Quebec

Snapshot
  • %
    urban points of service |
    %
    rural points of service*
    %
    urban points of service |
    %
    rural points of service
  • 82
    % urban population | 
    18
    % rural population*
  • 56 points of service per 1,783,510 women of reproductive age
    *
  • 10
     crisis pregnancy centre(s)*
Access Overview
  • 56
     publicly listed point of service*
     publicly listed points of service*
    (both medication and procedural abortion offered)
    48
     point(s) of service for medication abortion
    56
     point(s) of service for procedural abortion
    Functional gestational limit of 
    24 weeks
    Functional gestational limit of 
    24 weeks
    *

    Not for the whole province. 

    Centre de rendez-vous en avortement du 1er trimestre de Montreal (504-380-8299) supports people in the greater Montreal area to find abortion services up to 14 weeks gestation. 

    A full list of clinics offering abortion care can be found on the Government of Quebec’s website here (available in French only).

    Not for the whole province. 

    Centre de rendez-vous en avortement du 1er trimestre de Montreal (504-380-8299) supports people in the greater Montreal area to find abortion services up to 14 weeks gestation. 

    A full list of clinics offering abortion care can be found on the Government of Quebec’s website here (available in French only).

    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

Anyone enrolled in Quebec’s RAMQ public health insurance plan or a Quebec private insurance plan can receive Mifegymiso with full cost coverage.

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.  

Quebec’s Physician's Manual includes billing codes for medical abortion.

Telemedicine

Physicians in Quebec must apply for a “special authorization” from the Collège des médecins du Québec in order to practice telemedicine in Quebec. In-person and virtual care are billed at the same rate.1 However, existing barriers have resulted in Quebec having a low proportion of telemedicine providers.2

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

Access to abortion for minors

Under the Civil Code of Québec, minors under 14 years of age are required to get parental consent for medical treatment, including abortion. The decision must take into account the minor’s options and must be made in their best interest. If a minor and their parent(s) or guardian(s) disagree on the decision to make, a local community services centres (CLSC) worker can be consulted to help them. If they are unable to reach an agreement, the court might be called upon to intervene and determine a decision.3

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.

Bill 92, which was passed on December 7, 2016, establishes a 50 metre bubble zone around facilities or premises providing abortion care in Quebec. The law prohibits impeding access to a place where health or social services are provided, and demonstrations in the vicinity of places where voluntary abortion services are offered. 

The following is forbidden within 50 metres from abortion facilities:

  • Attempt[ing] to dissuade a woman from obtaining such a service or contest or condemn her choice of obtaining or having obtained the service; or 
  • Attempt[ing] to dissuade a person from providing, or from participating in the provision of, such a service or contest or condemn the person’s choice of providing, or participating in the provision of, such a service or working in such a place

Anti-abortion protesters who violate the "security perimeter" will be subject to a fine of $250 to $1,250. Those who, in addition, "threaten or intimidate a person who goes" to a clinic that provides abortions will incur a doubled fine of $500 to $2,500.

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

Physicians in Québec must “offer to help a patient find another physician” in cases of belief-based care denial, as per the Code of Ethics of Physicians. However, the directive to “offer help” is vague and the ambiguity may cause refusers to interpret the Code as not requiring an effective referral.

The Code also specifies that a physician must disclose their own personal convictions with a patient if those convictions prevent the physician from prescribing or providing professional services, and that they must inform the patient of the possible consequences of not receiving those services.4

Nurse practitioners

Quebec’s Code of ethics of nurses does not address belief-based care denial explicitly, but includes directives that suggest nurses must provide care to patients despite any personal or religious beliefs they might have:

  • A nurse shall fulfill her or his professional duties with integrity.
  • A nurse shall subordinate her or his personal interest to that of her or his client.
  • A nurse shall safeguard her or his professional independence at all times. In particular, a nurse shall practise [their] profession with objectivity and disregard any intervention by a third party that could affect the performance of her or his professional duties to the detriment of the client.
  • A nurse may not refuse to collaborate with health professionals engaged in providing care, treatment or services necessary for the client’s welfare.

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 Québec Health Insurance Plan issues reimbursements at amounts not exceeding Québec rates for insured medical services acquired outside the province, with patients being responsible for paying fees that exceed standard rates of equivalent services offered in Québec. 

Patients must fill out a reimbursement application form in order to be eligible. Prescription drugs are not covered.

Portability

Québec residents who access abortion care in another province or territory are only reimbursed at the rate of abortion costs in Québec. This means that residents are responsible for paying for any amounts above the Québec rate out-of-pocket. Quebec's approach contravenes the Canada Health Act: "Physician services received by Quebec residents when out-of-province are not reimbursed at host province rates, which is a requirement of the portability criterion of the Canada Health Act.”5

court cases on abortion

Association pour l’accès à l’avortement c. Québec (QC: 2006)

2006 QCCS 4694

In Quebec, doctors practicing in private clinics who performed a specific number of abortions had their fees significantly reduced. Consequently, under pressure, these private clinics charged patients additional fees for abortion services to recoup the costs. The Association pour l’accès à l’avortement filed a class action lawsuit against the Quebec government to recover these additional fees paid by patients. The Quebec Superior Court held that the Government of Quebec must reimburse patients who underwent abortion procedures in private clinics and paid extra fees between 1999 and 2006.

References

1 Virtual Care Task Force. (2022, February). Virtual Care in Canada: Progress and Potential. Canadian Medical Association. https://www.cma.ca/sites/default/files/2022-02/Virtual-Care-in-Canada-Progress-and-Potential-EN.pdf 

2 Renner, R. M., Ennis, M., Kyeremeh, A., Norman, W. V., Dunn, S., Pymar, H., & Guilbert, E. (2023). Telemedicine for First-Trimester Medical Abortion in Canada: Results of a 2019 Survey. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 29(5), 686–695. https://doi.org/10.1089/tmj.2022.0245

3 Access to abortion services. (2023, February 22). Gouvernement du Québec. https://www.quebec.ca/en/health/health-system-and-services/service-organization/abortion-services/access-abortion-services 

4  Abortion Rights Coalition of Canada. (2022, November). Canadian Policies and Laws on “Conscientious Objection” in Health Care. Abortion Rights Coalition of Canada. https://www.arcc-cdac.ca/media/position-papers/95-appendix-policies-conscientious-objection-healthcare.pdf 

5 Health Canada. (2022). Canada Health Act Annual Report 2020-2021. Canada.ca. https://www.canada.ca/en/health-canada/services/publications/health-system-services/canada-health-act-annual-report-2020-2021.html

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