I'll start, and Gigi may want to add.
First of all I'll say that the issue of access to abortion services has been a long-standing concern. Over the last decade New Brunswick and P.E.I. have drawn the most attention and concern from us. There has been considerable evolution in New Brunswick, and some in P.E.I. It used to be, and is still the case today, that a woman in P.E.I. needed to go off the island. I think we would say it's hard to square that standard of care with real accessibility as we understand it under the Canada Health Act. There has been some flexibility in the criteria and conditions that apply to women who have to go off the island. We know that there are some discussions going on about dealing with the current situation of no access on the actual territory of Prince Edward Island. It continues to be a topic of discussion with respect to that part of the country.
In general we are concerned and we are having some discussions about it, about the fact that it is still the case not just in rural areas but elsewhere that often abortion services are available only in hospitals; they're insured only in hospitals. There may be a private clinic, but in some parts of the country, historically, if a woman went to a private clinic instead of a hospital she was charged and not necessarily reimbursed by the province, which is a clear Canada Health Act violation, because you cannot be charged for what is otherwise an insured service performed in a different institutional setting. It's an issue we continue to pay a lot of attention to.
It is a bit tricky under the Canada Health Act to say to a province, for example, that may have several hospitals that are performing abortions that they have to meet a threshold of availability—which might often mean either more hospitals or clinics—where abortion services could be provided. I think we would not be disinterested in this issue, but.... Finding a province in breach of the Canada Health Act on extra billing and user charges is, relatively speaking, straightforward: either an individual was charged or he or she wasn't. When it comes to determining whether the extent to which a service is available in a jurisdiction violates the accessibility principle is a lot different. We're having a conversation amongst ourselves right at the moment about New Brunswick, which has made considerable improvement over the last several years in this regard. But some people might look at the New Brunswick situation and say, “Well, that's great, but there are not enough locations”. We haven't made that determination yet.
I'll just simply say it's something we're concerned about, we pay a lot of attention to it, but it is very tricky to actually have us sitting here in Ottawa saying that this service is not available in a sufficiently geographically dispersed manner to meet an accessibility test. That's a tough one for us.