Introduction
Organized feminism stands among the most influential protest mobilizations of the past six decades. During the second wave and following, movement activists across North America championed women's health and, more specifically, the defence of reproductive choice as crucial pivots in a far-reaching issue agenda (Staggenborg and Ramos, Reference Staggenborg and Ramos2016: 112–15, 130). Canadian campaigners since the 1960s identified access to safe, legal abortions within the public health care system as critical to women's control over their own bodies and movement success more generally (Brodie et al., Reference Brodie, Gavigan and Jenson1992; Johnstone, Reference Johnstone2018a; Wells, Reference Wells2020).
In January 1988, feminists celebrated the Supreme Court of Canada's Morgentaler decision that struck down restrictions dating from 1969 (R v. Morgentaler, 1988). Reflecting a “medicalized definition and institutionalization of abortion,” section 251 of the Criminal Code had required patients seeking the procedure legally to apply to a hospital-based therapeutic abortion committee (TAC) (Brodie et al., Reference Brodie, Gavigan and Jenson1992: 4). Composed of three physicians, TACs determined the likely dangers pregnancy posed to each woman's life or health. A federal government report found the process was cumbersome, lengthy and inequitable, given the absence of committees in areas outside major cities (Canada, 1977). Fewer than one in four publicly funded hospitals in the mid-1970s had TACs; research indicates this pattern particularly disadvantaged poor, rural, racialized and otherwise marginalized women (McDaniel, Reference McDaniel1985: 79). In 1969, Dr. Henry Morgentaler cited barriers to access when he opened his first abortion clinic in Montreal. He cited the same obstacles when establishing additional facilities, notably one in Toronto that prompted police charges and extensive litigation culminating in the 1988 verdict (Brodie et al., Reference Brodie, Gavigan and Jenson1992: 39–40).
In that ruling, a majority of high court judges deemed the prevailing terms of abortion provision a violation of women's rights to “security of the person” under section 7 of the Charter of Rights and Freedoms. Pro-choice activists responded by demanding that provincial governments—as the deliverers of health care to most Canadians—liberalize provision by (1) widening abortion access in hospitals, (2) fully funding abortions performed outside hospitals, and (3) particularly in provinces where violent attacks followed Morgentaler, enhancing the physical and psychological security of health care personnel and patients (PCAN, 2007). Campaigners sought temporary private court injunctions to limit disruptions caused by aggressive protesters near health facilities and providers’ homes. As time passed, the burdens entailed in enforcing and extending private injunctions led them to pursue permanent public injunctions—whereby courts restricted where, when and how many opponents could protest—as well as legislative injunctions known as bubble zone laws (ARCC, 2022). These demands closely resembled claims advanced by pro-choice groups in the United States and other countries (Cook et al., Reference Cook, Dickens and Bliss1999).
By contrast, anti-choice campaigners portrayed abortion as immoral, notably as the killing of the unborn (Brodie et al., Reference Brodie, Gavigan and Jenson1992: 35, 58, 77). Describing themselves as “pro-life,” opponents sought (1) curtailed abortion provision in hospitals, (2) the withholding of public funds for abortions performed outside hospitals, and (3) restricted access to hospitals, clinics and other health facilities that provided abortions (Cuneo, Reference Cuneo1989; Saurette and Gordon, Reference Saurette and Gordon2015). Anti-choice groups organized rallies, demonstrations, blockades and other actions that raised the level of threat facing not only physicians, nurses and staff but also patients seeking abortions (PCAN, 2007). Like their counterparts elsewhere, abortion opponents across Canada portrayed efforts to limit protest as dangerous infringements on democratic freedoms—notably freedom of religious expression (Albert, Reference Albert2005).
Violent opposition by anti-choice interests was particularly clear in four provinces: Alberta, British Columbia (BC), Manitoba and Ontario. Frustrated and angry with the 1988 court ruling, protesters destroyed equipment at a Vancouver abortion clinic (February 1990); mounted arson attacks against Dr. Morgentaler's abortion clinics in Edmonton (July 1991) and Toronto (January 1992); firebombed Morgentaler's clinic in Toronto (May 1992); shot three abortion providers at their homes in BC (November 1994), Ontario (November 1995) and Manitoba (November 1997); and initiated acid attacks against Morgentaler's clinics in Toronto (January 1992) and Edmonton (November 1996) (PCAN, 2007).
To date, scholars have not compared policy outcomes in these four jurisdictions. Facing violent attacks on clinics and medical providers, could abortion rights campaigners move their agenda forward? How useful are existing theories of feminist influence in explaining pro-choice impact?
During the same period that Canada's abortion struggle was deepening, public leaders faced strong pressures to eliminate budget deficits and curtail the reach of state intervention. An ascendant neoliberalism endorsed dramatic social policy retrenchment so that individuals—a mass of people left undifferentiated along gender, class, race or other lines in retrenchment talk—assumed greater responsibility for their own well-being (Bashevkin, Reference Bashevkin2000; Collier, Reference Collier2008, Reference Collier2012; Teghtsoonian, Reference Teghtsoonian2003; White, Reference White1997). The idea that social programs required reduction contradicted feminist claims—including abortion rights arguments—that these initiatives required expanded state attention and investment. Not surprisingly, Canadian research reports increasing conflict between neoliberal versus feminist perspectives by 1990, when federal leaders began cutting transfers to the provinces (Collier, Reference Collier2008: 20; Rice and Prince, Reference Rice, Prince and D1993; White, Reference White1997: 25).
This era also saw the election of parties from across the ideological spectrum in provinces where violent attacks occurred. Yet little is known about how two factors identified in the literature on feminist policy impact—neoliberal pressures and left/right variation—shaped subnational abortion policies. Research to date focuses close attention on contestation at the federal level (Haussman, Reference Haussman2005; Haussman and Mills, Reference Haussman, Mills, Bruce Doern and Stoney2012; Overby et al., Reference Overby, Tatalovich and Studlar1998; Sethna and Hewitt, Reference Sethna and Hewitt2009; Stettner, Reference Stettner2013; Wells, Reference Wells2020), the impact of the federal/provincial division of powers (Downie and Nassar, Reference Downie and Nassar2007; Erdman, Reference Erdman2007; Johnstone and Macfarlane, Reference Johnstone and Macfarlane2015; Palley, Reference Palley2006; White, Reference White2013) and the dynamics of anti-abortion activism (Cuneo, Reference Cuneo1989; Saurette and Gordon, Reference Saurette and Gordon2015). Existing studies of subnational abortion politics do not compare jurisdictions where violent attacks occurred, and they address theories other than those developed in the feminist policy literature (for example, Ackerman, Reference Ackerman, Stettner, Burnett and Hay2017; Farid, Reference Farid1997; Johnstone, Reference Johnstone2018a, Reference Johnstone2018b).
This article is among the first to address both gaps. It introduces longitudinal data to evaluate how governments in Alberta, BC, Manitoba and Ontario responded in the three decades following Morgentaler to pro-choice demands for widened provision of hospital abortions, full public funding of clinic abortions and enhanced security zone protections. Echoing Canadian research on childcare and violence against women policies, the study finds retrenchment pressures may have blurred ideological differences between governments but did not eliminate them (Collier, Reference Collier2008, Reference Collier2012; White, Reference White1997). Left-of-centre regimes in most provinces tended to respond more positively than right ones to feminist claims, such that New Democratic Party (NDP) governments in BC, Ontario and Alberta acted more favourably on abortion rights than did their conservative counterparts.
The article breaks new ground in illuminating four unexpected findings. First, it highlights the importance of centrist political formations, notably Liberals in Ontario and at the federal level, in advancing pro-choice interests.Footnote 1 In Ontario, provincial Liberal governments not only adopted more supportive positions than Progressive Conservative (PC) regimes but also passed a bubble zone law that New Democrats had earlier failed to introduce. During the same era that saw BC's NDP government legislate an injunction against disruptive protest following the shooting of a Vancouver physician, Ontario's NDP government wavered and then eventually secured a multi-site court injunction after arson and firebombing attacks at the Morgentaler clinic in Toronto (PCAN, 2007). At the federal level, health minister Diane Marleau warned, chastised and eventually withheld fiscal transfers to Alberta and Manitoba following their refusal to fund clinic abortions. Both jurisdictions altered their policies after Ottawa imposed sanctions (Health Canada, 2011: 24).
Second, Marleau's willingness to advocate for women's health at the federal level paralleled the interventions of subnational leaders, including Ontario attorney general Marion Boyd as well as premiers Kathleen Wynne and Rachel Notley in Ontario and Alberta, respectively. These politicians acted in a manner consistent with feminist critical actor ideas developed in the comparative gender and politics literature (Childs and Krook, Reference Childs and Lena Krook2008). As detailed below, each measurably advanced abortion rights in Canada.
Third, this account reveals important differences among and within provincial NDP organizations. Manitoba NDP and PC governments resembled each other in their shared refusal to fund clinic services and legislate bubble zones. This pattern is notable given that of the four provinces that experienced violent attacks, Manitoba had a nominally left party in power for the longest time during the 30-year period under study (see Table 1). We report divisions within the Ontario NDP cabinet and caucus of the 1990s, which could explain the Rae government's unwillingness to act as assertively pro-choice as BC New Democrats of the same era.
Table 1. Time in Office and Actions of Provincial Governing Parties by Ideological Placement, January 28, 1988–January 28, 2018
Note: Time in office was calculated using the swearing-in dates of provincial premiers. Percentage of time governed by specific parties was calculated by dividing total days in office by total possible days in office (10,958). Actions taken by provincial governments are indicated in italics.
Fourth, we underline the role of social, as opposed to economic, drivers of provincial decision making, notably on clinic funding. At various times in Alberta, BC and Manitoba, political leaders invoked fiscal arguments in refusing to cover clinic procedures. Yet on average, these procedures cost public health insurance schemes less than hospital abortions and less than the care provided to pregnant women prior to and including childbirth (Erdman, Reference Erdman2007: 1154). Had fiscal precepts determined outcomes, decision makers would have funded abortions procured in clinics.
The next sections summarize prior research on feminist policy impact, introduce the methodology used in this study and present the main empirical findings. The concluding part discusses implications of these results, including the relevance of surgical abortions given an approved abortion pill, and proposes fruitful directions for new research.
One caveat about language: although Canadian feminist and anti-feminist groups advanced broad agendas during the period under study, this text uses the shorthand terms pro-choice and feminist to refer to abortion rights advocates and uses anti-choice, anti-abortion and anti-feminist to refer to opponents of abortion rights.
Concepts and Propositions
Public policy research highlights pressures dating from the 1980s in Canada and elsewhere to reduce government spending and curtail the reach of state responsibility, notably in areas neoliberals deemed personal or “private.” Advocates of retrenchment promised that cost containment and a scaling back of social programs would lower taxes, shrink the size of government and unfetter markets (Pierson, Reference Pierson1994). Although neoliberal ideas spread across the ideological spectrum, some of their strongest Canadian promoters were in the Reform Party—a right-wing formation that demanded less federal presence in fields including health care. Reform's emphasis on cutting federal powers and expenditures coexisted with an explicit embrace of social conservatism, defined as the defence of traditional, religiously grounded values that clashed directly with feminist claims on abortion, childcare and other issues (Farney, Reference Farney2012: chap. 6).
These developments directly threatened pro-equality interests. In English Canada in particular, feminists promoted a positive role for the state and especially the federal government. They rejected neoliberal emphases on personal self-reliance that ignored systemic inequalities related to gender, class, race and other sources of social disadvantage (Bashevkin, Reference Bashevkin1996; Dobrowolsky, Reference Dobrowolsky, Harder and Patten2006; Knight and Rodgers, Reference Knight and Rodgers2012). Retrenchment arguments jeopardized abortion rights by degendering public policy and framing reproductive choice as a private matter not suitable for public financing or protection. By refusing to acknowledge systemic discrimination and its consequences, neoliberals effectively occluded major barriers to abortion access facing, for instance, Indigenous women in rural areas. Moreover, social conservatives in parties such as Reform championed patriarchal family organization and women's traditional role as mothers and wives—thus rejecting pro-choice emphases on the primacy of women's control over their bodies (Dubinsky, Reference Dubinsky1985; Farney, Reference Farney2012; Petchesky, Reference Petchesky1990).
In more general terms, feminist policy influence appeared vulnerable in an era of welfare state reorganization—whether that process took the form of targeted program reductions or larger structural changes (Pierson, Reference Pierson1994: 15–17). Research on Canadian childcare, violence against women, and social assistance programs shows that starting in the 1980s, fiscal pressures and the push to individualize (rather than socialize) risk worked against movement campaigners in provinces including Alberta, BC and Ontario (Collier, Reference Collier2008, Reference Collier2012; Harder, Reference Harder2003; Little, 1998; Teghtsoonian, Reference Teghtsoonian2003; White, Reference White1997). Although limited work examines abortion from the perspective of neoliberal retrenchment, reductions in both federal transfers to the provinces and federal grants to campaigning groups likely held negative consequences, since they slashed health care funding and removed financial supports for pro-choice activism (Feldberg et al., Reference Feldberg, Ladd-Taylor, Li, McPherson, Feldberg, Ladd-Taylor, Li and McPherson2003: 34–36).
Abortion was arguably more susceptible to retrenchment pressures than other feminist priorities. Unlike childcare and social assistance programs that formed recognized—albeit contested—components of provincial welfare states prior to the 1980s, open access to publicly funded reproductive health services never formed an integral element of social policy. Functioning TACs operated in fewer than one in four of Canada's public hospitals in the mid-1970s, when abortion debates largely concerned physicians, patients and individual privacy rather than women's right to control their bodies (Brodie et al., Reference Brodie, Gavigan and Jenson1992; McDaniel, Reference McDaniel1985; McLaren and McLaren, Reference McLaren and McLaren1997). Given that no golden age of abortion access existed, activists after 1988 had to develop new claims for public investment in women's reproductive health and state regulation of anti-choice protest—all in an age when the neoliberal mantra was ascendant.
Overall, retrenchment theories predict that growing neoliberal influence beginning in the 1980s would severely disadvantage pro-choice interests. In cumulative terms, they expect diminished progress over time for abortion rights campaigners because government leaders would either defund specific programs or impose wider systemic changes to limit women's reproductive health access.
A divergent perspective follows from political opportunity (PO) theorizing in the social movement literature. This conceptual stream stresses the characteristics of particular political contexts, notably the array of normative and institutional openings that shape protesters’ ability to influence government decision making. Research in the PO stream focuses on values and structural vulnerabilities in the policy environment where movements and regimes interact; it views the ideological positioning of parties in power as crucial to the openness of elites toward activist demands and hence to the impact of social protest (Gelb, Reference Gelb1989: 2).
Canadian research on childcare and violence against women policies generally supports partisan arguments. Left-of-centre provincial governments treated feminist claims more favourably than conservative regimes, “with centrist governments falling somewhere in between” (Collier, Reference Collier2008: 29; see also White, Reference White1997). These findings echo other Canadian accounts showing a direct association between progressive party ideology and feminist influence (Bashevkin, Reference Bashevkin2019; Burt and Lorenzin, Reference Burt, Lorenzin, Arscott and Trimble1997; Byrne, Reference Byrne and Bashevkin2009; Carbert, Reference Carbert, Arscott and Trimble1997; Erickson, Reference Erickson, Arscott and Trimble1997; Harder, Reference Harder2003; Little, 1998; Teghtsoonian, Reference Teghtsoonian2003; Trimble, Reference Trimble, Arscott and Trimble1997; Young, Reference Young2000). Similarly, studies of the United States, Germany and India report that progressive political circumstances were conducive to feminist advocacy while conservative ones were not (Guenther, Reference Guenther2010; Melich, Reference Melich1996; Morgen, Reference Morgen2002; Ray, Reference Ray1999; Reger, Reference Reger2012).
Governing party ideology was likely relevant to abortion policies in Canada because on one side, second-wave feminism from its inception was deeply immersed in left politics—as evidenced in the NDP affiliations of many participants in the 1970 Abortion Caravan (Wells, Reference Wells2020). On the other, North American anti-feminism, including organized opposition to pro-choice claims, originated in the social traditionalism of the political right (Cuneo, Reference Cuneo1989; Farney, Reference Farney2012). Considered as a unit, PO arguments suggest progressive governing party ideology will advantage while conservative governing party ideology will disadvantage pro-choice interests, with centrist regimes in between.
Given that neoliberalism coexisted with alternations of governing party, scholars usefully consider both theories in tandem. They report that the combined effects of neoliberalism and conservative parties in power were particularly unfavourable to feminist interests. Collier's study of BC and Ontario between 1985 and 2005 concludes that “the impact of neoliberalism on anti-violence policy is often more pronounced under right-wing regimes than left-wing ones” (2008: 21). Similarly, White's (Reference White1997) account of childcare in Ontario between 1980 and 1996 finds that left governments reduced program spending but were less likely than conservative regimes to systemically overhaul social policy. If applied to reproductive health, this literature suggests that in neoliberal times, abortion rights claims will be more disadvantaged under right-of-centre than left-of-centre governments.
One dimension of PO theory, however, flags the limits of this proposition. If prevailing norms shape leaders’ receptivity to movement agendas, then decision makers will be constrained by social values and not just left/right ideology. Under a series of disparate governments, Palley writes, high levels of religious traditionalism in Manitoba created “very intense opposition” to abortion (2006: 579). Research shows religion affected Canadian MPs’ views on abortion (Overby et al., Reference Overby, Tatalovich and Studlar1998; Rayside et al., Reference Rayside, Sabin and Thomas2017: chap. 2) and created internal divisions in left parties, including UK Labour and Australian Labor (Plumb, Reference Plumb2013: 260). In other words, traditionalist pressures even in nominally left parties may restrict pro-choice influence, meaning centrist parties of a secular bent may be more open to abortion rights claims than some left formations.
Methodology and Aggregate Findings
In research design terms, this study uses a similar cases approach to evaluate policies in four provinces inside a single federal system. Alberta, BC, Manitoba and Ontario are geographically proximate units where abortion facilities and providers were physically attacked following the Morgentaler decision (PCAN, 2007). These events reflected the organizational capacity of interests on both sides of the issue: pro-choice campaigners in all four jurisdictions had secured a degree of strength and visibility that their opponents were prepared to challenge using violent means (PCAN, 2007; Saurette and Gordon, Reference Saurette and Gordon2015). Strong retrenchment pressures existed in all four places beginning in the 1980s (Collier, Reference Collier2008; Erickson, Reference Erickson, Arscott and Trimble1997; Grace, Reference Grace, Carroll and Ratner2005; Harder, Reference Harder2003; White, Reference White1997). Varied political parties, from nominally left/progressive to right/conservative, won power in each province in the decades following 1988 (see Table 1).
This article uses an inductive methodology to compare abortion rights influence. We evaluate the 30 years between January 1988, when the Morgentaler decision was announced, and January 2018, before the COVID pandemic started. This end point ensures we do not consider post-COVID times, when governments across Canada markedly increased spending.
Using public information on election outcomes, we organized chronologies for each province according to party in power. Considering 1988–2018 was helpful because (1) Alberta's NDP won power for the first and, as of this writing, only time in 2015; (2) BC's NDP returned to government in 2017 following more than 15 years in opposition; (3) the Manitoba PCs and NDP alternated in power; and (4) Ontario saw three parties in office during the three decades. Given the importance of intergovernmental fiscal transfers to provincial health delivery, it is notable that three federal parties governed during this period: the PCs, Liberals and Conservatives.
The analysis relies on close reading of primary documents on the public record, including memoirs, statements by abortion rights groups, Hansard transcripts, official government press releases and government reports. Pro-choice websites provided comprehensive information on movement demands and the extent to which provincial governments responded to them (ACSHR, 2019; ARCC, 2021a, 2021b; ARCC, 2022; PCAN, 2007). We also consulted secondary sources, including media reports and academic studies, to verify chronological and other factual details. Taken together, these materials permitted us to construct detailed chronologies broken down by province and, within them, by party in power.
We evaluate the dependent variable using multiple indicators of provincial government action on three pro-choice demands. First, we consider patterns of hospital access using qualitative data on subnational responses to the 1988 decision, as well as numbers of hospitals providing abortion services. Hostility toward Morgentaler and reduced hospital numbers point toward lower pro-choice influence, while compliance with the decision and widened hospital access suggest greater impact. Second, we assess whether provinces funded clinic abortions and numbers of clinics operating in each jurisdiction, where public funding and rising clinic numbers indicate feminist impact. Third, to measure protections for abortion providers and patients, we probe the willingness of subnational leaders to pursue court injunctions and access zone laws, where multi-site injunctions and bubble legislation reflect pro-choice influence.
In explanatory terms, retrenchment arguments predict that pro-choice interests would be increasingly stymied over the 30-year period. By contrast, a party politics approach expects abortion rights advocacy to be more influential when New Democrats hold power and less effective when conservatives govern. As summarized in Table 1, neither thesis seems compelling at the aggregate level. Contrary to neoliberal expectations, data on all three dimensions suggest policies tended to liberalize over time. Bubble zone laws, for instance, eventually passed in three of the four jurisdictions. In no case did abortion rights outcomes unfold in a uniformly unfavourable direction.
With reference to ideology, the duration in power of nominally left parties was not positively associated with pro-choice impact. As shown in Table 1, Manitoba had NDP governments for about 17 years (or 56% of the 30 years), BC for approximately 10 years (34%), Ontario for about 5 years (16%) and Alberta for roughly 3 years (9%). Yet Manitoba demonstrated sustained unwillingness to fund clinic abortions and pass access zone legislation. Moreover, focusing on left versus right occludes the possibility that centrist formations might take meaningful pro-choice actions. Conversely, Table 1 shows conservative parties were most frequently in power in Alberta (91% of the time), followed by BC (66%), Manitoba (44%) and then Ontario (28%). This ordering is hard to reconcile with BC's long-term willingness to fund clinic abortions and protect access via legislative injunction and with Manitoba's refusal to pass an access law or cover clinic procedures for significantly longer than Alberta.
Given that the aggregate time in power of nominally left or right parties in the 30 years after Morgentaler holds limited predictive capacity, we now consider each dimension of abortion policy under specific provincial governments.
Hospital Access
Consistent with partisan arguments, right-of-centre governments in three jurisdictions either rejected or grudgingly accepted the Morgentaler decision. In the fourth, Ontario's centrist Liberals acted expeditiously to implement the ruling. PC premiers Ralph Klein in Alberta and Mike Harris in Ontario tried to retrench welfare states during the mid-1990s, which in turn threatened reproductive health services in hospitals. Only in Ontario did quantitative patterns of hospital provision support left/right arguments.
In BC, Social Credit premier Bill Vander Zalm announced outspoken opposition to Morgentaler within a month of the decision. In his words,
This government, like all other governments, must accept the ruling of the Supreme Court of Canada. But this government will not fund abortion on demand or be a party to the same Supreme Court ruling which indicated there could be the killing of an independent human being. This government will work vigorously towards alternatives to abortions, and commits itself to fund programs and facilities to assist expectant mothers in need (BC Hansard, 1988: 3165).
BC's cabinet revised the Medical Services Act to define abortion as a not medically required and hence not publicly insured service unless performed in a hospital when the life of the pregnant woman faced significant threat. The provincial Supreme Court ruled the political executive had exceeded its jurisdiction in determining medically required services. Social Credit leaders did not appeal the decision (BC Civil Liberties Assn. v. British Columbia, 1988; Farid, Reference Farid1997: 126–27; PCAN, 2007).
The number of BC hospitals providing abortions generally declined over time, and not in a manner consistent with left/right factors. After taking office in late 1991, the NDP government released a list of 33 hospitals that were expected to perform abortions, and in 1996, it amended the provincial Hospital Act such that all listed hospitals were expected to do so (PCAN, 2007; Downie and Nassar, Reference Downie and Nassar2007: 166). Under Liberal premier Gordon Campbell, 20 hospitals (22%) offered the procedure in 2002, compared with 26 (29%) in 2008 (Palley, Reference Palley2006: 576; Reid, Reference Reid2013). A total of 10 BC hospitals provided abortions in 2019, when the NDP held power under John Horgan (ACSHR, 2019).
In Alberta, PC premier Don Getty announced in February 1988 that his government would accede to Morgentaler and disband TACs. Noting that he had not yet received much public feedback, Getty stated, “I hope they [constituents] understand this is something we had to do because of the [Supreme Court] decision” (as quoted in Zdeb, Reference Zdeb1988). Getty's successor, Ralph Klein, tried in 1995 to remove abortion from the list of medically necessary services—an idea vigorously opposed by doctors (PCAN, 2007; Saurette and Gordon, Reference Saurette and Gordon2015: 141). Klein nested restrictions on reproductive health access in a larger systemic retrenchment that promised to cut spending on hospitals and health care, eliminate the deficit and reduce taxes (White, Reference White1997: 13–16). In 2004, Klein declared his willingness to incur financial penalties from the federal government in order to de-list abortion services but did not take further action (PCAN, 2007).
Numbers of Alberta hospitals offering abortions were not positively associated with a left party in power. Four hospitals offered the procedure under Klein in 2002, representing fewer than 5 per cent of the province's facilities, compared with six (6%) under his PC successor, Ed Stelmach, in 2008 (Erdman, Reference Erdman2007: 1095; Palley, Reference Palley2006: 576; Reid, Reference Reid2013). Under Rachel Notley's NDP government in 2019, two Alberta hospitals provided the procedure (ACSHR, 2019).
Manitoba experienced some of Canada's most protracted abortion debate (Palley, Reference Palley2006: 579). Given long waiting lists at the province's main hospital, Dr. Morgentaler located his first clinic outside Montreal in Winnipeg (Palley, Reference Palley2006: 573). Former provincial NDP cabinet minister Joe Borowski led sustained high-profile protests against the Winnipeg clinic, which opened in 1983. The protests contributed to Premier Howard Pawley's NDP cabinet becoming “helplessly split” over questions of access (Ross, Reference Ross1983: 21; see also Morton, Reference Morton1992). Enforcing what Pawley and his attorney general deemed a violation of the Criminal Code, Manitoba's NDP government charged Morgentaler and refused to grant his clinic hospital status (McDaniel, Reference McDaniel1985: 79; Pawley, Reference Pawley2011: 166–67; Ross, Reference Ross1983). Elected in spring 1988, the PC government of Gary Filmon formalized that position by stipulating abortions be procured in hospitals in order to be publicly funded. As Erdman writes, “Manitoba amended its health insurance regulations to exclude ‘[t]herapeutic abortions, unless performed by a medical practitioner in a hospital in Manitoba other than a private hospital’” (2007: 1094). Pro-choice interests litigated through 2005 against that provision.
Numbers of Manitoba hospitals offering abortion services did not decline with a rightist party in power. Two facilities (4%) provided the procedure in 2002 and 2008 under NDP premier Gary Doer while three offered abortions in 2019 under PC leader Brian Pallister (Palley, Reference Palley2006: 576; Reid, Reference Reid2013; ACSHR, 2019). Manitoba resembled Alberta in that fewer than 5 per cent of public hospitals provided abortions in 2003 (Erdman, Reference Erdman2007: 1095).
Ontario Liberals chose not to restrict abortion access or funding after the high court ruling (Erdman, Reference Erdman2007: 1094). David Peterson's government disbanded hospital-based TACs and made no attempt to oppose the judgment (Farid, Reference Farid1997: 126; PCAN, 2007). Two Liberal backbenchers, however, voiced hopes that the federal government would provide “protection for the unborn” in new legislation (Ontario Hansard as quoted in Johnstone, Reference Johnstone2018a: 93).
Longitudinal figures on Ontario hospitals suggest left regimes were more responsive to pro-choice claims than centre or right formations. When Bob Rae's NDP lost power in June 1995, 81 of 219 provincial hospitals (37%) performed abortions, although only 6 (3%) did so after the 16-week mark (Farid, Reference Farid1997: 130). By 2002, under the PC regimes of Mike Harris and Ernie Eves, the number of hospitals offering abortions dropped to 44 (23%) (Palley, Reference Palley2006: 576). Declining hospital provision reflected the consequences of Harris’ Savings and Restructuring Act. Passed in 1996, this legislation permitted Ontario to shutter facilities as part of a major social policy overhaul. Abortion rights groups were not allowed to present their case against restructuring at Queen's Park committee hearings (Farid, Reference Farid1997: 132). In the period 1997–2003, PC governments closed multiple Ontario hospitals providing abortion and birth control services and combined pro- with anti-choice institutions. Wellesley Hospital in Toronto, for example, was forcibly amalgamated with the Catholic-controlled St. Michael's Hospital, while Peterborough Civic Hospital was merged with the Catholic-controlled St. Joseph's Health Centre (Farid, Reference Farid1997: 134; Gilmour, Reference Gilmour, Goyette, Magill and Denis2006: 366–70; Palley, Reference Palley2006: 582). The election of Dalton McGuinty's Liberals failed to reverse patterns of decreased provision. As of 2008, 33 Ontario hospitals (17%) provided abortions (Reid, Reference Reid2013). That number fell further to 20 hospitals under Doug Ford's Conservatives in 2019 (ACSHR, 2019). Ontario data thus suggest access to hospital abortions was widest under the NDP, suffered significant contraction under PC restructuring policies and did not recover under subsequent Liberal leaders. At the same time, Ontario materials confirm the limited availability of second trimester and later abortions even during the NDP years.
Overall, policy outcomes as measured by hospital access generally support partisan arguments. On the political right, Social Credit leaders in BC opposed the Morgentaler verdict but complied after losing in court. PCs in Alberta reluctantly conceded but, like PCs in Ontario, systemically retrenched during the mid-1990s in ways that threatened hospital-based services. In Manitoba, PC as well as NDP governments opposed liberalized provision. The sole centrist governing party in 1988, the Ontario Liberals, promptly disbanded TACs. Data on numbers of hospitals offering abortions reveal a decline over time, with the proportion especially low in Alberta and Manitoba. Only in Ontario did hospital provision peak under a left governing party.
Clinic Abortions
Supporting partisan claims, left and centrist governments in BC and Ontario funded clinic abortions. In Alberta, sanctions imposed by the federal Liberals on a provincial PC regime eventually produced the same outcome, while in Manitoba, federal sanctions together with court losses led the NDP to fund clinic procedures. In quantitative terms, left/right party in power helps to explain numbers of clinics in three of the four provinces.
BC's Social Credit government stipulated in February 1988 that provincial health insurance would only cover hospital abortions, and only when the life of the mother was endangered. The provincial Supreme Court struck down those provisions the following month. In November 1988, Western Canada's first freestanding abortion clinic opened in Vancouver. Everywoman's Health Centre immediately became a target for disruptive protesters whose February 1990 break-in destroyed $30,000 worth of equipment. Tensions surrounding Everywoman's and a second Vancouver clinic dating from late 1990 led NDP leader Mike Harcourt to promise on the eve of the 1991 provincial election that once in power, his party would open abortion clinics across BC. Within weeks of taking office, the BC NDP announced public funding for both existing clinics (PCAN, 2007).
Efforts by Alberta's PC government to limit hospital abortions and block public funding for clinic procedures led pro-choice interests to establish the Morgentaler clinic in Edmonton. Opponents targeted the facility in an arson attack before it formally opened in 1991, and in 1996, they organized a butyric acid attack. In 1992, abortion campaigners created the Kensington Clinic in Calgary, which also became a frequent site of protest activity (PCAN, 2007). Funding practices changed in Alberta after Marleau's warning that not covering clinic abortions violated the Canada Health Act and would result in fiscal sanctions. Ottawa began withholding transfers such that “From November 1995 to June 1996, total deductions of $3,585,000 were made to Alberta's cash contribution in respect of facility fees charged at clinics,” including those offering abortions. Alberta reversed its position on clinic funding in October 1996 (Health Canada, 2011: 24).
Federal sanctions imposed as a result of Manitoba's decisions were lengthier than those levied against Alberta, and also more punitive given the disparate populations and fiscal capacities of the two provinces. Federal data indicate Ottawa deducted about $2.4 million from transfers to Manitoba through the end of 1998 (Health Canada, 2011: 24). In denying funding to the Morgentaler clinic in Winnipeg, Manitoba governments consistently invoked fiscal rationales. Yet evidence shows that, on average, abortions were less expensive when procured outside versus inside public hospitals and cost significantly less than maternal health care combined with childbirth (Erdman, Reference Erdman2007: 1154). Provincial court rulings found the Manitoba Health Services Commission could exclude specific services from coverage but not impose conditions on their provision (Lexogest Inc. v. Manitoba Attorney General). Manitoba appeals court judge Charles Huband referred to tensions between fiscal rhetoric and reality in his 1993 Lexogest ruling: “If an abortion could be provided at less cost at a hospital than a freestanding clinic, it would make eminently good sense and would be entirely within the spirit of the Act to require that they be performed in the hospitals as a prerequisite to coverage. But the opposite appears to be the case. . . . It is perverse that an insurance scheme designed to control costs should willfully increase them” (as quoted in Erdman, Reference Erdman2007: 1154). In 1993, Manitoba's PC government amended the Health Services Insurance Act such that cabinet could ban public payments for medically necessary services depending on where the services were delivered—in this case, abortions performed in clinics (Erdman, Reference Erdman2007: 1103; PCAN, 2007).
Elected to power in 1999, the Manitoba NDP faced continued federal threats to impose fiscal penalties. As well, two anonymous women launched a class-action suit in 2001 alleging the province's refusal to fund their abortions at the Morgentaler clinic in Winnipeg violated multiple sections of the Charter (Jane Doe v. Manitoba). A summary court decision issued in December 2004 struck down exclusionary sections of the Health Services Insurance Act and determined Manitoba had violated women's rights in not funding clinic abortions (Erdman, Reference Erdman2007: 1098, 1102; Palley, Reference Palley2006: 573–74; PCAN, 2007). The NDP government response dated January 2005 stated that clinic abortions were “not medically necessary” and insisted the ruling “jeopardizes the province's responsibility to determine the most effective and efficient way to deliver health care” (as quoted in Erdman, Reference Erdman2007: 1142). In late 2005, the NDP cabinet altered provincial regulations to fund abortions in private clinics (Erdman, Reference Erdman2007: 1098; PCAN, 2007).
In April 1990, the Ontario Liberals passed the Independent Health Facilities Act, which remained in force under an NDP government elected later that year. The legislation ultimately covered abortions procured in five clinics in Toronto as well as the Morgentaler clinic in Ottawa, which opened in 1994 (ARCC, 2021a: 2). Elected in 1995, the Harris PCs covered payments to physicians but blocked facilities fees for new abortion clinics, including the Bloor West Village Women's Clinic, Brampton Women's Clinic, Mississauga Women's Clinic and Women's Care Clinic in Toronto (ARCC, 2021a: 2; Downie and Nassar, Reference Downie and Nassar2007: 154). Feminists saw this approach as a violation of the Canada Health Act under the terms of Marleau's January 1995 letter to her provincial counterparts, which defined hospitals and clinics as equivalent health care facilities.Footnote 2 Ontario escaped federal fiscal sanctions of the type imposed in this period on Alberta and Manitoba—likely because in Ontario, doctors’ fees were publicly funded while facility charges incurred by patients ranged from under $100 to $600 per clinic abortion (Downie and Nassar, Reference Downie and Nassar2007: 154; Weeks, Reference Weeks2019b). In office for 15 years beginning in 2003, Ontario Liberals did not amend the list of fully funded clinics (ARCC, 2021a: 2).
In quantitative terms, numbers of abortion clinics grew over time in BC in a manner consistent with governing party ideology: from 6 in 2008 under Gordon Campbell's Liberals to 14 in 2019 under John Horgan's NDP. Left/right arguments also find support in Alberta, where clinic numbers increased from two under the PCs in 2008 to three under the NDP in 2019, and in Manitoba, where they fell from two under the NDP in 2008 to one under the PCs in 2019. Data on clinics in Ontario are inconsistent with expectations, growing from 11 under the Liberals in 2008 to 18 under the PCs in 2019 (Reid, Reference Reid2013; ACSHR, 2019).
In short, data on funding for clinic abortions and numbers of clinics suggest left or centre governments tended to assist pro-choice interests while conservative regimes disadvantaged them. Manitoba, where PC as well as NDP leaders opposed clinic funding through 2005, deviated from the general pattern on clinic coverage. External pressure from federal fiscal sanctions led Alberta to finance clinic procedures. Manitoba funded clinic abortions after both federal penalties and a series of court losses.
Safe Zone Protections
Limited access to hospital abortions led pro-choice interests in all four provinces to establish freestanding clinics. Those facilities then became targets of sustained, sometimes violent opposition. From the perspective of clinic staff and patients, the tenor and frequency of anti-abortion protest posed grave physical as well as psychological risks (Cook et al., Reference Cook, Dickens and Bliss1999; PCAN, 2007).
Abortion rights campaigners demanded that provincial decision makers improve safety around medical facilities, as well as the homes of health providers (ARCC, 2022; PCAN, 2007). Their initial strategy of securing private court injunctions yielded mixed results. In Ontario, Dr. Morgentaler requested in 1994 that picketing be prohibited at 23 locations, including hospitals, clinics and doctors’ homes. Provincial judges granted a much narrower limit on activity near three abortion clinics, as well as physicians’ homes (Lewis, Reference Lewis2010). Once injunctions were secured, activists found the burden of enforcement largely fell on clinic staff, who had to call police each time a violation occurred. After police dispersed protesters, officers typically left the scene and the harassment of clinic staff and patients resumed (Janusz, Reference Janusz2018; Johnstone, Reference Johnstone2018a: 133).
A second approach involved public injunctions, whereby provincial cabinets rather than abortion providers asked judges to restrict protest in specified locations. In Ontario, this strategy ran afoul of schisms inside the NDP. During the early years of Bob Rae's government, Attorney General Howard Hampton and Solicitor General Allan Pilkey declined to seek a public injunction to protect patients and providers at Toronto abortion clinics. A subsequent NDP attorney general, Marion Boyd, obtained a public injunction protecting 23 locations, including hospitals, clinics, physicians’ homes, and medical offices; its constitutionality was upheld in a 1994 decision (Ontario [Attorney General] v. Dieleman; Albert, Reference Albert2005: 20–32; Johnstone and Macfarlane, Reference Johnstone and Macfarlane2015: 111; PCAN, 2007). Divisions over abortion extended beyond the Rae cabinet: during the same period, NDP MPPs introduced anti-abortion petitions on the floor of the legislature (Ontario Hansard, 1992a, 1992b). No such internal splits were discernible in the BC NDP during the 1990s.
Difficulties entailed in obtaining and enforcing court injunctions led campaigners to press for legislative solutions known as “safe access,” “buffer zone” or “bubble zone” laws that would restrict protest in contested locations. Three of the four provinces—two led by NDP and one by Liberal political executives—passed safe access laws.Footnote 3 Months after Dr. Garson Romalis was shot in Vancouver, BC's NDP government enacted the first bubble zone law in Canada. Most members of the Opposition Liberal caucus endorsed the 1995 legislation (Isitt, Reference Isitt2018: 109).Footnote 4 Known as the Access to Abortion Services Act (AASA), the law limited protest near clinics, doctors’ homes and doctors’ offices and made harassment (including physical interference as well as videography) of providers and patients illegal (Downie and Nassar, Reference Downie and Nassar2007: 172; Isitt, Reference Isitt2018: chap. 4). Vancouver police charged abortion opponents with violating the AASA shortly after it came into effect. Protesters contested the constitutionality of the legislation; in response, BC's provincial court ruled it contravened Charter rights to freedom of conscience and religion. The provincial appeals court then deemed the violations to be justified under section 1 Charter protections for women's health (R. v. Lewis, 1996). The Supreme Court of Canada declined to hear an appeal, and subsequent efforts to challenge the AASA were unsuccessful (ARCC, 2022; PCAN, 2007).
In Ontario, the Rae cabinet did not introduce buffer zone legislation nor did subsequent PC (Harris/Eves) or Liberal (McGuinty) political executives. Instead, Ontario's law dates from the Liberal government of Kathleen Wynne, which passed the Safe Access to Abortion Services Act in 2017. Modelled on the BC precedent, the Ontario law created protected zones outside abortion clinics and medical offices and prohibited protesters from targeting the homes of physicians or clinic staff. In 2018, Rachel Notley's NDP government in Alberta passed the Protecting Choice for Women Accessing Health Care Act, which closely resembled earlier BC and Ontario statutes (Clancy, Reference Clancy2018; Janusz, Reference Janusz2018).
In Manitoba, the NDP held power for more than 16 years starting in 1999 but failed to initiate access zone legislation. Beginning in 2018, Opposition Member of the Legislative Assembly and NDP house leader Nahanni Fontaine tried multiple times to introduce a private member's bill modelled on what other provinces had enacted. Each of her efforts was defeated by the governing PCs (ARCC, 2021b). The willingness of Manitoba New Democrats to press forward on this issue suggested growing pro-choice and waning social traditionalist influences on the party during recent years.
Overall, data on safe zone protections indicate left and centrist governments were more likely to pursue pro-choice policies than were right-of-centre regimes. Two NDP and one Liberal political executive passed buffer laws, compared with zero conservative governments. Important variations can be discerned, however. Ontario NDP cabinet ministers eventually pursued a public court injunction to protect clinics in Toronto during the same era that BC New Democrats enacted the country's first access zone law. Most BC Liberal MLAs endorsed legislation introduced in 1995 by the NDP government, while in Manitoba, PC MLAs voted unanimously against Fontaine's proposed safe zone law in 2021 (Isitt, Reference Isitt2018: 109; CTV News Winnipeg, 2021).
Conclusions
This study, which is among the first to examine abortion policy in provinces where violent attacks followed the Morgentaler decision, focuses on feminist demands for enhanced hospital access, public funding of clinic procedures and safe zone protections. It finds that in neoliberal times, progressive governing party ideology was generally associated with movement influence such that the presence of left political executives tended to favour pro-choice interests while conservative governments disadvantaged them. In Alberta during the Klein era and Ontario during the Harris years, hard-right political executives tried to restructure welfare states in ways that jeopardized reproductive choice. Provincial abortion policies in the late 1980s and following thus resembled childcare and violence against women outcomes in their broad variation along left/right lines (Collier, Reference Collier2008, Reference Collier2012; White, Reference White1997).
This article presents four significant, largely unanticipated findings. First, it demonstrates that some centrist provincial leaders were more receptive to movement claims than their NDP comparators. In Ontario, provincial Liberals eliminated TACs, funded clinic abortions and passed an access zone law. The fact that Liberals, rather than New Democrats, legislated bubble zones is at odds with findings on childcare and violence against women, which show centrists tended to act less progressively than left politicians (Collier, Reference Collier2008: 29; see also White, Reference White1997).
Second, our analysis underlines the role of centrists operating at the federal level. Federal Liberals withheld health transfers to Alberta and Manitoba during the 1990s. Both provinces later agreed to fund clinic abortions.
Third, we find feminist critical actors mattered (Childs and Krook, Reference Childs and Lena Krook2008). Federal health minister Diane Marleau defended women's reproductive choice by imposing fiscal sanctions on recalcitrant jurisdictions. At the provincial level, leaders including Marion Boyd and Kathleen Wynne in Ontario and Rachel Notley in Alberta, responded sympathetically to feminist movement claims.
Fourth, this study suggests that NDP governments varied widely in their treatment of pro-choice demands. Beginning in 1991, BC's NDP government widened access in public hospitals, covered the full cost of clinic abortions and passed a buffer zone law. Alberta's NDP government responded favourably after winning power in 2015. By contrast, Manitoba NDP leaders denied public funding for clinics until faced with both federal sanctions and multiple judicial reversals. No bubble zone law exists in Manitoba as of this writing. In Ontario, the only jurisdiction in the cluster with three competitive parties at the provincial level, Liberal as well as NDP governments adopted pro-choice positions on hospital access and clinic funding. Yet no Ontario government pursued a safe access law until the Liberals, led by the province's first female premier, passed one in 2017.
Future research could usefully explore each of these points and, in particular, how traditionalist versus secular or humanist values influenced Canadian political parties. With respect to abortion, what factors encouraged BC Liberals to join NDP MLAs in endorsing a buffer zone law in 1995? Conversely, what pressures limited pro-choice influence in both of Manitoba's major provincial parties? How did groups opposed to abortion foster alliances with Liberal and NDP MPPs in Ontario? Although social traditionalism features in discussions of abortion politics in the Maritime provinces (Ackerman, Reference Ackerman, Stettner, Burnett and Hay2017; Johnstone, Reference Johnstone2018b: 767–68), this phenomenon has received less attention in studies of other regions.
Readers may question whether at a practical level, access to surgical abortions mattered following Health Canada's approval of medication known as Mifegymiso in 2015. Once the pills became available in Ontario in late 2017, their use accounted for a growing proportion of abortions amid a relatively stable abortion rate (Schummers et al., Reference Schummers, Darling, Dunn, McGrail, Gayowsky, Law, Laba, Kaczorowski and Norman2022). Yet medical abortions were efficacious only within particular gestational limits: at the time of writing, clinics in Vancouver and Toronto offered medication to terminate pregnancies of under 10 weeks while those in Edmonton and Winnipeg had 9-week limits. As well, Mifegymiso use was largely confined to facilities in major cities: nearly three-fourths of abortion pill prescriptions in Alberta in 2018 came from a single women's clinic in Calgary, while in Manitoba, public health coverage for the prescription required that it be dispensed by one of three clinics located in Winnipeg and Brandon (Weeks, Reference Weeks2019a). Given that North American women typically learned they were pregnant at the 6-week mark (Branum and Ahrens, Reference Branum and Ahrens2017), inequities in access to medical abortions in Canada seemed to resemble those identified in earlier periods for surgical procedures—such that women living in small-town, rural and remote areas were measurably disadvantaged.
These patterns underline how in Canada, factors beyond fiscal constraints and governing party ideology continue to shape abortion rights. In multiple provinces after 1988, social traditionalism hindered efforts to realize in policy terms what feminists saw as a major judicial breakthrough. In the shadow of the historic Roe v. Wade reversal in the US Supreme Court, currents pressing against pro-choice interests in Canada's provinces merit careful scrutiny.
Acknowledgments
An earlier version of this material was presented at the online Canadian Political Science Association meetings in June 2022. I am grateful to Erika Dyck, Lorna Marsden and the CJPS reviewers and editors for their comments; Marcus Closen, David de Paiva and David Maecker for their research assistance; and SSHRC and the University of Toronto's Tri-Council Bridge Fund for financial support.
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