Mr. Speaker, the federal government does not directly fund hospitals or clinics to provide medically necessary health care services, including abortion care services. Rather the provincial and territorial governments fund and administer the provision of these services within the framework of the Canada Health Act and with federal assistance through the Canada Health Transfer, or CHT.
The Canada Health Act sets out the criteria and conditions that must be satisfied by provincial and territorial health care insurance plans for provinces and territories to qualify for their full share of the federal cash contribution available to them under the CHT. The CHT provides provinces and territories with federal funding to assist them in exercising their primary jurisdiction in the administration of their public health care insurance plans and the delivery of health care service.
The Canada Health Act requires that all medically necessary hospital and physician services be covered by provincial and territorial public health care insurance plans, whether they are provided in a hospital or in a facility providing hospital care, such as a private clinic. Surgical abortion services are deemed medically necessary by all provinces and territories, or PTs, and as such, are insured under their PT health insurance plans. Medical necessity is determined by provincial and territorial health insurance plans, in consultation with the medical profession.
The most recently available data from the Canadian Institute for Health Information, or CIHI, states there were an estimated 87,485 reported induced abortions in Canada in 2021. The number of reported induced abortions occurring in a hospital setting was 20,217, or 23.1%, while 67,286, or 76.9%, occurred in a non-hospital setting.
In the period after mifepristone restrictions were removed, most abortion providers in Ontario were general practitioners, at 66.5%, with obstetrician-gynaecologists, at 23.2%, and nurse practitioners, at 9.1%, taking up a smaller proportion of the workforce. By 2019 nearly 90% of practitioners offering abortion care provided 10 or fewer per year, and among all abortion providers the annual median number provided dropped to 1, or IQR 1-5. These findings indicate a strong integration of abortion care into more general services. Meanwhile existing services were preserved; the number of practitioners providing more than 50 abortions per year, that is, those with an abortion-focused practice, was unchanged after the policy implementation.
CIHI reports that almost 2/3 of all reported abortions in 2021 were procedural, or surgical, while 1/3 were medical, or through medication. CIHI acknowledges that there is likely continued undercounting of medication abortions, with the use of Mifegymiso. Access to abortion services has improved for Canadians with the advent of medication abortion, through Mifegymiso, particularly since prescribing guidelines were updated by Health Canada in 2017, and coverage for the drug has been established in all provinces and territories
To further improve nation-wide access to sexual and reproductive health care, including abortion, Health Canada’s Sexual and Reproductive Health Fund was created. Through Budget 2021 and 2023, $81 million has been committed to the fund over six years. The fund supports community-based organizations that help make access to abortion, gender affirming, and other sexual and reproductive health care information and services more accessible for underserved populations, such as members of 2SLGBTQI+ communities, Indigenous and racialized people, and women and youth from underserved communities.
To date, $8 million has been invested in four projects focused on access to abortion. Through these projects, new resources and supports are being developed for health care professionals, access to accurate information about abortion is being improved, and financial and logistical support for travel for abortion care is being provided. Specifically, the funding has made possible a 225 percent increase in the number of people receiving travel and logistical support to access abortion services, that is, 107 people assisted in 2021-22 vs. 348 people assisted in 2022-23.