pat-
terns indicate that areas with limited abortion access show higher
use of the internet to search for abortion providers outside those
locations (Reis and Brownstein).
Abor tion History in Canada
Abortion in Canada has been historically deployed as a back-
up method of birth control for women. Abortion was often
self-induced using home-made concoctions or commercially sold
abortifacients and could also be performed by medical or non-
medical personnel. While many women died because of post
abortion infections, most survived. Nevertheless, abortion was
a significant contributor to maternal mortality rates (McLaren
and McLaren, “Discoveries and Dissimulations”; McLaren and
McLaren, “The Bedroom and the State”). Abortion and contra-
ceptives were criminalized in the late nineteenth century when
eugenic thought was predominant. Intent on preventing “race
suicide,” eugenicists sought to increase the numbers of Canadian-
born, white, Anglo-Saxon Christians by restricting birth control
access overall. However, eugenic concerns over the fertility of
immigrants, the disabled and the poor encouraged the devel-
opment of a birth control movement. While there was support
for the legalization of contraceptives, abortion remained a clan-
destine matter (McLaren, “Our Own Master Race”; Backhouse;
Overseas Journeys
Over time, some non-Catholic hospitals formed Therapeutic
Abortion Committees (TACs) to deal with abortion requests on
a case-by-case basis but the threat of prosecution deterred many
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Canadian Women, Abortion Tourism, and Travel 461
doctors from performing abortions (Brodie, Gavigan, and Jenson
25). Pressure for the reform of birth control laws increased after
1945 when eugenically inspired fears of overpopulation, especially
in the developing world, surfaced (Sethna, “The Evolution of
the Birth Control Handbook” 101). In the 1960s, illegal abortion
was recognized as a leading public health issue. The liberaliza-
tion of abortion legislation in various countries coincided with an
increase in global tourism. Canadian women who could afford the
costs or who could raise the money, began travelling to Japan,
Poland, Sweden, Mexico, and Switzerland for abortions. One
college student recalled her flight overseas:
Because abortions were not legal in Canada, I was taken to Japan [by a
parent] where they were.... Because of the language problem, I didn’t
know what was happening or going to happen to me. ...Although the
staff was very kind, my surroundings were unsanitary. ... I had to bor-
row a substantial amount for the trip. Financially, this experience set me
back a year and more. (Report of the Committee on the Operation of the
Abortion Law 186)
The passage of Britain’s 1967 Abortion Reform Act (excepting
Ireland) spurred even more abortion tourism. The Act allowed
for legal abortions if two doctors could agree that there was
a risk of fetal anomalies or that the continuation of the preg-
nancy threatened the woman’s life, her physical or mental health,
or any of her existing children. Because the Act had no resi-
dency requirements, women from all over the world, including
Canada, came to Britain to access abortion services (Sethna,
“All Aboard” 92). The transportation industries, abortion refer-
ral agencies, and doctors directly or indirectly encouraged their
travel. Disgust over profiteering that was occurring at the expense
of foreign nationals led British authorities to rebuke “commer-
cial entrepreneurs”—ranging from taxi drivers, hotel owners and
private sector doctors—for taking financial advantage of these
women, bringing the medical profession into disrepute and cre-
ating an international scandal (Report of the Committee on the
Working of the Abortion Act 131).
Canadian women who did not go abroad relied upon a net-
work of relatives, friends, acquaintances, and sympathetic medical
professionals who referred them to local abortionists or to those
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462 Christabelle Sethna and Marion Doull
in another city or province. A young, pregnant, Toronto woman
My parents had found out why I was so sick and they were wonderful about
it. My dad said he had just read that abortion was legal in Sweden and that
somehow they would arrange to send me there. But the next day a cousin
of a friend called to tell me of a man in Ottawa who would give me an
abortion for $400. I was told to come alone, bring cash and I would be met
at the airport. (Childbirth by Choice Trust 140)
Canadian abortion providers were inundated with requests for
abortions from women inside and outside Canada. Vancouver
physician Dr. William McCallum had women referred to him
“from as far away as Montreal, New York, Miami, Los Angeles,
Hawaii, Nome, and from every town and village in British
Columbia” (qtd. in Childbirth by Choice Trust 114). After
Montreal-based Dr. Henry Morgentaler began performing abor-
tions openly in his clinic in contravention of Canada’s law, women
from all over North America besieged him with requests for the
procedure (Dunphy 89, 113).
Abor tion Law Reform and Abortion Tourism
In 1969, the Canadian government succeeded in reforming the
country’s birth control legislation such that contraception was
decriminalized and abortion was legalized. Once the new law
came into effect in August that year, legal abortions could be
obtained only under stringent conditions. A woman seeking an
abortion had to be referred by a doctor to a Therapeutic Abortion
Committee (TAC) in an accredited hospital. The TAC, composed
of three or more doctors, determined whether the pregnancy
threatened the life or health of the woman. However, accredita-
tion varied according to provincial requirements, hospitals were
not obligated to strike TACs, and doctors were not obliged to
serve on these committees. Catholic hospitals opted out. And
nowhere was the concept of health defined (Muldoon 173–174).
Dissatisfaction with the new abortion law was immediate. Nascent
feminist groups were particularly irked by the control it ceded
to doctors and the unfairness with which it was applied. They
discovered that TACs were most likely to approve the abortion
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Canadian Women, Abortion Tourism, and Travel 463
requests of women who were married, white, and middle class.
These groups organized to demand the repeal of the new abor-
tion law. In the interim they helped women navigate the stringent
requirements for legal abortions, or directed women to abortion
providers in the United States (Palmer; Thomson 25; Sethna and
Hewitt 470). After some American states legalized abortion, thou-
sands of Canadian women journeyed south of the border for
abortion services. After the American Supreme Court declared in
1973 that abortion merited constitutional protection, even more
abortion options became available in the United States for women
who could afford to travel (Sethna, “All Aboard” 97).
Ongoing opposition to the new abortion law from various
quarters led the Canadian government to appoint a Committee on
the Operation of the Abortion Law to study how the abortion leg-
islation functioned in practice. Released in 1977, the Committee’s
report confirmed that the law had not alleviated the need for
women to journey to abortion ser vices as only 20.1 percent of
accredited hospitals in Canada had TACs. The report provided
proof of women’s entangled domestic and international border
crossings for abortion services. Women who contacted their physi-
cians after suspecting pregnancy had to wait an average of eight
weeks for a TAC-approved abortion at a hospital. Women who
approached community agencies for assistance were directed to
the United States for abortion services, especially if they lived in
Ontario, Quebec, or the Maritime provinces. Women who sought
help at university student health services were most often sent
to hospitals in Canada. However, in a quarter of these cases,
they were directed to hospitals out of town or to the United
States. The most significant reasons for travel to the United States
included gestational limits for abortion imposed by local hospitals
in Canada, TAC rejection of an abortion request, confidentiality
issues, and the difficulty getting a medical appointment within
a reasonable length of time (Report of the Committee on the
Operation of the Abortion Law).
The Committee concluded that “a continuous exodus of
Canadian women to the United States” was one of the pre-
dominant consequences of the 1969 legislation (Report of the
Committee on the Operation of the Abortion Law 17). It held two
main factors responsible for this exodus: the near impossibility
of procuring an abortion in Canada in a timely fashion and
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464 Christabelle Sethna and Marion Doull
the existence of competitive “abortion referral pathways” to the
United States (Report of the Committee on the Operation of
the Abortion Law 74). These pathways turned a profit for abor-
tion referral agencies and the transportation industries on both
sides of the border. American abortion clinics and hospitals servic-
ing Canadian patients also benefitted financially. In fact, half the
American abortion clinics and hospitals the Commissioners sur-
veyed actively solicited Canadian women by providing Canadian
doctors with brochures, writing letters to Canadian physicians
and referral agencies, listing their services in Canadian telephone
directories, and placing advertisements in Canadian newspapers.
Some American abortion clinics sprung up near the border delib-
erately to attract Canadian patients. Based on the available data
for the year 1974, 11,194 Canadian women had abortions in the
United States (Report of the Committee on the Operation of the
Abortion Law).
Domestic Abortion Services
A few Canadian hubs for abortion services emerged due to a con-
centration of accredited hospitals with TACs and abortion clinics
in urban locales. However, clinic abortions were technically ille-
gal under the 1969 law because they were not performed after
TAC approval in an accredited hospital. An Ontario study commis-
sioned by this province’s Ministry of Health found that because
abortion services were unavailable or limited in smaller centers,
the resultant delays led to high rates of second trimester abortion,
especially among teenagers. Figures for the year 1985 indicated
that one in five Ontario women left their county of residence to
have a hospital abortion in another part of the province. Over
50 percent of all abortions in Ontario were performed in hospitals
in Toronto, Ontario’s largest city. Hospital abortions for out-of-
town women caused hardships such as repeated travel for e ach
step in the referral process and the consequent costs. Five thou-
sand Ontario women went to abortion clinics in Toronto and the
United States (Powell 34).
Legal challenges to the 1969 abortion law coalesced
around Dr. Henry Morgentaler, who continued to perform
abortions in his Montreal clinic. Morgentaler insisted that
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Canadian Women, Abortion Tourism, and Travel 465
abortions up till 12 weeks of gestation could be done quickly
and easily in a clinic setting, thereby avoiding TAC-fuelled delays
and the complications of later term abortions. In the 1980s,
Morgentaler opened a clinic in Toronto and another in the city of
Winnipeg, Manitoba arguing that the law “discriminates against
the poor who cannot travel to the United States and afford the
cost of an abortion there, as well as those living far from the bor-
der and women who have difficulty leaving their family behind
in order to travel to the States” (qtd. in Pelrine 85). Morgentaler
clinics proved to be a draw not only for Canadian women.
Abortion referral services in the United States sent American
women who lived close to the border northward. In fact, the doc-
tor’s first arrest in 1970 occurred after he performed an abortion
on an American teenager who had travelled from Minnesota to
Montreal (Dunphy 89).
Extra-Legal Impediments
On January 28, 1988 the Supreme Court of Canada invoked the
Charter of Rights and Freedoms and struck down the 1969 abortion
law in the landmark case R. v. Morgentaler . The Court recognized
that the law was unfair because it forced women to bear the
hardships of travel to access abortion services:
If women were seeking anonymity outside their home town or were simply
confronting the reality that it is often difficult to obtain medical services
in rural areas, it might be appropriate to say ‘let them travel.’ But the evi-
dence establishes convincingly that it is the law itself which in many ways
prevents access to local therapeutic abortion facilities. The enormous emo-
tional and financial burden placed upon women who must travel long
distances from home to obtain an abortion is a burden created in many
instances by Parliament. (R. v. Morgentaler 71)
The striking down of the abortion law did not solve the problem
of lack of access to abortion services (Rodgers 111). In the post-
1988 era, anti-choice opposition to abortion and the failure of the
federal government to assert its authority over provinces and terri-
tories where abortion access was problematic, undermined access
to abortion services (Palley). For example, women from Nova
Scotia who sought abortions in the province’s hospitals before and
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466 Christabelle Sethna and Marion Doull
after the Supreme Court decision continued to experience long
delays. They waited anywhere from t wo to six weeks for a hospital
abortion due to the lack of physical space, competing demands for
other medical procedures and the small number of abortions per-
formed daily. In contrast, women who left Nova Scotia for abortion
services reported that they could get an appointment at an abor-
tion clinic in Toronto or Montreal within a week (CARAL-Halifax
Chapter). Ten years after the Supreme Court decision, Atlantic
Canadian provinces were some of the most troublesome spots for
abortion access in the country. Prince Edward Island banned abor-
tions in its hospitals. Women heading to the mainland for abortion
services incurred high costs for travel, accommodation and child
care. Prince Edward Island, Nova Scotia, New Brunswick, and
Newfoundland would not fund clinic abortions even when hos-
pital abortions in those provinces were unavailable. One New
Brunswick woman reported:
The Supreme Court decision has had very little real impact in my region.
Before 1988 women travelled six to ten hours for a costly clinic abortion in
the United States. Since 1988, women travel six to ten hours for a somewhat
less-costly Canadian clinic abortion. (CARAL, “Access Granted” 33)
Geographical disparities surfaced throughout the country.
Abortion access in big cities improved. However, as these cities
were located primarily in the south, women from rural and north-
ern regions had to make long journeys to them. Such travel placed
considerable financial burdens on women who were young and
poor. Aboriginal women in the Northwest Territories were hard
hit. A review of abortion services available between 1986 and
1991 detailed the travel challenges the women in this region faced.
As the Northwest Territories “cover one third of the Canadian land
mass, have a majority Aboriginal population and are composed of
communities with limited or no road access,” the Department of
Health earmarked 11.2 percent of its budget for medical travel
because “the movement of patients to services is an enormous
component of the Northwest Territories health care system and
has shown consistent large increases from one year to the next”
(Report of the Abortion Services Review Committee 9).
The difficulty of abortion access for women in this large and
remote region was compounded by the fact that women seeking
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Canadian Women, Abortion Tourism, and Travel 467
abortions had one main point of access into the medical system,
namely a physician, a nurse, or a nurse practitioner. Their refusal
to give a woman seeking abortion a letter of referral for a medical
travel warrant authorizing government payment for a commer-
cial flight for medical treatment meant that the woman would
be unable to have the costs of travel for abortion services cov-
ered. A woman could appeal the referral or purchase a regular
airline ticket out of pocket and ask for reimbursement later. When
non-medical caregivers made medical travel warrant referrals, a
woman seeking an abortion had to sign a confidential statement
declaring her pregnancy, her desire for counseling and/or her
need for an abortion before a witness. These statements had to be
sent to the Department of Health, thereby compromising her pri-
vacy. During the time period under investigation, 1,332 women,
the majority of whom were Inuit, Indian, or Métis, had abor-
tions at Stanton Yellowknife Hospital. Only 481 of these women
lived in Yellowknife; the remaining 851 women travelled from
the Kitikneot region, Inuvik, Baffin, and Keewatin to the hospital.
During this same time period, an additional 656 women travelled
from the Northwest Territories to Montreal, Ottawa, or Winnipeg
for their abortions. Notably, a number of women who had abor-
tions at Stanton Yellowknife Hospital protested that they received
insufficient pain relief during or after their abortions and that
medical staff treated them in a disparaging manner (Report of
the Abortion Services Review Committee).
The Decline in Hospital Abor tions
In 1977 only 20.1 percent of hospitals across Canada had estab-
lished TACs as required by the 1969 abortion law (Report of
the Committee on the Operation of the Abortion Law). Yet in
2003, 15 years after this law was struck down, the Canadian
Abortion Rights Action League (CARAL) calculated that one in
five hospitals, or just 17 percent, were providing abortion services.
Neither Prince Edward Island nor the newly created territory
of Nunavut in northern Canada provided any abortion services.
Quebec and Ontario had the highest number of hospitals pro-
viding abortion services, while the Western provinces of Alberta,
Manitoba, and Saskatchewan, had the lowest. In addition to these
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468 Christabelle Sethna and Marion Doull
geographical disparities, access to hospital abortion was com-
promised by restrictive gestational limits, approval procedures,
consent policies, wait times, misinformation, confidentiality issues,
and anti-choice medical staff, counseling centers, and harassment
and violence (CARAL, “Full Report”).
One of the biggest extra-legal impediments to abortion access
was reported to be the necessity of travel, especially for women
in smaller communities. For example, Nunavut women seeking
abortion first had to travel to the capital of Iqaluit, which could
take up to three days, and then fly to Ottawa or Montreal for
abortion services. For some women, travel to another province
for abortion services was even more onerous because of defi-
ciencies in reciprocal billing agreements between some provincial
and territorial governments. The Canada Health Act regulates
the conditions provincial and territorial health insurance plans
must meet in order for the federal government to provide them
with the health care transfer payments necessary for the full
coverage of medically necessary services. All provincial and ter-
ritorial health insurance plans must be publicly administered,
comprehensive, universal, portable, and accessible. Because abor-
tion is considered a medically necessary service, provincial and
territorial health insurance plans should theoretically cover all
abortion costs. However, some plans refuse to cover abortion if
it takes place outside the woman’s province or territory of res-
idence. CARAL also singled out four provinces—Nova Scotia,
New Brunswick, Manitoba, and Quebec—which did not provide
coverage for abortions performed in clinics as opposed to hospi-
tals. CARAL concluded “there is no other medical procedure in
Canada today that remains open to such state interference and
has to be negotiated by women in need of medical treatment”
(CARAL, “Summary” 5).
In 2006, Canadians for Choice (CFC) conducted a follow-
up study that recorded a further decrease in hospital abortion
access, down to 15.9 percent nationally (J. Shaw 1). The study
attributed the drop to abortion providers’ fear of anti-choice vio-
lence, the lack of medical school training in abortion techniques,
and budget-conscious hospital mergers between Catholic hospi-
tals and secular hospitals. Hospitals that are the product of such
mergers usually adopt the Catholic Health Ethics Guide, thereby
restricting access to contraceptive and abortion services. This
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Canadian Women, Abortion Tourism, and Travel 469
study also identified the necessity of travel as a chief barrier to
abortion access. However, some positive changes were recorded.
Abortion services became available in Nunavut. Manitoba agreed
to fund all abortion procedures whether or not they took place in
a hospital or clinics. The Quebec government encouraged women
to file class action suits regarding the reimbursement of abortion
fees they paid up front (J. Shaw 33).
Anti-Choice Climate
On January 28, 2008 speakers who gathered at a University of
Toronto symposium to mark the twentieth anniversary of R. v.
Morgentaler agreed that abortion access in Canada had amelio-
rated over the last two decades. Still, they lamented the stubborn
existence of various extra-legal impediments. Although abortion
is legal in Canada and is considered a medically necessary ser-
vice, abortion access remains grossly uneven due to extra-legal
impediments. Morgentaler, the guest of honor, reminded those
present that Prince Edward Island still does not have any abortion
facilities and that his legal battles against the government of New
Brunswick for refusing to fund abortions taking place in clinics is
ongoing (Morgentaler 6). The presence of Dr. Garson Romalis, a
Vancouver abortion provider who was shot in 1994 and stabbed
in 2000 was a somber symbol of anti-choice violence (Romalis).
In 2009, Dr. George Tiller, a provider of late term abortions in
Wichita, Kansas was assassinated. The closure of his clinic after
his murder eliminated one of the few options for American and
Canadian women seeking pregnancy termination after 20 weeks
of gestation (Harding).
Moreover, although Canadian pro-choice organizations have
long asked the federal government to punish provinces or terri-
tories that violate the Canada Health Act for restricting abortion
access, the government of Canada has been reluctant to take on
the issue. Its reluctance is played out against a growing anti-choice
climate. Politicians in Parliament have introduced bills restricting
abortion access (MacCharles). Activists have petitioned provincial
governments to release confidential information about hospi-
tal abortions under Freedom of Information legislation (Craine,
“BC Hospitals Refuse”). Groups on university campuses compare
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470 Christabelle Sethna and Marion Doull
abortion to the Holocaust of the Jews (Craine, “Five Canadian
Pro-Life”). Rallies demand that abortion be delisted as a medi-
cally necessary service (Craine, “2,300 Ontario Pro-Lifers”). Crisis
pregnancy centers attempt to trick women into bringing a preg-
nancy to term by disseminating misinformation about the negative
mental and physical consequences of abortion (Arthur).
In 2010, Prime Minister Stephen Harper caused an interna-
tional firestorm after he announced that Canada’s plan for alle-
viating maternal mortality—a laudable Millennium Development
Goal—would not include abortion access. Harper’s actions were
roundly condemned not only because unsafe abortion is a leading
cause of maternal mortality and morbidity, but also because they
appeared to confirm the existence of a domestic anti-choice “hid-
den agenda” resembling oppressive American policies such as the
“global gag rule” (Holmes and Sethna). Dismay over the Prime
Minister’s actions in terms of best medical practices to improve
maternal health globally should not obscure the ver y real lack of
access to abortion services many Canadian women face at home
(Peritz). Before 1969, women who could afford to do so, travelled
to access abortion services in other countries because abortion in
Canada was illegal. After 1969, the year abortion was legalized,
women travelled inside and outside Canada to access abortion
services because of the inequitable application of the abortion
law. Since the Supreme Court struck down the abortion law in
1988, marginalized populations of women—Aboriginal women,
young women, women from the North, women from rural areas,
and women from Atlantic Canada—have tended to travel farthest
within Canada to access abortion services (Rodgers).
Abortion is a common but contentious health service that is inac-
cessible to various women. Abortion tourism is seldom acknowl-
edged as part o f the broad spectrum of medical tourism even
though it is a widespread transnational phenomenon that is
unique to women. Canadian women have participated in abortion
tourism for decades across international and domestic borders in
order to circumvent legal and extra-legal impediments to abortion
access. Clearly, abortion tourism acts as a safety valve relieving
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Canadian Women, Abortion Tourism, and Travel 471
pressure to provide abortions within a country, province, state,
county, or jurisdiction. As a result, politicians do not have to court
controversy by dealing with abortion issues. Hospitals do not have
to allot space for abortion services. Medical schools do not have
to include abortion training in the curriculum. Doctors do not
have to provide abortion referrals, perform abortions, or face
anti-choice harassment violence.
On an international scale, improving access to abortion ser-
vices may require a public accounting of what individual countries
are doing to address women’s reproductive health, especially
when nations like Canada are signatories to international conven-
tions protecting women’s health (Davies). On a domestic level, the
integration of comprehensive sex education curricula, the pro-
vision of contraceptives, and accessible abortion services might
ensure that the reproductive health of diverse populations of
women, regardless of geographical location, can be better pro-
tected (Canadians for Choice and Fédération du Québec pour
le planning des naissances). The journeys of women seeking
access to abortion services in a timely fashion signal how pro-
foundly gendered structural constraints and globally stratified
inequities can shape women’s reproductive choices. Therefore, it
is imperative that researchers not only pay more attention to abor-
tion tourism but also to the participation of women in medical
tourism across international and domestic borders.
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... If legal reform of abortion provision sought to bring it out of the 'backstreet', it did so by placing it in the clinic and vesting decisionmaking power over abortion in the hands of medical professionals and by extension the government. The persistence of medical gatekeeping over abortion is still pervasive in the continuing patterns of geographical inequality in abortion access: even countries with permissive laws or decriminalised abortion continue to see enormous disparities between different states and regions, leading to long-distance travel to access abortion (Sethna and Davis, 2019;Sethna and Doull, 2012;De Zordo et al., 2016). ...
... Some people, regardless of the legal status of abortion where they are or how accessible it is, are able to travel internationally or domestically for a safe abortion. Abortion travel has occurred on a global scale since the 1960s (Sethna and Doull, 2012), but this option is stratified by class and economic privilege. Factors including arranging childcare, finding accommodation, booking and paying for transport, and taking time off from work, all make travelling for abortions burdensome and even impossible (Doran and Hornibrook, 2016). ...
Full-text available
Abortion has historically been ignored in geography. Although bodies and pregnancy have been increasingly studied since the 1990s, a reticence around abortion remains. In recent years, however, this has begun to change. This article critically reviews how geographers and other scholars are now considering abortion and uses three conceptual lenses of discourse, spatiality and mobility to argue that abortion should be a mainstream topic of critical concern for geographers. Through these themes we show that geographical attention to abortion makes questions of space, power, and citizenship visible in new ways and, furthermore, in ways that are only recently possible.
... Patient mobility involving women's travel abroad for reasons of (fast or legal) accessibility or affordability of an abortion is also referred to as abortion tourism, or circumvention tourism (Cohen 2012) if the procedure is illegal in the source country. Abortion tourism falls under the field of medical tourism, also referred to as health(care) tourism, and more recently international/transnational patient travel/mobility, or cross-border healthcare as the use of the denominator tourism has been criticized for its misleading association with pleasure and relaxation (Sethna and Doull 2012). ...
Full-text available
The communication aspect of cross-border healthcare and translation and interpreting in this field are under-researched. This paper presents the results of a qualitative webpage content analysis of the multilingual websites of three Viennese abortion clinics. We investigate if and how content affected by a social and cultural taboo is (re)framed linguistically in versions addressed at patients from Poland, where abortion has been largely illegal since 1993. Our results show that awareness of the need for comprehensive target group-oriented information provision and quality translation and/or adaptation varies and that the Polish websites in our corpus tend to adopt a slightly different, more feminist and pro-choice point-of-view in comparison to the German versions.
Purpose The aim of this article is to review the literature on fertility tourism in terms of social policy implications. There has been a global growth in interest in fertility tourism, especially amongst these in developed countries travelling to developing countries for fertility needs. Due to women's increased involvement in the workforce and changing societal norms, the age at which females start having children has risen resulting in a need for many to seek fertility help. These developments have led to a growth in fertility tourism and related services. Design/methodology/approach The authors undertake a systematic literature review on fertility tourism to identify cognate research themes that relate to social policies such as assisted reproduction facilities, medical tourism and changing societal attitudes. Findings The findings of the study have important implications for social policy particularly regarding the tourism and health industry, practitioners and policymakers. This involves focussing on new geographic regions that are underrepresented in current research but have a high interest in fertility tourism. Currently much of the research is centred around western contexts but as evident in our review newly emerging markets in countries that have high infertility rates requires further attention. In addition, the authors provide directions for future research avenues that focus on how to evaluate changing social policies with regards to reproductive choices. Originality/value Whilst there has been much discussion in the media about fertility tourism there is limited knowledge about social policies related to human reproductive systems, so this article is amongst the first to discuss societal implications.
Since the decriminalization of abortion in Canada in 1988, there have been no legal restrictions on when in pregnancy an abortion can take place. However, abortion care is only consistently available in Canada up to 23 weeks and 6 days; women, transgender men, and gender non-binary individuals who need abortion care after 24 weeks typically obtain services in the United States. Furthermore, abortion care beyond 16 weeks is unavailable in some regions of the country. The authors undertook this scoping review to explore what is currently known about later gestational age abortion in Canada. Using a six-stage framework, they identified 32 relevant sources that were published in the last 30 years, and they consulted with seven topic experts to validate the findings from our document synthesis. The limited body of literature on abortion after 16 weeks in Canada sheds light on the safety of both medical and instrumentation procedures, the type and training of abortion-providing clinicians, the characteristics of those obtaining abortion care after the first trimester, and geographic disparities in service availability. These topic experts emphasized the need for future research on patient experiences and developing and implementing strategies to help provinces and territories expand abortion care to later gestational ages and improve comprehensive reproductive health services.
Objectives Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about. Study design We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. Results Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal. Conclusions People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel—specifically, being forced to travel because of legal restriction and service unavailability—are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels.
In the decades before the historic legalization of abortion in the Republic of Ireland in 2018, activists used creative methods to educate, agitate, and advocate for changes in abortion law and access. In the 2000s, the availability of the “abortion pills,” mifepristone and misoprostol, began to affect patterns of illegal abortion access, as well as the methods of protest used by those advocating for legal abortion. This article examines protest actions orchestrated by Irish abortion activists from 2014 to 2018 that used abortion pills as technologies of protest. I argue that abortion pill protests introduced a new “protest logic” to abortion activism, both in Ireland and around the world (De Zordo, Mishtal, and Anton 2017). By using abortion pills as a central object in public protests, activists repackaged abortion pills from “technologies of access” to “technologies of protest.” These new tactics were not without controversy. I suggest that the conflicts that emerged from abortion pill protests helped shape new activist claims about abortion access and ultimately led to positive social and legislative change. As abortion pill use increases globally in the face of growing restrictions, the use of pills as technologies of protest will continue to affect abortion activism and other social movements.
Full-text available
In a mixed methods study, I investigated student experiences of an on-campus crisis pregnancy centre. Participants sought testing, counselling, and referral to abortion and instead encountered religious, anti-choice messages. Taking a reproductive justice approach to understanding student needs, I argue that the study’s findings underscore the imperative that campuses provide accessible sexual and reproductive health services while simultaneously limiting campus access to anti-choice organizations.
Abortion mobilities emerged within political geography and the reproductive mobilities scholarship to address extant theoretical and empirical gaps in these fields. This paper seeks to highlight and assess the abortion mobilities scholarship to date. Starting with a working definition of abortion mobilities, this paper argues for the relevance of abortion to political geography and outlines three key themes in political geography that abortion mobilities address: borders, states and anti‐genderism, intersectional politics and reproductive justice, and activism and abortion pills.
The abortion road trip is a narrative device that has emerged in the last decade whereby the central plot of the story is the journey taken in search of an abortion. In this paper we analyze two young adult novels (Girls on the Verge and Unpregnant) and two films (Grandma and Never Rarely Sometimes Always) that follow adolescent girls traveling for abortions in the contemporary United States. Through the analysis of these four narratives, we argue that representations of the abortion road trip are novel for their focus on the barriers and politics of abortion access in the United States. While the representations do prioritize certain barriers over others, they mark an important shift in abortion discourse in popular culture. Instead of the ‘drama’ of the plot being the decision to have an abortion, it is increasingly other socio-politico-legal issues such as the lack of abortion clinics, the distance required to travel, legal rights for adolescents, the cost of the procedure, and the opinions of family and friends that take center stage. The focus on these structural, political barriers can help to educate audiences about the realities of abortion access in the US and move abortion discourse beyond the individual.
Advancing reproductive health, much more than other fields of health, requires inputs from health care providers, health policy makers, legislators, lawyers, human rights activists, women’s groups and the society at large. Health professionals tend to be relatively uninformed of how the laws by which they are bound have developed, and of the range of legal arguments they may invoke to advance their purposes. Similarly, laws that relate to reproductive health have often been developed ideologically, with little health-related understanding of how they are likely to affect or obstruct necessary clinical care of patients and the reproductive well-being of communities. Legal management of matters affecting reproduction and reproductive choice, whether by legislators, legal administrators or practitioners or judges, is undertaken with little perception of their medical or societal implications for reproductive health. Further, health care providers and administrators, and legislators, tend to work within familiar local frameworks of law and health policy, without specific regard to the significance of human rights principles applicable to reproductive health to which their states have committed themselves. Health care providers, health policy makers and lawyers address reproductive health from different perspectives. A primary reason for writing this book is to explain these different perspectives in ways that facilitate dialogue and collaboration among different groups, in order to enhance formulation of reproductive health laws and policies, and to expand and improve the quality of reproductive health services.