Abortion Care in Canada: An Introduction
Project Overview
missINFORMED is excited to announce the launch of The Abortion Care in Canada Project! This project sheds light on the current landscape of abortion in Canada, including what you can expect if seeking an abortion, common barriers to access, and myths and misconceptions around abortion. Abortion is a fully decriminalized healthcare service in Canada. However, there are many barriers to access including a shortage of willing and able providers and an ever-increasing number of anti-choice organizations that spread misinformation about abortion. There are also recent wins like the approval of mifepristone (pronounced mi·fe·pris·tone) in 2015, an effective and safe abortion pill for first-trimester abortions (1).
This campaign was designed to bring awareness to the lived experiences of young people seeking and receiving an abortion in Canada and to provide people with evidence-based information about abortion care and access. We are excited to bring you panel discussions from experts in the field of reproductive justice, articles to give you a snapshot of the current abortion landscape in Canada, and events to celebrate choice and reproductive autonomy in our communities. Our hope is that through these resources we can educate young folks on the importance of maintaining and improving abortion access in Canadian healthcare, while also dispelling common misconceptions around abortion.
Setting the Stage: Our use of gender-inclusive language and key terms
Why do we use gender inclusive language?
Abortions are healthcare for anyone who is or can become pregnant. The anti-abortion movement is undoubtedly rooted in the historical misogynistic and patriarchal beliefs that continue to undermine the autonomy of women. However, these beliefs similarly victimize transmen, intersex folks, and nonbinary people who can become pregnant. Language is important. Using the term women exclusively when discussing abortion access leaves out groups of people who also face significant barriers when accessing abortion. Some of these barriers may differ from those experienced by cis-women and they deserve to be acknowledged. For this reason, we will be using gender inclusive language throughout our pieces unless discussing specific studies or articles that specify gender identity, or discussing misogyny and gendered oppression related to reproductive justice.
Helpful Definitions
Here we provide definitions for some common terms we will be using throughout this campaign. Often, more than one term might exist for a single concept - for example, medication abortion is also sometimes referred to as the abortion pill. For consistency and ease of use, we will be using the terms below when more than one term exists for a definition.
Emergency contraception (the “morning after” pill) prevents pregnancy after unprotected sex. It does this primarily by blocking the release of an egg from an ovary (2). Emergency contraception is not a form of abortion care, but it is still very important in conversations about bodily autonomy. Check out our article to learn more about emergency contraception.
Medication abortion* is an abortion that uses medications to end the pregnancy. They may involve the use of medications like mifepristone, misoprostol, or others (3).
*Sometimes these types of abortion are referred to as “the abortion pill”, medical abortions, or chemical abortions. The term ‘medication’ is preferred because it makes it clear how the abortions are performed – with medications (3).
Mifepristone (pronounced mi·fe·pri·stone) blocks the action of progesterone (4). Progesterone is a hormone that is normally present during pregnancy. Blocking progesterone causes changes to the lining of the uterus, the muscular wall of the uterus, as well as the cervix (4). All of these changes help to terminate the pregnancy and expel it from the uterus (4). Mifepristone is used in combination with misoprostol (4).
Misoprostol (pronounced mi·so·pros·tol) mimics the actions of prostaglandins in the body (4). Prostaglandins are hormone-like molecules that stimulate the uterus to contract (among many other functions) (5). By behaving like prostaglandins, misoprostol stimulates uterine contractions to help expel the pregnancy (4). Misoprostol is usually used in combination with mifepristone, but it can be used alone when mifepristone is not available (4).
Other agents: may be used in some countries that do not have access to mifepristone. This includes medications such as methotrexate (4). These other agents are less commonly used in Canada because mifepristone is available, which is considered the gold standard in abortion care (6).
Procedural abortion* is an abortion that primarily uses medical instruments with or without medications to end the pregnancy through a medical procedure (3). Procedural abortions may also be used if a medical abortion does not work (7).
*Sometimes these types of abortions are referred to as “surgical abortions”. The term ‘procedural’ is preferred because most of these procedures do not involve surgery and are performed in an outpatient clinic (3)
Suction or Vacuum aspiration uses a hand-held suction device to remove the pregnancy from the uterus (7). There are two methods of suction/vacuum aspiration. Manual vacuum aspiration (MVA) uses a syringe and a thin tube to apply suction, while electric vacuum aspiration (EVA) uses an electric pump and a thin tube to apply suction (7). Both manual vacuum aspiration and electric vacuum aspiration are performed during the first trimester (7).
Dilation and evacuation (D&E): uses a dilator device to help open the cervix, and then removes the pregnancy from the uterus using an instrument and suction (7). Medications are used prior to the procedure to help the cervix dilate (9). This procedure is similar to a vacuum aspiration, but it is typically performed later in a pregnancy during the second trimester (7).
Dilation and curettage (D&C)* uses a dilator device to help open the cervix, and then removes the pregnancy from the uterus using a medical instrument (7). Medications that help to dilate the cervix may also be used prior to the procedure (7). A sharp D&C uses a curette to scrape the pregnancy from the wall of the uterus (8). A sharp D&C is not currently recommended as the primary method for a procedural abortion (3). The term suction or aspiration D&C is also sometimes used to refer to suction or vacuum aspiration (defined above), where the pregnancy is removed from the uterus using suction (8).
*To avoid confusion between sharp versus suction D&C and to recognize that sharp D&C is no longer the standard of care for abortion, the terms “suction aspiration” or “vacuum aspiration” will be used instead. Using the term D&C can create confusion and fear around abortion as a serious surgical procedure when it usually isn’t. We have defined D&C here because many people are still familiar with this term and you may have heard it before.
Induction of labour (IOL) or Induction termination: uses medication to induce labour and cause delivery of the pregnancy (9). Depending on how far along the pregnancy is, additional medications may be given to ensure there is no fetal heartbeat present when delivered (10). This procedure can be performed during the second and third trimester (7).
A note from our team,
Terminology around abortion is still evolving as we try to use terms that are both medically accurate and affirm reproductive choice. As we work towards best practices, the missINFORMED team is open to hearing from you. Please feel free to reach out to our team if you would like to share about what terminology makes the most sense and is most comfortable to you.
With care,
missINFORMED
References:
Ferguson I, Scott H. Systematic review of the effectiveness, safety, and acceptability of mifepristone and misoprostol for medical abortion in low-and middle-income countries. Journal of Obstetrics and Gynaecology Canada. 2020 Dec 1;42(12):1532-42. Available from: https://www.jogc.com/article/S1701-2163(20)30339-X/abstract
Cleveland Clinic. Morning-After Pill. 2022 Jul 1. Available from: https://my.clevelandclinic.org/health/treatments/23386-morning-after-pill [Accessed 2023 Mar 4]
Upadhyay UD, Coplon L, Atrio JM. Society of family planning committee statement: abortion nomenclature. Contraception. 2023 Oct 1;126. Available from: https://www.contraceptionjournal.org/article/S0010-7824(23)00178-6/fulltext
Up-to-Date. First-trimester pregnancy termination: Medication abortion. 2024 Feb 21. Available from: https://www.uptodate.com/contents/first-trimester-pregnancy-termination-medication-abortion?topicRef=3313&source=see_link#H159967666 [Accessed 2023 Mar 4]
Cleveland Clinic. Prostaglandins. 2022 Apr 11. Available from: https://my.clevelandclinic.org/health/articles/24411-prostaglandins [Accessed 2023 Mar 4]
CMAJ: Renner RM, Ennis M, Contandriopoulos D, Guilbert E, Dunn S, Kaczorowski J, Darling EK, Albert A, Styffe C, Norman WV. Abortion services and providers in Canada in 2019: results of a national survey. Canadian Medical Association Open Access Journal. 2022 Sep 1;10(3):E856-64. Available from: https://www.cmajopen.ca/content/cmajo/10/3/E856.full.pdf
Schnettler WT, Wilson JH, Lubert AM, Girnius A. Maternal cardiac care: a guide to managing pregnant women with heart disease. 1st ed. Philadelphia, PA: Elsevier; 2023 https://www.sciencedirect.com/science/article/pii/B9780323824644000311
Up-to-Date. Dilation and curettage. 2023 Jul 6. Available from: https://www.uptodate.com/contents/dilation-and-curettage?search=dilation%20and%20curettage&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H28 [Accessed 2023 Mar 4]
Up-to-Date. Overview of second-trimester pregnancy termination. 2024 Feb 5. Available from: https://www.uptodate.com/contents/overview-of-second-trimester-pregnancy-termination?search=manual%20vacuum%20aspiration&topicRef=3287&source=see_link#H9928622 [Accessed 2023 Mar 4]
Up-to-Date. Second-trimester pregnancy termination: Induction (medication) termination. 2024 Feb 5. Available from: https://www.uptodate.com/contents/second-trimester-pregnancy-termination-induction-medication-termination?search=manual%20vacuum%20aspiration&topicRef=14194&source=see_link#H8856997 [Accessed 2023 Mar 4]