Roe is out. BC must bring universal reproductive health care in

As medical students—and as human beings—we were horrified when the Supreme Court of the United States overturned Roe v. Wade. The ruling left millions of people in an impossible situation, forced to choose between an unintended or unsafe pregnancy, and the now complex and potentially dangerous pursuit of an abortion. Political leaders in British Columbia were quick to denounce the decision and affirm their commitment to safe abortion care in BC. But if our government is serious about protecting sexual and reproductive health and rights, it should move swiftly to cover the cost of essential reproductive health care for everyone who needs it in BC, regardless of their citizenship or residency status.

As a result of the Dobbs decision, expectant parents in at least 13 US states will be stuck between a rock and a hard place. Unable to access an abortion, many will be exposed to the harms of carrying an unintended pregnancy, which include negative physical and mental health consequences, reduced educational attainment, and an elevated risk of experiencing poverty. Preventing termination in cases of high-risk pregnancies and life-limiting or fatal fetal anomalies can lead to enormous suffering and trauma for the birthing person and child alike.

Made to choose between carrying an unintended or unsafe pregnancy and ending it through potentially dangerous means, pregnant people in the United States may seek abortions in Canada. British Columbia may be the most accessible “abortion safe haven” for residents of two states at its southern borders: Idaho, where a trigger law effectively bans abortion 30 days after the Supreme Court ruling, and Montana, where the future of abortion access is uncertain.

The good news is that US residents will be welcome to use health infrastructure on this side of the border to these ends. The bad news is that they will be required to pay for these essential services out-of-pocket, which risks amplifying existing inequities. 

Societal privilege has long determined whether a pregnant person in the US can access a safe abortion. This dynamic will worsen in the post-Roe era. People with freedom and wealth will be able to cross state or national borders to terminate their pregnancies. Left behind will be those facing socioeconomic barriers, like people who are in prison or immigration detention, people in rural and remote areas, and people living in poverty. 

Unfortunately, this is not unlike the current situation for residents of British Columbia: although abortion care is decriminalized in this province, access is far from guaranteed. Many people struggle to obtain these essential and time-sensitive services due to geographical, financial, logistical, and residency constraints. Access to abortion in BC’s rural and remote communities is difficult. For surgical abortions, people without provincial health insurance like newcomers to Canada, migrant workers, and those with precarious immigration status must finance the procedure (which can cost upwards of $500) and associated expenses themselves. 

Like us, many people in this province are appalled by the overturning of Roe. But we need not watch helplessly as the reproductive rights of people in the US are stripped away. Here in BC, we can both demonstrate and strengthen our commitment to reproductive rights by improving the accessibility of abortion and other reproductive health services for all. 

Specifically, the BC government could—and should—introduce a minimum package of reproductive health care that is available cost-free to everyone who requires it. This package should include contraception as well as medical and surgical abortion.

Such a move would not be without precedent. In 2018, the BC government made Mifepristone and Misoprostol (the so-called abortion pill) available to all patients with a valid prescription at no cost. Pharmacists are able to dispense Mifegymiso (a combination of the drugs Mifepristone and Misoprostol). During the 2020 election, the New Democratic Party campaigned on the promise of universal contraception, a commitment that has yet to be fulfilled.

Nor would it be the first time that BC made access to health care truly universal. At the onset of the pandemic, the BC government introduced coverage for COVID-related care for BC residents not yet eligible for MSP. It did so because the context demanded it: hundreds of thousands of people in BC would become ill over the course of the pandemic, and many simply would not be able to pay out-of-pocket for testing, vaccines, and treatment. The recent decision by the US Supreme Court, which has set thousands of people in that country scrambling to access time-sensitive and essential health care, calls for similarly decisive action from the BC government. 

When news of the Supreme Court’s draft decision broke in May, BC’s elected leaders publicly affirmed their commitment to sexual and reproductive health and rights in BC. Now that the decision has been handed down, and BC’s health system may soon be called upon to provide care for those affected in the US, action must follow. This means making key sexual and reproductive health services available to all those who need it at no cost, BC residents and nonresidents alike. In doing so, the BC government would demonstrate solidarity with pregnant people in this province and beyond. It would be standing up for human and reproductive rights; rights that, in 2022, clearly still need defending.
—Sandra Smiley, MSc, MPH
—Maya Naidu, BSc
—Kira Tosefsky, BSc
—Michelle Lisonek, BSc
—Ishmam Bhuiyan
—Annie Foreman-Mackey, MPH
Medical students with the UBC Political Advocacy Committee

This post has not been peer reviewed by the BCMJ Editorial Board.

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George Szasz, CM,MD. says: reply

I congratulate you for your understanding the the gravity of the situation, your clear vision for universal sexual and reproductive health care and your support for such in the context of our Province's health care system. George Szasz, CM MD

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