The 2024 US election threw a spotlight on reproductive justice, where abortion access took centre stage in the aftermath of the 2022 Dobbs decision to overturn Roe v. Wade. Abortion access shaped US political discourse leading up to the election, and Democrats campaigned on the profound impacts of reproductive healthcare on millions of Americans. As US presidential candidate Kamala Harris insisted throughout her campaign, reproductive justice is not confined to abortion alone. A singular focus on abortion undercuts the full spectrum of reproductive needs.
In Canada, reproductive healthcare is deeply commodified, affecting access to resources from contraception to fertility treatments. The inequities of reproductive healthcare have also created significant disparities based on economic status and other aspects of marginalisation. In the shadow of the US media landscape, there is certainly a focus on abortion access when discussing reproductive healthcare. Canadians tend to pride themselves on being “better” than their southern neighbours, but in this instance, being better is not good enough. Comprehensive reproductive justice demands attention to broader commodification in health services, especially if we aim for equitable outcomes in family planning, pregnancy, and beyond.
The Case for Reproductive Justice
In 1994, the Women of African Descent for Reproductive Justice, coined the term “Reproductive Justice” to describe the intersection between reproductive rights and social justice. It is a comprehensive term, inclusive of everything from contraception access, to prenatal care, STI prevention, comprehensive sexual health education, and postnatal care. It also includes things like living wages to care for families, adequate parental leave, and support systems for those impacted by domestic violence. Reproductive justice ensures the fundamental choice to have children, as much as the choice to not have children. With a history of forced sterilisation and eugenics, particularly of Indigenous women, girls, and Two-Spirit people, the critical importance of choice proves highly relevant in a Canadian context. Reproductive justice now also includes healthcare treatments and issues that were less common more than thirty years ago, such as access to in vitro fertilisation (IVF). Reproductive justice will continue to evolve in the years to come.
The cost and availability of contraception is a critical pillar of reproductive justice. This is why free birth control was deemed an essential component of the NDP pharmacare bill. South of the border, the struggle continues as a debate over the US Affordable Care Act’s contraceptive mandate, leaving access to birth control both precarious and commodified. In Alberta, US-style rhetoric is now seeping into calls for the province to opt-out of national, publicly-funded pharmacare. Although 74 percent of Albertans support free contraception, the province remains a holdout in offering such coverage, reflecting a trend influenced by the right-wing in the US. Alberta also faces worrying proposals for opt-in sexual health education, and this coupled with resistance to public contraception, highlights the need for strong Canadian policies that prioritize reproductive rights as public goods, shielded from foreign ideological influences.
Beyond Abortion: the Sorry State of Reproductive Healthcare in Canada
Access to fertility treatments is an increasingly common reality in both the US and Canada. According to the Canadian Fertility and Andrology Society (CFAS), one in six Canadians struggle with infertility. But as costs for treatments continue to rise, only the most affluent can seek out support in becoming parents. While one cycle of IVF costs around $20,000 on average, certain provinces do offer varying degrees of support: Ontario and Quebec cover one IVF cycle, and British Columbia will begin offering coverage in April of 2025. Manitoba, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland and Labrador all offer tax credits for different amounts and with different conditions. Alberta, Saskatchewan, Yukon, Northwest Territories and Nunavut offer no help – and the territories do not have any dedicated fertility clinics.
With vast discrepancies in fertility treatments available to Canadians, Canada is simultaneously a global hotspot for the practice of surrogacy. With costs ranging from, on average, $80,000 to $140,000, surrogacy in Canada remains a cost-prohibitive procedure. While highly popular among those seeking international surrogacy, surrogacy has become unfeasible for many Canadians. The Journal of Obstetrics and Gynaecology Canada recently found that, “in Canada, as many as 1/3 of surrogate pregnancies have international intended parents.”
With IVF an increasingly contentious topic in the American political landscape, Canada’s role within the international fertility market will continue to expand, and the price of fertility treatments will likely increase alongside rising demand. Though support for IVF enjoys general cross-party support in the United States, individual states have increasingly sought to restrict access to reproductive treatments on the basis of foetal personhood laws. In other words, the American debate on abortion has led to an increase in proposed IVF restrictions. Canada, in turn, may see a detrimental ripple effect in the years to come, as localised fertility treatments are priced to cater to an international audience.
No Reproductive Justice without Parental Leave
Unlike many Americans, Canadians who successfully become pregnant can access parental leave upon the birth of their child. While highly beneficial as a policy, parental leave in Canada has not kept up with inflation. Maternity benefits, provided at the national level, are available at a benefit rate of 55%, and are accessible for 15 weeks. Standard parental leave provides a further 40 weeks, to be shared between both parents, at the 55% rate. So, if an individual making $60,000/year became pregnant and took both maternity and parental leave, for a total of 50 weeks to stay at home with the new baby, benefits would pay $635 per week. This would provide an annual income of $36,533, an amount that may be liveable in a dual-income household.
But consider the case of a single mother, since one fifth of Canadian households are single parents. She would be priced out of renting even a one-bedroom in most Canadian cities, including Toronto and Vancouver, but also Calgary, Hamilton, and Oshawa. A two-bedroom apartment in virtually any Canadian city would be far out of reach. This is not just hypothetical. It is the lived reality of many new parents in Canada, since Canada’s maternity and parental leave program ranks among the lowest in wage replacement rates out of the 38 OECD countries.
Oftentimes, discourse centring the American experience stymies attempts to increase Canadian parental leave rates. Instead of focusing on where Canada can do better, the total lack of national parental leave in the US enables our own policymakers to fall back on the “better than our neighbours” excuse. While conditions are somewhat better than the United States, Canadian parental leave is still nowhere near good enough, especially when it leaves Canadian parents to face poverty in the first year of a child’s life.
Rethinking Post-partum Care
Canadian post-partum care also offers room for improvement. One study from 2021 noted, “considerable variation in the timing and frequency of postnatal visits,” highlighting how, “[Canadian] women are still reporting dissatisfaction and are facing challenges.” Similarly, a 2018 study found that while many women were objectively satisfied in the purely medical context of postpartum care, two-thirds of the women had concerns about going home that were related to infant feeding, feeling overwhelmed, and not knowing how to settle their baby.
Canada has failed to deliver adequate support for new parents, particularly new mothers, beyond purely medical considerations. Canadians could borrow policy ideas from the Netherlands and Belgium, where new mothers benefit from access to a maternity nurse who comes to the home to provide a minimum of 24 hours of care within the first eight days after discharge from the hospital. The Swedish model, where breastfeeding counselling is covered by insurance, and midwives conduct as many home visits as needed within the first four days after delivery, presents another alternative. France offers in-home postpartum care, and all birthing parents automatically receive a referral for pelvic floor therapy. Korea offers substantive post-natal care centres, based on the traditional practice of Sanhujori, a holistic approach to care for new mothers.
Around the world, examples abound of decommodified postpartum support, and the benefits it provides. Canadians may forget that around the world, post-partum care is rapidly evolving, while Canada is falling behind. A better foundation for new families needs to be established that supports new parents in a deeply vulnerable time to ensure infants are given the best start possible.
Conclusion
As US abortion restrictions and the broader commodification of reproductive healthcare continue to shape Canadian public sentiment and policy, it is increasingly clear that Canada must develop independent and equitable frameworks for reproductive justice. By decommodifying reproductive healthcare and insulating it from the potential spillover of restrictive US policies, Canada can reinforce reproductive justice as a comprehensive public good. This approach should address needs ranging from accessible sexual education to universal access to contraception, as well as support for new parents and those seeking to become parents.
Canada’s record-low fertility rates are no coincidence when the pressures of affordability on reproductive healthcare do not enable health choices. It is essential that we invest in comprehensive support for new parents, including increased parental leave and postpartum care. Canadian policymakers, faced with the mounting influence of American policies, and a population increasingly in need of extended support, have a unique opportunity to enact transformative reforms that could shape a fair and just future for all Canadians.
