For Indigenous people in Canada, accessing abortion is not only about medical care—it’s about asserting autonomy over our bodies amidst a healthcare system riddled with barriers, bias, and neglect. Indigenous women, girls, and Two-Spirit people, as well as the gender-diverse community, face a “double oppression”: one from the historical impacts of colonialism that continue to marginalize Indigenous communities, and another from the structural barriers and biases embedded within health services.
While abortion is legal and covered by provincial health plans, many Indigenous communities are left without viable access, forcing individuals to travel hundreds of kilometres, navigate prohibitively high costs, or face discrimination within mainstream health facilities. This lack of access reflects a larger issue: Indigenous reproductive rights remain severely overlooked, fueling a crisis that demands urgent attention and change.
Historical context: Colonization and reproductive autonomy
Canada’s colonial legacy has led to policies like forced sterilization and limited healthcare access. While forced sterilization practices are no longer legal, there have been reports of forced and coerced sterilization in Canadian hospitals as recently as 2019. These injustices have left a legacy of mistrust toward medical institutions. When it comes to abortion, this legacy has created barriers for Indigenous communities who may already lack access to adequate health services.
Geographic barriers: Physical distance and limited resources
Indigenous women, girls, and Two-Spirit people face particular challenges when accessing sexual and reproductive healthcare. For those who must travel off-reserve for abortion care, privacy can become a concern, as on many reserves confidentiality is difficult to maintain. Additionally, access to abortion services is complicated by the fact that registered nurses—who are often primary healthcare providers on reserves—are not authorized to perform abortions.
One of the most significant barriers to accessing abortion for Indigenous people is that many Indigenous communities are located in rural or remote areas, far from abortion clinics. In regions like northern Ontario and the Prairies, people may need to travel hundreds of kilometres to reach a safe, legal provider. This logistical burden can be overwhelming without reliable transportation or support networks.
In New Brunswick, this issue came to a head when the province’s last clinic providing surgical abortions closed in February 2024. However, with a new Liberal government elected in October, Regulation 84-20 was amended to fund abortions outside of hospitals, offering hope for expanded access across the province.
Beyond physical distance, travel for abortion care places a significant financial strain on Indigenous people, who are disproportionately affected by poverty. Expenses for transportation, accommodation, and time off work are often prohibitive, and some are forced to turn to private clinics, some of which may charge fees not covered by provincial health insurance (such as in Ontario). For many, these compounded barriers make seeking essential reproductive care an unattainable and/or costly process.
Systemic inequities and discrimination in healthcare
Systemic discrimination and a lack of cultural safety in healthcare settings make it even harder for Indigenous people, like Joyce Echaquan, to seek care. Echaquan’s tragic death in 2020 from pulmonary edema, compounded by neglect and racism in a hospital setting, highlights the compounded risks Indigenous patients face. Her live-streamed abuse exposed the deep-seated racism that often makes medical experiences unsafe for Indigenous people.
Healthcare providers’ lack of cultural safety training leads to harmful assumptions about Indigenous patients’ needs and choices, further perpetuating discrimination. Indigenous women and Two-Spirit individuals also face judgment from their own communities, influenced by cultural or religious beliefs about abortion. To ensure equitable access to care, healthcare institutions must adopt policies that prioritize cultural safety and patient autonomy, and address the unique needs of Indigenous people.
Compounding issues: The impact of social determinants of health
The social determinants of health—such as income, education, and social support— And the legacy of colonization and centuries of systemic discrimination have left Indigenous people confronting the harsh realities of poverty which only intensify the challenges in accessing essential care like reproductive and abortion services.
When individuals are struggling to meet their basic needs, seeking reproductive healthcare often becomes a distant priority—especially when services are far away and expensive, and the fear of facing racism in healthcare settings is ever-present. Addressing these deep-rooted challenges requires policies that support the well-being of Indigenous communities, such as increasing access to affordable housing, providing stable employment opportunities, and funding healthcare initiatives that are both accessible and culturally safe. These steps are crucial to ensuring Indigenous people can access the care they need without unnecessary hardship or fear. By focusing on policies that uplift and support the most equity-denied, we create a system where everyone benefits.
The need for Indigenous-led reproductive health solutions
Given the barriers Indigenous people face in accessing abortion, Indigenous-led initiatives are essential to creating safe, respectful, and culturally grounded reproductive healthcare.
Programs such as the First Nations Health Authority (FNHA) in British Columbia, which provides culturally safe health services for Indigenous communities, exemplify the potential of Indigenous-led reproductive healthcare. Expanding such programs to include comprehensive abortion services would enable Indigenous people to access care without leaving their communities or risking discrimination. Additionally, supporting Indigenous midwives, doulas, and reproductive health educators can build trusted, community-based networks for people seeking information and support around abortion. All abortion providers in Canada should receive regular anti-oppression training that is Indigenous-led and informed.
Many Indigenous communities are also working to revive cultural healing practices disrupted by colonization and oppressive government policies. Indigenous-led healthcare partnerships offer innovative models of interprofessional collaboration across healing lodges, remote clinics, and urban hospitals. Evidence suggests that such partnerships not only improve holistic health outcomes but also enhance access to care, promote preventive health measures, and support adherence to care plans. By building systems rooted in Indigenous ways of knowing, we create spaces for healing and autonomy that ultimately strengthen the health and resilience of Indigenous communities.
Policy changes and advocacy for reproductive rights
While individual programs and community-led initiatives are essential, systemic policy change is also necessary to guarantee abortion access for Indigenous people. Canadian governments must recognize abortion as a human right and implement measures to make abortion care accessible, safe, and respectful for Indigenous people across the country. This requires funding for transportation and accommodation for those in remote areas, expanding telemedicine options, and creating culturally safe guidelines for abortion care.
Indigenous-led organizations and allies play a crucial role in driving these policy changes. Groups like the Abortion Rights Coalition of Canada and Action Canada for Sexual Health & Rights advocate for improved abortion access and provide essential resources for Indigenous people navigating the healthcare system. Supporting these organizations through funding, policy advocacy, and public education can help amplify their impact and drive lasting change.
The persistence of health inequities among Indigenous people highlights Canada’s failure to develop national public policies that meet contemporary Indigenous health needs. These challenges are rooted in the structural impacts of the Indian Act and historic inequities embedded in Canadian policy, signalling a lack of political will to address Indigenous health comprehensively. Addressing these issues requires collaboration across sectors, drawing from frameworks like the Truth and Reconciliation Commission’s Calls to Action, which emphasize reconciliation as a precursor to health equity. Systemic change is a shared responsibility, one that depends on the commitment and collaboration of diverse actors and knowledge systems to build policies that center Indigenous rights and self-determination in healthcare.
The path forward for equitable access to abortion
For Indigenous communities in Canada, access to abortion care goes beyond medical needs—it is an issue of autonomy, cultural resilience, and social justice. Ensuring equitable access to abortion means dismantling systemic and social barriers, from geographic isolation to discrimination within healthcare settings, that hinder Indigenous people’s rights to reproductive care. Through policy reform, Indigenous-led solutions, and the integration of Indigenous knowledge, Canada can work toward a future where Indigenous people have full control over their reproductive health.
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