2021 Statelessness & Citizenship Review 3(1) abortion. 6 Making it available to people in Canada was an important step in addressing historical gaps in access to abortion outside of urban centres, as it can be offered by primary care providers like family doctors, nurse practitioners and midwives. In real terms, widely available medical abortion improves access by allowing individuals to access abortion care earlier in their pregnancy, reducing the number of pregnancies carried to a more advanced gestation, when seeking abortion care becomes more logistically and financially complicated (ie, having to travel further, having to cross borders, needing to take more time off work, child/eldercare, etc). However, for undocumented people, the potential of medical abortion is largely out of reach since access to this care depends on having a health card and/or the ability to pay for clinical fees out of pocket and/or travel. Further, if the closest place or only place to access this medication is in the United States, for example, this requires the crossing of an international border, which means having documentation is essential. The price tag for Mifegymiso hovers between CAN300 and CAN450 for a dose. 7 When combined with additional clinical, diagnostic and doctors’ fees, the price can be upwards of CAN1,000 per patient. 8 Programs that cover health fees associated with abortion care for undocumented individuals are few and far in between. While COVID-19 benefitted the majority, through accelerated access to medication abortion care through low-touch or notouch telemedicine appointments, undocumented people were not equally benefitted. We noted some other concerning trends regarding surgical abortion and abortion care later in pregnancy. In the early months of the pandemic, hospitals that usually saw patients from all over Canada because they offer later abortion care closed their doors to patients outside of their province or their health region because of COVID-19 restrictions. 9 This meant that people had to access abortion care in the United States earlier on during their pregnancy as centres who offered later care were effectively not open to the public anymore. For example, people would typically travel to cities like London, Ontario or Vancouver, British Columbia, for abortion care later in pregnancy. Due to restrictions on interprovincial travel, people who required abortion later in pregnancy, who lived in Nova Scotia or Manitoba, for example, had to travel to Colorado or Washington. Having to travel to the United States can be an unmanageable obstacle when a person is precariously housed, does not have a cell phone, has a criminal record, struggles with mental health issues or substance use issues, has a complex health history, is a victim of domestic violence or reproductive coercion, faces constant emergencies due to poverty, has intellectual or cognitive disabilities, has poor executive function or is underage. Even those able to travel to the United States during the pandemic had to contend with new requirements. These included a 6 7 8 9 World Health Organization, Safe Abortion: Technical and Policy Guidance for Health Systems (2nd ed, 2012), 3. See also ‘FAQ: The Abortion Pill Mifegymiso’, Action Canada for Sexual Health & Rights (Web Page, 4 June 2019) <https://www.actioncanadashr.org/resources/factsheets-guidelines/2019-04-06-faq-abortionpill-mifegymiso>. Canadian Agency for Drugs and Technologies in Health, Pharmacoeconomic Review Report: Mifepristone and Misoprostol (Mifegymiso) (2017) Appendix 1 Table 5. See, eg, ‘Abortion’, Centre De Santé Des Femmes De Montréal (Web Page) <http://www.csfmontreal.qc.ca/wp/en/services/abortion/>. This proposition is predominately based on the author’s own observations. See also ‘Further Reductions in Non-urgent and Emergent Care at London Health Sciences Centre’, London Health Sciences Centre (Web Page, 29 March 2020) <https://www.lhsc.on.ca/furtherreductions-in-non-urgent-and-emergent-care-at-london-health-sciences-centre>. 144