Prince Edward Island

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
63
% urban population |
37
% 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.
1 point of service per 32,690 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.
3
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

1
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.
point(s) of service for medication abortion
point(s) of service for procedural abortion
Functional gestational limit of
13 weeks
Functional gestational limit of
13 weeks
*
Occasionally services provided up to 15 weeks based on provider availability
Abortion services are offered in Prince Edward Island through the Sexual Health, Options & Reproductive Services (SHORS) program. Their toll free line is 1-844-365-8258. Residents can also call 811 to access Health PEI.
Abortion services are offered in Prince Edward Island through the Sexual Health, Options & Reproductive Services (SHORS) program. Their toll free line is 1-844-365-8258. Residents can also call 811 to access Health PEI.
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 Prince Edward Island residents with a valid health card. Mifegymiso is not available through pharmacies on the island and is instead stocked by SHORS, which distributes the drug as needed to administering physicians.

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 the Master Agreement between the Medical Society of Prince Edward Island and the Government of Prince Edward Island and Health PEI, which outlines physicians’ billing codes.

Telemedicine

The abortion pill is distributed through SHORS, which currently does not offer telemedicine abortion. However, SHORS aims to gather all necessary information for medical abortion by telephone or by compounding visits so patients do not require multiple in-person appointments.

During the COVID-19 pandemic, Health PEI introduced temporary billing codes for virtual visits. There are also permanent codes for “Non-Face-to-Face-Care” that cover physician-patient and interprofessional communications by telephone.

The College of Physicians and Surgeons of Prince Edward Island has a telemedicine policy, and the College of Registered Nurses of Prince Edward Island has a Practice Directive on Telehealth Nursing Practice.

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 Consent to Treatment and Health Care Directives Act, every person, including minors, is presumed to be capable of giving or refusing consent to medical treatment and making a health care directive unless the contrary is demonstrated. A person is capable if they are, in their health care practitioner’s opinion, able to understand the information that is relevant to making a decision concerning the treatment, understand that the information applies to their particular situation, understand that the patient has the right to make a decision; and appreciate the reasonably foreseeable consequences of a decision or lack of a decision.¹

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.

There is no bubble zone legislation in Prince Edward Island. However, federal Bill C-3, which makes it illegal to intimidate healthcare workers and patients or obstruct them from providing care or seeking treatment at locations where healthcare services—including abortions—are delivered, applies.

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 of Prince Edward Island endorses and expects physicians to adhere to the Canadian Medical Association’s Code of Ethics. In addition, the College has a Conscientious Objection to Provision of Service Policy that obligates physicians who deny a patient treatment on the basis of personal or religious beliefs to offer “timely access” to another physician or resource who can provide “accurate information about all available medical options.” It’s important to note that a referral to “accurate information” is not the same as referring patients for medical care that they need or request.²

The Conscientious Objection to Provision of Service Policy adopts sections of the Canadian Medical Association’s Code of Ethics, and also states that in cases of conscientious objection:

A physician must communicate clearly and promptly about any treatments or procedures the physician chooses not to provide because of his or her moral or religious beliefs.
A physician must not withhold information about the existence of a procedure or treatment because providing that procedure or giving advice about it conflicts with their moral or religious beliefs.
A physician must not promote their own moral or religious beliefs when interacting with patients.

Further, the policy states that physicians are expected to provide patients with enough information and assistance to allow them to make informed choices for themselves, including advising patients that other physicians may be available to see them or suggesting that the patient visit an alternate health-care provider, and that “where needed, physicians must offer assistance and must not abandon the patient.”

Nurse practitioners

The College of Registered Nurses and Midwives of Prince Edward Island adopts the Canadian Nurses Association’s Code of Ethics for Registered Nurses, which states that in cases of belief-based care denial, 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. Health PEI includes out-of-country coverage for patients referred for insured health services not available in Canada. A physician must request approval for out-of-province health services from Health PEI in order for a patient to be eligible for coverage. Sexual Health, Options & Reproductive Services (SHORS) staff can also assist with out-of-province options.

Historically, Health PEI has approved 100% of the requests SHORS has submitted on behalf of patients for out-of-province and out-of-country medical care since its inception in 2017. Coverage includes all components of medical care except for travel and accommodations, and includes care in private clinics outside of Canada.

There is no legislation related to out-of-country medical care in Nova Scotia.

Travel support

The Maritime Bus Program provides travel assistance through Maritime Bus Company to patients with a PEI health card who need to travel to New Brunswick or Nova Scotia for medical appointments including abortion care. Those approved will have their bus ticket subsidized by 50% or 100% depending on income.

court cases on abortion

P.E.I. v. Morgentaler (PE: 1996)

139 DLR (4th) 603

Under the PEI Health Services Payment Act, abortions were only covered if performed in a hospital and are considered medically necessary by the Health and Community Services Agency. Dr. Morgentaler challenged this provision as beyond the jurisdiction of the Agency. The Prince Edward Island (PEI) Supreme Court agreed, finding that the regulation was beyond the mandate of the Agency.

Abortion Access Now PEI v. Government of PEI (2016)

Draft Notice of Application

Abortion Access Now PEI (AAN PEI) legally challenged the constitutional validity of PEI’s abortion policy, which prohibited induced abortions in the province since its inception in 1982 and forced people to travel to neighbouring provinces to access abortion services. LEAF provided legal support to AAN PEI to launch the challenge. Only 3 months after the constitutional challenge was announced, PEI ceased their abortion policy, with the Premier recognizing that the judiciary would have determined that the policy infringed on Charter rights. On January 31, 2017, the first legal abortion in almost 35 years was performed at the newly established Women’s Wellness Clinic, located at the Prince County Hospital in Summerside.³

References

¹ Consent to Treatment and Health Care Directives Act, RSPEI 1988, c C-17.2. https://canlii.ca/t/54404

² 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

³ Kingston, A. (2017, February 3). After 35 years, abortions are finally available in P.E.I. Macleans. https://macleans.ca/news/canada/after-35-years-abortion-available-in-pei/

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