Alberta

Snapshot

%
urban points of service |
%
rural points of service*
The Nova Scotia Centralized Abortion Network (NSCAN) can refer patients to primary care providers who can prescribe medication throughout the province, including in rural areas and through telemedicine. Primary care providers are not captured in Action Canada’s directory.
%
urban points of service |
%
rural points of service
82
% urban population |
18
% rural population*
Urban refers to census metropolitan areas and agglomerations (CMAs and CAs) in Canada. Rural refers to areas outside of CMAs and CAs
People living in the Kitikmeot region of Nunavut can also access abortion through the Northern Options for Women program.
9 points of service per 1,003,785 women of reproductive age
*
Women, aged 15-49 (reproductive age as defined by the WHO). Source: 2021 Canadian census. Not all people who can get pregnant are women, but the data available only includes two gender categories.
21
crisis pregnancy centre(s)*
Crisis pregnancy centres (CPCs) are anti-abortion organizations that present themselves as clinics or counselling centres.

Data from the Abortion Rights Coalition of Canada.

Access Overview

9
publicly listed point of service*
publicly listed points of service*
(both medication and procedural abortion offered)
Data on the points of service, which includes clinics and hospitals that provide abortion care, are gathered from Action Canada’s directory. These numbers are up to date, but do not include all primary care providers who prescribe medication abortion.
8
point(s) of service for medication abortion
4
point(s) of service for procedural abortion
Functional gestational limit of
24 weeks
Functional gestational limit of
24 weeks
*
4 points of service offer abortion after 12 weeks in Alberta. 2 points of service offer abortion up to 20 weeks, and only 1 can offer services up to 24 weeks.
No centralized system to assist the public in connecting with abortion services
Information about abortion is available on the
provincial/territorial website
Information about abortion is not available on the provincial/territorial website

Medication abortion

Cost coverage

Mifegymiso is fully covered for residents of Alberta.

Billing code

Billing codes are used by physicians to bill provincial/territorial health insurance plans for the different services that they provide. When there isn’t a billing code for medical abortion, physicians can be de-incentivized from providing it.

There is no billing code for medical abortion in Alberta’s Medical Procedure List. When interviewed for an article written about barriers to medical abortion in Alberta, the Alberta government said that “visits and consultations are not illness specific,” and that “a physician would bill for a visit/consultation regardless of topic discussed.”

Telemedicine

Alberta has virtual care billing codes that physicians can use for telemedicine. The College & Association of Registered Nurses of Alberta also permits the provision of nursing services to clients physically located within the province, including telemedicine services when appropriate.

Telemedicine abortion has been found to be as safe and effective as medical abortions provided at clinics. Because telemedicine abortion allows patients to access care in their homes and often requires just one trip to a pharmacy or clinic, expanding its availability is critical to improving abortion access for people who live in rural communities, who can’t take time off work to go to appointments, or who are at risk of stigma or discrimination.

Legislation, policies, and regulations

1984: Regulation 84-20 is enacted

This regulation, initiated by the province’s Liberal government under Premier McKenna, prevented abortion from being covered by the provincial health care funding unless performed in a hospital by a specialist, and only after two doctors certified that the procedure was medically required. Clinic abortions were already prohibited under a private act, the New Brunswick Medical Act, which regulates the medical profession.⁷

1994: Morgentaler opens an abortion clinic in Frederiction

The McKenna government responded to the clinic opening by amending the Medical Act to include an offence provision that would find physicians guilty of professional misconduct if they were involved in performing an abortion out of a hospital setting approved by the Minister of Health. Immediately upon opening the clinic, Dr. Morgentaler’s medical license was suspended by Order of the Council of the College of Physicians and Surgeons for performing abortions outside a hospital, relying on sections 56(b.1) and 56.2 of the Medical Act.⁸ Morgentaler immediately challenged the constitutionality of the amendment.

Relying on the Supreme Court decision in R. v. Morgentaler (1993), the New Brunswick Court of Queen’s Bench found the impugned sections of the Act to be unconstitutional as they were beyond the jurisdiction of the New Brunswick legislature, and concluded that the legislature sought to prohibit abortions outside hospitals “with a view to suppressing or punishing what [it] perceived to be the socially undesirable conduct of abortion.” The court took into consideration the fact that the amendment dated from a point in time when abortion was considered a criminal offence. The court also stated that the creation of the amendment was not in the interest of ensuring the highest quality of care for women in the province, but that it was designed to “prohibit the establishment of free-standing abortion clinics and, particularly, the establishment of such a clinic by Dr. Morgentaler.”

The decision was upheld on appeal to the New Brunswick Court of Appeal, and leave to appeal to the Supreme Court of Canada was denied. Dr. Morgentaler’s license was reinstated and his clinic was permitted to remain open. The regulation was removed, but reinstated later into the Medical Services Payment Act, with the punishment for doctors no longer included.⁹ The exclusion of clinic-based abortions from Medicare remained in place for the entire time the Fredericton Morgentaler Clinic was in operation.

Dr. Morgentaler brought an action in 2004 challenging the legality of Regulation 84-20 that sought a declaration that Regulation 84-20 not only violates the Canada Health Act, but also is unconstitutional in that it violates rights guaranteed by sections 7 and 15 of the Charter.¹⁰ The province engaged in delay tactics for several years, challenging Dr. Morgentaler’s standing to even bring the case. Finally, the Court agreed in 2009 to grant Dr. Morgentaler public interest standing to bring his legal challenge. The Court found that there was a serious issue to be tried and that, while there were other classes of persons more specifically affected by this regulation, (namely patients who had undergone abortions at Dr. Morgentaler’s Fredericton Clinic), that there are many valid reasons why patients would not or could not bring this challenge and that Dr. Morgentaler was therefore “a suitable alternative person to do so.” However, by then, Dr. Morgentaler had exhausted his financial resources. Coupled with his advancing age, he decided not to continue with the suit.¹¹

In 2014, Liberal Premier Brian Gallant promised to remove all barriers to abortion in New Brunswick by amending Regulation 84-20, and removing the requirement that the procedure be conducted by a specialist after the certification by two doctors that the procedure was medically necessary. He did not remove the requirement that surgical abortion can only be funded by the province if conducted in a hospital.¹²

Access to abortion for minors

There is no legislated age of consent for medical treatment in Alberta. The Court of Appeal in J.S.C. v. Wren declared in 1986 that the mature minor doctrine was part of the law in Alberta, but also stated that “parental rights (and obligations) clearly do exist, and they do not wholly disappear until the age of majority.”¹ The mature minor doctrine applies to minors accessing health care, including abortion.² This means that a minor who can understand and appreciate the nature, purpose, and reasonably foreseeable consequences of a proposed medical treatment and its alternatives/refusal can give valid legal consent.

Bubble zone legislation

Bubble zone legislation aims to prevent anti-abortion protestors from harassing people within the vicinity of a facility that provides abortion care. Even though criminalizing individual people will not effectively curb the larger anti-abortion movement, these laws can be effective in deterring anti-choice protestors from harassing providers and patients entering and exiting abortion clinics.

The Protecting Choice for Women Accessing Health Care Act was passed on May 30, 2018 and established an “access zone” of 50 metres around facilities that provide abortion care, though access zones can be extended up to 150 metres through regulations. Physicians and other service providers may apply for a zone of up to 20 metres around their offices and 160 metres around their homes. The law also prohibits the harassment of physicians and service providers.

Belief-based care denial

Although abortion is an essential medical service, physicians and nurse practitioners can refuse to provide abortion care due to their personal beliefs under current legislation and policies set by regulatory bodies. This practice is often referred to as “conscientious objection,” although a more accurate term may be “belief-based care denial.”

Physicians

The College of Physicians & Surgeons of Alberta has a Standard of Practice on Conscientious Objection enforceable under the Health Professions Act that states that in cases of conscientious objection, physicians must ensure patients are offered timely access to either another physician who can provide the medical treatment or information, or a resource that will provide accurate information about all available medical options. The option to offer patients information or a resource means that physicians aren’t necessarily obligated to refer patients to providers who can give them the care they need.³

The Standard of Practice on Conscientious Objection also states that:

A regulated member must communicate promptly and respectfully about any treatments or procedures the regulated member declines to provide based on [their] Charter freedom of conscience and religion.
A regulated member must not withhold information about the existence of a procedure or treatment because providing that procedure or giving advice about it conflicts with his/her Charter freedom of conscience and religion.
A regulated member must not promote [their] own moral or religious beliefs when interacting with patients.

Alberta has a Catholic healthcare provider called Covenant Health. Covenant Health operates hospitals, clinics and employs a large network of healthcare providers. Their Health Ethics Guide explicitly states that abortion is not permitted. On conscientious objection, the guide states that “health care and other professionals should not be expected to participate in procedures that are contrary to their professional judgement or to their conscience or that are contrary to the values or mission of their organization. However, they must not abandon those to whom they provide care.”

Nurse practitioners

The College and Association of Registered Nurses of Alberta has formally adopted the Canadian Nurses Association’s Code of Ethics for Registered Nurses, which states that in cases of conscientious objection, nurses are obligated to notify their employers or the patient receiving care in advance so that alternative arrangements can be made.

‍

Out-of-country medical policy

In some instances, patients may have to travel outside of the country to receive abortion care currently not available in Canada. The Alberta Health Care Insurance Plan includes out-of-country coverage for patients referred for insured health services not available in Canada under the Out-of-Country Health Services Regulation.

Travel support

The Out-of-Country Health Services Regulation does not include coverage for travel, accommodation, or subsistence costs.

court cases on abortion

Canadian Centre for Bio-Ethical Reform v. City of Grande Prairie (AB: 2016 / 2018)

2018 ABCA 154

The Alberta Court of Appeal upheld a lower court decision from 2016 where the City of Grand Prairie refused to place offensive anti-abortion ads by the Canadian Centre for Bioethical Reform on the backs of buses. The Court of Appeal noted that the lower court’s decision was reasonable.

Lethbridge & District Pro-Life Association v City of Lethbridge (AB: 2020)

2020 ABQB 654

An anti-abortion group brought an action against the City of Lethbridge for refusing to place five ads for buses, bus benches and shelters. The Alberta Court of Queen’s Bench highlighted that the City of Lethbridge did not appropriately balance the Canadian Code of Advertisement Standards with other considerations such as the advertiser’s freedom of expression and the city's statutory objectives. As such, the court held that the city's decision was unreasonable.

UAlberta Pro-Life v Governors of University of Alberta (AB: 2020)

2020 ABCA 1

The complainants – an anti-abortion organization – requested the Alberta Court of Appeal decide whether the Charter applied to a university decision regarding an anti-abortion event hosted by the organization. The Court held that the University of Alberta’s regulation of free expression on campus is considered governmental action and subject to Charter scrutiny.

References

¹ The College of Physicians & Surgeons of Alberta. (2015, June). Informed Consent for Minors. CPSA.https://cpsa.ca/wp-content/uploads/2020/06/AP_Informed-Consent-for-Minors.pdf

² Teaching Sexual Health. (n.d.). Do you need parental consent to get an abortion? https://teachingsexualhealth.ca/teachers/faq/do-you-need-parental-consent-to-get-an-abortion/

³ The Refusal to Provide Health Care in Canada. (2022, November). Abortion Rights Coalition of Canada. https://www.arcc-cdac.ca/media/position-papers/95-refusal-to-provide-healthcare.pdf

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