many canadian women lack access to reproductive health services

... And second, health columnist André Picard writes about the state of reproductive freedom in Canada. Although abortion remains legal here, access is questionable - or nonexistent - for many Canadian women. Women in Eastern Canada, and especially rural women all over Canada, face a shortage of abortion services, as they do shortages of health providers in general.

On Saturday night in Toronto and at a number of events across the country in coming days, women will celebrate the 20th anniversary of the momentous Morgentaler decision.

And celebrate they should, all the while remembering that much remains to be done to ensure that reproductive choice exists in this country.

On Jan. 28, 1988, the Supreme Court of Canada struck down the country's abortion law and ended the prosecution (or rather state-sanctioned persecution) of Montreal doctor Henry Morgentaler.

As the late Madam Justice Bertha Wilson wrote in the judgment, a woman has a right to continue or terminate a pregnancy, free of state interference.

No law is necessary because no law can do justice to this deeply personal decision.

"It is not just a medical decision," Judge Wilson wrote. "It is a profound social and ethical one as well. It asserts that a woman's capacity to reproduce is to be subject not to her control, but to that of the state."

Since then, Canada's approach has been hailed as a model for ensuring safe, legal abortion - and it is, at least on paper.

While there are, theoretically, no restrictions on abortion, the number of abortions has not increased.

In fact, the number of abortions has held steady over all, and the teen abortion rate has actually fallen.

Each year in Canada, there are about 330,000 lives births and 110,000 abortions.

Despite what you see in Hollywood movies, the vast majority of those having abortions are not teens, but women in their 20s and 30s. They have, almost universally, exercised their freedom of choice judiciously, law or no law.

While the highest court ruled that the state has no place in the uteruses of the nation, the state does have a role in the provision of medically necessary health services, of which abortion is one.

Yet our health system - from the politicians who oversee it to the policy makers and administrators through to the physicians and nurses who should provide non-judgmental care in public institutions - has largely failed women who seek abortions.

The failings are many and varied, but revolve principally around lack of access to timely care.

In short, the arbitrary rules that have crept into the system in the past two decades make a mockery of the Supreme Court ruling.

In Canada, fewer than one in five hospitals perform abortions. One province, Prince Edward Island, offers no abortion services at all. Another, New Brunswick, has created unjustified (and likely unconstitutional) barriers to access, requiring referrals from two doctors.

In the nation's capital, Ottawa, the wait time for an abortion stretches to six weeks, a perversity. (If there is one area of care for which there should be a wait-time guarantee, it is abortion, obviously a time-sensitive procedure.)

But the greatest injustice is that faced by Canadian women living outside major metropolitan centres, particularly those in the North.

Virtually every hospital and clinic offering abortion services in Canada is located within 150 kilometres of the U.S. border, and there is not a single abortion provider north of the Trans-Canada Highway in Ontario.

A woman in northern Manitoba, for example, needs to travel about 20 hours to access the nearest in-province abortion provider. For women in the three territories, travel can be an insurmountable obstacle.

Abortion should be covered by medicare but, in reality, it is expensive. If a woman opts for an abortion in a private clinic - something that is often necessary given the lack of service offered in hospitals - she must pay out of pocket and be reimbursed. (This policy was recently struck down by the courts in Quebec, which deemed that medicare should foot the bill, regardless of where the procedure is done.)

Worse yet, if a woman travels out of province or to the United States - which, again, many women are forced to do because of lack of timely access domestically - she will not be reimbursed at all.

Further, Canadian women wanting to terminate a pregnancy have no option other than surgical abortion.

Drug-induced abortion - the method of choice of about one-third of women in Europe and the United States - is not even available in Canada. Mifepristone (brand name Mifeprex, also known as RU-486) is a safe, proven alternative, and its lack of availability in Canada is a scandal.

Between the legalization of abortion in 1969 and its complete decriminalization in 1988, women fought many tough battles.

Yes, it is time to celebrate.

But there are many more battles to be fought to ensure choice is not only theoretical but real.

Too bad the public is so complacent about this important issue. Thankfully, there is a new generation of women who are redefining the struggle.