This week marks the twentieth anniversary of R v. Morgentaler, the Supreme Court's ruling that decriminalized abortion in Canada. This landmark decision has protected the health and saved the lives of countless women, and was named as one of the most important and influential Charter cases of the last 25 years. To commemorate the decision the National Abortion Federation co-sponsored a symposium with The University of Toronto's Faculty of Law, and with generous support from the Canada Research Chair in Health Law and Policy.

The symposium brought together abortion providers, legal scholars, politicians, reproductive rights experts, and students to examine the core themes of the decision and the future of abortion rights in Canada. The lawsuit's namesake Dr. Henry Morgentaler attended and spoke about the day the Supreme Court decriminalized abortion, which he called, "the best day of my life."

In the years leading up to the Morgentaler decision, abortion was permitted only in very limited circumstances. Hospitals with Therapeutic Abortion Committees could approve and provide abortion care only in cases of life or health endangerment. In order to obtain a legal abortion, women were forced to face an intimidating process of going before a hospital committee to petition for care. This policy established unequal access to abortion throughout the provinces and territories, and made it particularly difficult for women outside major urban centers to obtain abortion care. It is estimated during this time that 35,000 to 120,000 illegal abortions took place each year in Canada, and we may never know the actual number of women who sacrificed their lives and health through back alley or self-induced abortions.

Throughout history major movements have been started by dedicated people who were willing to stand up and give a voice to people in need. The battle for abortion rights was fought in Parliament, in the courtroom, and in the streets. Just as they had done for voting rights and human rights, women mobilized–this time around obtaining the right to have a safe and legal abortion.

As women organized in our quest for reproductive freedom, one man stood out as a leader for our cause and a champion for our rights. Dr. Morgentaler defied the law and opened the first Canadian freestanding abortion clinic in Montreal in 1969. For the next 20 years he continued to fight the system and even served prison time for providing women with safe abortion care. At tremendous risk to his life and personal safety, Dr. Morgentaler remained committed to liberalizing Canada's abortion law and continued to speak out for women's reproductive freedom. These efforts were successful, and today Canada is one of only a few countries without a federal law restricting abortion.

Symposium presenters including Carolyn Bennett, M.P. and CBC columnist Heather Mallick reflected on this decision's impact on the Canadian health system, the political landscape, and the women of Canada. Several providers spoke about witnessing the devastation of illegal abortion and their commitment to caring for women. One provider said, "After an operation patients frequently say ‘Thank you Doctor,' but abortion is the only operation I know of where they also sometimes say, ‘Thank you for what you do.' I love my work. I get enormous personal and professional satisfaction out of helping people, and that includes providing safe abortions. The people that I work with are extraordinary, and we all feel that we are doing important work, making a real difference in peoples' lives." However, the moving stories of abortion providers were also accompanied by a reminder that there is still a need to improve abortion training and awareness among family physicians.

Although abortion has been decriminalized for 20 years, challenges to accessing abortion care in Canada still exist. Even though abortion is considered a safe, legal, and insured service, access is variable across the country and some women are still denied equal access to abortion care. Currently, there are no abortion services available in Prince Edward Island, and access remains a challenge for rural women throughout Canada. In New Brunswick, a woman can only obtain a publicly funded abortion if provided by an ob/gyn in a hospital with written approval from two doctors. This policy contradicts the Morgentaler decision and unfairly restricts access for women in the province.

Women not living in their home province or territory also face challenges because abortion is not part of the inter-provincial billing agreement. In fact, abortion is the only time-sensitive and medically necessary procedure excluded from the list of services on the inter-provincial billing agreement. This policy requires students attending school in another province, or women who have recently moved and are in the process of transitioning their health care benefits, to pay the full cost of their abortion care out-of-pocket, or incur additional expenses traveling back to their home province in order to obtain a publicly funded abortion.

Anti-choice physicians can also present barriers to access. Although many abortion providers accept self-referrals, some facilities require women to obtain a physician referral before they can access abortion care. Many women often go to their family physician for this referral or simply to get information about their options. The Canadian Medical Association's policy of allowing physicians to refuse to refer patients for abortion care is a clear violation of CMA's own Code of Ethics, which requires physicians to first consider the well-being of the patient; to practice medicine in a manner that treats the patient with dignity; and to provide patients with the information they need to make informed decisions about their medical care. The CMA's policy treats women unfairly and impedes women's access to care.

Now more than ever, it is important that we don't lose sight of the women who continue to face these obstacles in order to obtain the abortion care they need. We must continue to work together to ensure that women have the same access to abortion care whether they live in an urban center or a small town, or whether they live in British Columbia or Prince Edward Island.

It is critical to the lives and health of Canadian women that abortion is safe, legal, and accessible. Many of the symposium attendees were students who have never lived in a world without legal abortion. We welcome them to join us in remaining vigilant to preserve this freedom so that we never have to return to the days of back alley abortions where our sisters, mothers, and friends had to risk their health-and sometimes even their lives-to end an unwanted pregnancy.