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Most Canadians have lived with evidence-based reproductive health policy for so long that they take it to be the global norm, but it is not. Since 1988, abortion has been legally recognized as a standard medical procedure in Canada, free from criminal laws that either protect or restrict it.

Abortion provision in Canada is treated no differently than any other health service — health system governance of abortion care aims to ensure competence and safety, just like governance of other common conditions, such as hypertension, infection, or surgical care of appendicitis. This means that, in Canada, reproductive health decisions remain firmly within the domain of health care, with clinical practice guided by evidence, rather than political or ideological debate.

This sets Canada apart not only from the U.S., but from most high-income countries globally. Canada remains the only country in the world to have fully decriminalized abortion. Elsewhere, abortion practice is restricted in criminal law, most commonly with restrictions on reason for abortion or gestational age — and often care conditions, such as limiting care to specific clinical locations or requiring unnecessary tests, waiting periods, or committee approval — with some countries forbidding abortion under any conditions. In Canada, abortion decisions are made solely between the pregnant person and their health care provider.

Canada reinforced the position of abortion as a routine health service in 2017, with the globally unprecedented decision to the medication abortion drug mifepristone as a . This set Canada apart from every other country where this medication is used worldwide.

Elsewhere, mifepristone was generally available from reproductive health-specific clinics, patients were required to swallow the medication under physician observation and sign mandatory consent forms, all purportedly to preserve patient safety. However, experts had long believed these restrictions to be medically unnecessary and driven by ideology rather than science. Therefore, Canada’s landmark decision positioned Canada at the forefront of progressive health policy, setting a global gold standard.

Our evaluated the impact of this policy and confirmed that abortion remained safe under this delivery model. This influenced a similar policy in and prompted the U.S. Food and Drug Administration to remove some .

This month, we published finding that, over five years after mifepristone was introduced (from 2017-2022), access to medication abortion across Ontario increased substantially.  found that, despite these access gains, abortion rates have remained stable in Ontario. This stands in stark contrast to regions where limited access to sexual and reproductive health services has led to marked in abortion rates.

Despite federal leadership, accessing abortion services remains challenging for some groups and in some settings across Canada, including residents of , and for .

A recent found persistently poor access to abortion in Alberta from 2012-2023. In Alberta, many must travel to reach abortion services and uptake of mifepristone for medication abortion has been slow. Though this is likely due to a mix of factors, the authors note overwhelmingly faith-based health facilities across Alberta and a related calls out the 50 years of politically conservative provincial leadership.

Now, with a federal election underway in Canada and deteriorating reproductive rights and service access in the U.S. through ideologically driven policy change, it is more important than ever that Canada’s next federal government continues Canada’s legacy as a global leader in evidence-based reproductive health policy. Voters must demand clear positions and policy platforms for all sexual and reproductive health services.