Newfoundland and Labrador

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
53
% urban population |
47
% 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.
4 points of service per 100,270 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.
1
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

4
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.
3
point(s) of service for medication abortion
3
point(s) of service for procedural abortion
Functional gestational limit of
16 weeks
Functional gestational limit of
16 weeks
*
Only 1 point of service offers abortion services up to 16 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 anyone with a valid Medical Care Plan (MCP) card.

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.

The Medical Payment Schedule includes a billing code for medical abortion.

Telemedicine

The billing code for medical abortion can be used for services provided at a patient’s home. Newfoundland and Laborador physicians can also bill for telephone or video link consults through the use of temporary Pandemic Virtual Care Assessment (PVCA) codes. Per the specifications for these codes, both the patient and the physician must be located within the province.

The College of Physicians and Surgeons of Newfoundland and Labrador has a standard of practice on virtual care that sets out the College’s expectations of physicians who provide virtual care. The College of Registered Nurses of Newfoundland and Labrador has developed standards for virtual nursing that state: “Although ‘virtual’ care is not meant to replace traditional face-to-face care, sometimes, virtual care is the desired option, or the only option, especially for those who live in rural and remote areas where face-to face visits are not available.”

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

Under the Advanced Health Care Directives Act, it is presumed that people 16 years of age or older are competent to make health care decisions, while minors younger than 16 years of age are not. This means that minors under the age of 16 may consent to medical treatment including abortion care if they understand the information that is relevant to making a health care decision and are able to appreciate the reasonably foreseeable consequences of that decision.¹

Despite this, a patient under the age of 19 must have parental consent to have a medical abortion at the Health Sciences Centre, unless they are independent of their family.²

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 Access to Abortion Services Act was the second safe access zone law passed in Canada and is nearly identical to British Columbia’s law. Under the Act, facilities that provide abortion care must apply for a zone, which is then established by regulations. Homes and offices of doctors who provide abortion are automatically protected, and access zones for the residences of a class of service providers, or the residence of a specific service provider, may be established by regulation. Harassment of doctors and service providers outside of the safe access zone is also prohibited under the Act.

The dimensions of the zones are calculated from the edge of the lot on which the home or facility is located and are set at:

160 metres for a doctor's or service provider's home
10 metres for a doctor's office (which can be extended up to a maximum of 20 metres)
up to a maximum of 50 metres for a facility

The Athena Health Centre had moved in 2015 and became besieged by protesters. The clinic began to collect evidence and do research, and met with government ministers to get support. The Justice Minister advocated the law in public, and in the meantime, the clinic was given an injunction to protect patients. The injunction banned anti-abortion activists within a 40 metre radius of Athena Health Clinic, where 90% of abortions in Newfoundland and Labrador are performed, as well as a 40 metre radius within the homes of clinic staff.

Soon after, the Access to Abortion Services Act and the Access to Abortion Services Regulations increased the access zone to a 50 metre radius and 160 metre radius from residences of clinic staff. The government adapted British Columbia’s bubble zone legislation because their law had already withstood constitutional scrutiny by the courts.

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 and Surgeons in Newfoundland and Labrador adopts the Canadian Medical Association’s Code of Ethics and Professionalism, which does not require physicians to provide or refer for a medical service they object to providing based on personal beliefs. This means that a physician may deny a patient abortion care, and is not obligated to provide them a referral to another provider or clinic.

Nurse practitioners

The College of Registered Nurses of Newfoundland and Labrador adopts 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.

Newfoundland and Labrador’s Medical Care Plan includes out-of-province coverage for patients referred for medically necessary physician services not available in Canada.

A Newfoundland and Labrador physician must submit a request form on behalf of the patient and receive prior approval from the Medical Care Plan in order for the patient to be eligible for coverage.

Travel support

Newfoundland and Labrador has two travel support programs for patients covered by the province’s Medical Care Plan (MCP):

Medical Transportation Assistance Program (MTAP)

MTAP is available for patients who need to access “specialized insured medical services” that are not available in their community and/or within the province. It includes airfare (and related eligible taxi fares); private vehicle usage; purchased registered and private accommodations (and related meal allowance); busing and use of ferries based on program criteria. Limitations and deductibles may apply.

Medical Transportation Benefits for Income Support Clients (ISMT)

ISMT is a needs based program that provides non-urgent medical transportation benefits to eligible Income Support clients and home support, long-term care, private paying personal care home and low-income residents seeking access to insured medical services. Eligible patients and their escorts receive 100% of eligible travel, accommodations, and meal expenses, within set limits. Patients may be required to pay a contribution towards the cost of the trip based on a financial eligibility assessment.

court cases on abortion

No cases found.

References

¹ Government of Canada, Department of Justice, Electronic Communications. (2023, February 2). Department of Justice - Article 12 of the Convention on the Rights of the Child and Children’s Participatory Rights in Canada. https://justice.gc.ca/eng/rp-pr/other-autre/article12/p3a.html

² Therapeutic Abortion in NL. (2020, July). Planned Parenthood Newfoundland & Labrador Sexual Health Centre. https://www.plannedparenthoodnlshc.com/uploads/1/0/0/3/100308324/therapeutic_abortion_in_nl.pdf

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