“Since no level of government has released cost figures for abortion, we can only estimate what the direct costs of abortion are.”
- Who pays?
- Who decided?
- Medically necessary?
- What have the courts said?
- What does it cost taxpayers?
- Some published estimates on the cost of abortions
- Do taxpayers want to pay for abortions?
- Provincial summary
In Canada, almost all abortions are paid for by taxpayers. In British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Newfoundland, abortion is paid for under the publicly funded system whether it is performed in a hospital or private clinic. In New Brunswick, hospital abortions are paid for by taxpayers but private clinic abortions are not. No abortions are performed in Prince Edward Island. The province does cover abortions performed elsewhere if they have been declared by a doctor to be medically necessary and have been pre-authorized and approved.
Under the Constitution, health care is a provincial responsibility. Provinces decide what services will be covered by the publicly funded health care system. In his March 2001 interim report on health care, Liberal Senator Michael Kirby, chairman of the Standing Senate Committee on Social Affairs, wrote that “the determination of what services meet the requirement of medical necessity is made in each province by the provincial government in conjunction with the medical profession.”
For provinces to receive funding from the federally-administered Canadian Health and Social Transfers, they must follow the guidelines of the Canada Health Act (CHA) which requires provinces to fund “medically necessary” services, but it does not define what those are and there is no list of specific services.
This was confirmed by Health Canada in response to an access to information request from MP Garry Breitkreuz. Health Canada replied: “This is further to your request under the Access to Information Act, dated August 1, 2001, for: documents, reports & correspondence in the department that provide evidence that abortions are “medically necessary”. I regret to inform you that after a thorough search of all likely record holdings, departmental officials have confirmed that they have no records relevant to your request.”
Politicians sometimes say they pay only for medically necessary abortions but most do not require any evidence of medical necessity. Physicians simply submit the bill to the health care system for reimbursement. Only Prince Edward Island requires a specific medical reason for abortion to be covered by taxpayers.
In 2001, the president of the Canadian Abortion Rights Action League argued before the House of Commons Finance Committee that, “Women who make the decision to abort a child at a certain point in their lives do so for socio-economic reasons. Sometimes it is a desire to complete their education and become financially independent. In many cases, couples with children wish to restrict their family in order to provide adequate financial support.” (Hansard, October 31, 2001)
Almost all abortions performed in Canada are done because a pregnant woman chooses to end the pregnancy for personal reasons, not medical ones. Medical necessity is rarely part of the decision.
What have the courts said?
Until 2005, no court in Canada had ever ruled that abortions must be publicly funded. In 2005, Winnipeg judge Jeffrey Oliphant ruled that the failure to pay for private clinic abortions was a “gross violation” of women’s rights. The decision was overturned in 2006 by the province’s Court of Appeal because the judge had not heard any evidence on the issues involved. An appeal to the Supreme Court of Canada was refused. The provincial government had already begun paying for all abortions in 2004 but not as a result of the court case.
In 2006 a Quebec judge ordered the province to pay the full costs of private clinic abortions. The province had been covering a portion of these costs. The provincial government complied without appealing the decision.
What does it cost taxpayers?
Since no level of government has released cost figures for abortion, we can only estimate what the direct costs of abortion are. (These estimates exclude any indirect costs, that is, costs for follow-up procedures for immediate complications and side effects, and longer-term treatments for associated post-abortion problems. See book,Women’s Health After Abortion: The Medical and Psychological Evidence. Elizabeth Ring-Cassidy and Ian Gentles. The deVeber Institute for Bioethics and Social Research, 2002.)
We use the figure of $80 million a year, based on an average cost of $800 per abortion for 100,000 abortions. In 2004, the Canadian Institute for Health Information reported 100,039 abortions performed in Canada on Canadian women. They admit that is at least 10% below the actual number of abortions performed because of reporting problems from some provinces and private clinics. Also, in 2004 the number of abortions performed in Manitoba clinics went unreported. So, the $80 million figure is already low for the 2004 year.
Since hospital abortions constitute more than half of all abortions performed in Canada, we used an average of the $500 cost (at the low end) of a clinic abortion and $1000 (again, at the low end) estimate for hospital abortions. The $800 cost per abortion is in fact a very conservative estimate and the $80 million a year figure is probably an underestimate of how much taxpayers spend on medically unnecessary abortions.
Some published estimates on the cost of abortion
- “Abortions at clinics are significantly more cost-effective than abortions at hospitals (mostly because hospitals use general anaesthesia (sic) rather than a local anaesthesia (sic)). The average cost for an early surgical abortion at a clinic is about $500, while the cost for the same abortion at a hospital can exceed $1000.”
- Abortion Rights Coalition of Canada, “Position Paper #2,”http://www.arcc-cdac.ca/funding.html
About 500 abortions are performed at Morgentaler’s clinic in Fredericton each year. Patients pay between $500 and $750 for medical care.
- Canadians for Choice, “Reality Check: A close look at accessing abortion services in Canadian hospitals,” 2006.
- “Women who have BC medical coverage are required to pay $80.00 to cover the cost of medications … women who do not have BC medical coverage are required to pay $370.00 … if you do not have valid medical coverage from a Canadian provincial/territorial medicare insurance plan then you will be required to pay the full cost of the procedure which is $1300 for surgery done at the hospital.”
- Vancouver Island Women’s Clinic, www.viwomensclinic.ca/cost.html
“The average cost for an early surgical abortion at a private abortion clinic is about $500, while the cost for the same abortion at a hospital can exceed $1000,” said Joyce Arthur of Pro-CAN. “Hospitals have bigger bureaucracies and more overhead. Most use general anesthesia for abortions, while clinics use less expensive local anesthesia and conscious sedation. Abortion clinics deliver more ‘bang for the buck’ than hospitals.”
- Abortions are significantly more expensive in hospitals. An early surgical abortion at a clinic costs between $450 and $550, while the same abortion at a hospital can be estimated at about $900 to $1200.
Do taxpayers want to pay for abortions?
The opinions of Canadians toward the use of public funds for abortion have not changed much over the last several years. Only 32% of Canadians indicate that abortion should always be financed using a health-funded tax system.
Just under half of Canadians (47%) think abortion should be financed through taxes but only in case of medical emergencies, such as a threat to the mother’s life or in the case of rape or incest and 17% think that abortion should be a private responsibility, either out-of-pocket or using Blue Cross or other private health care plans. Almost two-thirds of Canadians polled therefore, do not support tax-funding of all abortions, the current situation in 8 of 10 provinces.
Environics Poll Results from September, 2007
Environics Poll Results from October, 2006
Environics Poll Results from November, 2005
Environics Poll Results from October, 2004
Leger Poll Results from November 20, 2003
In 2004, Statistics Canada reported 901 abortions in Newfoundland. Taxpayers pay the full cost of hospital and clinic abortions. There is one private abortion clinic in the province. In 2006 three of the fourteen hospitals in Newfound and Labrador offered abortion services.
There were 1,936 abortions performed in Nova Scotia in 2004. Taxpayers pay the full cost of hospital abortions. There are no private abortion clinics. The Morgentaler clinic closed its doors in 2003. Of the 30 hospitals in Nova Scotia, four provided abortion services in 2006.
Prince Edward Island
There were 143 abortions performed on women from PEI in 2004. However, no hospitals in the province perform abortions. Women who want abortions must leave the province. Taxpayers pay the cost of abortions in out-of-province hospitals if the procedure is determined to be medically necessary by a doctor in PEI. These must be pre-authorized and approved. A spokesman for PEI’s health department reported in 2007 that about 10 such abortions are approved each year. Clinic abortions are not covered by the provincial health care system.
Statistics Canada reported 1,042 abortions in New Brunswick in 2004. Taxpayers pay the full cost of hospital abortions. They do not pay any of the costs of abortions performed at the Morgentaler Clinic in Fredericton. Henry Morgentaler is suing the province to have taxpayers pay the full cost of abortions performed at his for-profit clinic. The Morgentaler clinic is the only clinic in New Brunswick. Three of the 28 hospitals provides abortion services.
There were 30,588 abortions reported to Statistics Canada in 2004. Taxpayers pay the full cost of hospital abortions and, since 2006 the full cost of clinic abortions. Of the 129 hospitals in Quebec, 31 provide abortion services. Eighteen CLSCs (provincial government health clinics) offer abortion services. There are at least four abortion clinics in Quebec.
There were 35,238 abortions reported in Ontario in 2004. Taxpayers pay the full cost of hospital and clinic abortions. There are eight private abortion clinics in the province. Out of 194 hospitals, 33 provide abortion services in 2006.
There were 2,752 abortions performed in Manitoba in 2004, according to Statistic Canada. Manitoba taxpayers pay the full cost of hospital and clinic abortions. There is one private abortion clinic in the province. Of the 52 hospitals in the province, two provide abortion services
There were 1,806 abortions performed in the province in 2004. Taxpayers pay the full cost of hospital abortions. Four of the 68 hospitals in Saskatchewan provide abortion services. There are no private clinics in Saskatchewan.
There were 11,283 abortions performed in Alberta in 2004, according to Statistics Canada. Taxpayers pay the full cost of abortions in six out 100 hospitals that provide abortions and in the province’s two private, for-profit clinics.
Statistics Canada reported 14,738 abortions performed in B.C. in 2004. Taxpayers pay the full cost of all hospital and clinic abortions. There are four private abortion clinics in B.C. Of the province’s 90 hospitals, 26 provide abortion services.
The number of abortions in the Yukon in 2004 was suppressed in order to meet the confidentiality requirements of Canada’s Statistics Act. Taxpayers pay for hospital abortions. Of the two hospitals in the Yukon Territories, one provides abortion services. There are no private clinics in the Yukon but the province pays part of the cost for women to have abortions at a B.C. clinic.
There were 270 abortions in the NWT in 2004. Taxpayers pay the full cost of hospital abortions. Abortion services are provided at two of the three hospitals in the Territories. There are no private clinics in the NWT.
Due to incomplete reporting to Statistics Canada, residents in Nunavut who obtained abortions were excluded from the official 2004 abortion statistics. Taxpayers pay the full cost of hospital abortions and the travel expenses to the nearest facility when referred by a doctor. The one hospital in Nunavut does provide abortion services although women over 13 weeks must travel to Ottawa.