How Deeply Flawed Studies on Abortion and Breast Cancer Become Anti-Choice Fodder

Cross-posted from RH Reality Check, January 9, 2014 

 

The anti-choice movement has been making a lot of noise over a new study out of China, published in the journal Cancer Causes & Control, that purports to show a 44 percent increase in breast cancer risk for women who have had an abortion, with the risk increasing after each subsequent abortion. The study claims this may help explain the “alarming” rise in breast cancer in China over the past 20 years, which parallels the one-child policy introduced in 1979.

But the study’s methodology and data appear seriously flawed, with the results likely reflecting “recall bias.” This would invalidate the study’s findings. Recall bias is a common hazard in case-control studies, which use questionnaires or interviews to gather historical data from participants. Results can be skewed or inaccurate because people have a tendency to forget past events, or neglect to mention them, especially if they are uncomfortable with sharing the information with researchers. For example, underreporting occurs when people are asked about substance use, criminal offenses, family background, or school performance.

Recall bias is even more of a problem when it comes to reporting reproductive history, especially past abortions. In the United States, only 47 percent of abortions were reported in the largest and most recent fertility survey (from 2002). A 1996 analysis cited numerous studies on the topic and found that, as a likely result of abortion stigma, women reported only 20 to 80 percent of their abortions. (The wide range is due to varying interview circumstances, geographic locations, or demographic characteristics of the women.) A significant body of evidence has accumulated on abortion underreporting, going back to the early days of legal abortion in 1960s eastern Europe, as documented by Christopher Tietze and Stanley K. Henshaw:

The classic example is the Fertility and Family Planning Study of 1966, conducted in Hungary a decade after the legalization of abortion. In that survey, the numbers of abortions reported by the respondents for the years 1960-65 corresponded to only 50-60 percent of the number actually performed. A comparable level of underreporting was also noted in 1977.

But how does an apparent association arise between abortion and breast cancer (ABC)? In case-control studies on the topic, researchers select and divide women into two groups: women with breast cancer (the “cases”) and women without the disease (the “controls”). The women in both groups will then be asked whether they’ve had an abortion to see if the disease might be more commonly associated with that. However, cancer patients will be strongly motivated to remember and share their full medical history in the search for answers (this is called “rumination bias”), while women acting as controls in a study have no stake in the outcome and so are less likely to mention past abortions. They would be even less likely to report several past abortions because of the increased stigma. The result is a flawed study, because it will appear that women with breast cancer had more abortions than those in the control group, when they probably didn’t.

This “differential recall” is a known risk in case-control studies in general, although few studies have been done to show the effect in studies on the ABC association. A 1991 analysis in Sweden compared two studies: one that used women’s abortion records from a national registry, and a case-control study that relied on women self-reporting their abortions (that were also recorded in the registry). In the end, 27.1 percent of controls underreported past abortions, compared to 20.8 percent of cases (see Rookus/Leeuwen letter). Another study took place in the Netherlands in 1996 in which case and control groups were interviewed in different regions of the country. The correlation between induced abortion and breast cancer was very strong in regions of the country with a predominantly Roman Catholic population, but much weaker in regions with less abortion stigma. Although the sample size of women who had abortions was small in the Catholic regions, a large number of women in those areas also underreported contraceptive use to a greater extent than in more liberal regions.

Anti-choice activist Dr. Joel Brind has been promoting the ABC association for over two decades. He claims that the Chinese study “neutralized” the recall bias argument. But Brind missed—or chose not to mention—that the journal article contained a confusing error, one that helped to hide the study’s own recall bias shortcomings. Early on, the study authors say:

The lack of a social stigma associated with induced abortion in China may limit the amount of underreporting.

But later in the study, the authors say:

[T]he self-reported number of IA [induced abortions] will probably be underestimated, as the stigma of abortion still exists in China, especially when a woman has more than two IAs. Therefore, this underestimation will inevitably create spurious associations between IA and breast cancer, especially for more IAs.

These two contradictory statements should never have gotten past the peer reviewers.

Regardless of whether abortion is stigmatized in China and to what degree, abortion is still underreported even in countries where abortion is more widely accepted, such as Estonia and Hungary. But the study authors are probably right in their second statement: Abortion stigma does exist in China. An increasing number of young unmarried women are having abortions—often multiple abortions—but there is a stigma in China against premarital sex and an even bigger stigma against out-of-wedlock pregnancies. In these circumstances, it would be very surprising indeed if young Chinese women were not underreporting their abortions. Further, since the study authors admit that abortion stigma in China is more pronounced for subsequent abortions, this would explain the rising association that the authors found between multiple abortions and breast cancer—because women in control groups would be increasingly less likely to report their second or third abortions.

Another type of study, called a “cohort study,” is considered more reliable than case-control studies. In a typical cohort study, researchers spend many years following large numbers of women, some of whom have had abortions, to see which ones develop breast cancer later. Recall bias is not an issue because abortion data is drawn from public records. The result is an accurate percentage of how many women got breast cancer compared to others who didn’t have abortions. Out of at least nine cohort studies done since 1996, not one has found a statistically significant association between abortion and breast cancer, and some found negative associations—meaning abortion might actually protect against breast cancer.

The Chinese study was not a cohort study or even a case-control study. It was a meta-analysis, which combines the results of numerous studies on the same topic to come up with a pooled average. The authors found 36 previous Chinese studies on the ABC association and combined their results to come up with an “odds ratio” of 1.44, which means a 44 percent increased risk of breast cancer for women who had one abortion. However, the authors used 34 case-control studies and only two cohort studies (not included in the nine mentioned above). Neither cohort study showed a statistically significant ABC association. Further, six of the case-control studies that were rated as having the highest quality methodology, according to the authors’ own evaluation, also showed no correlation. In other words, the supposed ABC association arose solely from the weakest 26 studies selected for the meta-analysis, some of which were not even published in peer-reviewed journals.

The major weakness of meta-analyses has a popular acronym—GIGO. It means “garbage in, garbage out.” In other words, if most of the studies you add to the mix are seriously flawed, your pooled result will be worthless as well. To their credit, the study’s authors make clear that induced abortion is not confirmed as a causal risk factor for breast cancer and that their own results should be interpreted with caution. In fact, the scientific community has already dismissed abortion as a risk factor based on the best studies. Given that the correlation only shows up in case-control studies but never cohort studies, it’s highly likely to be an artifact of recall bias.

Although correlation does not equal causation, anti-choice advocates are using the Chinese study to jump to the unwarranted conclusion that abortion causes an increased breast cancer risk. Unfortunately, the study authors never mention other possible risk factors that could help explain the recent rise in breast cancer in China, let alone why they should be rejected in favor of abortion. These include:

• Fewer full-term pregnancies (one or two) because of the one-child policy;
• Economic development leading to more affluence and rising body weight (as found in one of the two Chinese cohort studies);
• Increased industrialization and dramatically increased exposure to environmental toxins in a country with few environmental controls; and
• Improved protocols for cancer testing, leading to more diagnoses of breast cancer.

Because the study focuses only on China, it also obscures the lack of association between breast cancer and abortion in many other countries. For example, western Europe has low abortion rates and high breast cancer rates, while Russia has high abortion rates and moderate breast cancer rates. It is unreasonable to assume the existence of an ABC association when it’s found inconsistently and depends more on geography or study methodology. Further, if there really were a causal connection, it would show up more robustly across most studies, instead of being all over the map.

The study’s ABC association was quite weak in comparison to major risk factors for breast cancer, such as advanced age, having a family history of breast cancer, or being childless. In a specific population such as women in China, weak associations can turn up by chance, and are therefore random and meaningless. For example, if you compared the population of storks with the rates of childbirth outside hospitals in various countries, a correlation will appear in some of them. It does not mean that storks deliver babies in some countries but not in others. It just means that you can find a correlation between almost anything if you’re determined to find it.

The promotion of flawed studies to try to prove that abortion leads to breast cancer is a political effort spearheaded by anti-choice groups and individuals, who primarily use these studies to reinforce abortion stigma and frighten women. The studies may also be a vehicle to smuggle in dogmatic beliefs under the guise of objectivity and the scientific method. As such, they irresponsibly advance an anti-choice agenda at the expense of science and women’s welfare.

Thanks to Stanley Henshaw and Dr. Christian Fiala for help with previous drafts of this article.

A cynical view of Conservative politics and voters

Cross-posted from Rabble, originally published January 3, 2014

January 2014 marks eight full years of power for Prime Minister Stephen Harper, years filled with sweeping attacks on a host of things that Canadians value dearly. He and his Conservative government have damaged or weakened Canada's health-care system, social welfare programs, women's equality and human rights initiatives, First Nations rights, environmental protection, science and evidence-based policies, our international reputation as peacekeepers, and our very democracy. 

 

Although much has been written about these injuries and losses, most of it has been from left-leaning news sources and commentators, such as rabble, labour unions, the Canadian Centre for Policy Alternatives, and a handful of more progressive mainstream media. Even Harper's 2006 boast: "You won't recognize Canada when I'm through with it," which I had assumed was infamous and well-known, appears almost exclusively on progressive blogs, or website comments and letters to the editor. The average Canadian probably has no idea Harper even said that!

Why isn't there more widespread awareness and opposition to how Harper is transforming Canada to conform to his narrow ideological agenda? That agenda seems to largely consist of promoting war, maximizing oil profits, creating a corporate oligarchy, and muzzling any real or potential critics, among other sins.

Opposition parties do a pretty good job in Parliament trying to hold the government's feet to the fire, in spite of being hamstrung by the current majority government. However, most people don't watch CPAC. We can point some fingers at the failures of the mainstream media of course, because of the concentration of media in a few corporate hands, the decline of traditional investigative journalism, and a media culture that fawns over power and has lost sight of its true masters -- the common people (the rabble!).

But the media has also been hamstrung. We've been living under the most secretive government in Canada's history, according to a 2012 vote by members of the Canadian Association of Journalists. They chided the federal government for keeping information out of public hands, avoiding questions at media events, and restricting media access to contentious information. At the time, the group's president Hugo Rodrigues said: "The death grip on information has long frustrated journalists in this country, but it may now be reaching a point where the public at large is not only empathetic, but shares it."

Although one would hope that's the case, we are still confronted with the conundrum of pretty solid support for Harper from his Conservative base. A November 2013 poll found that Conservative party support has only slipped slightly, despite the Senate scandal that had already implicated Harper by then.

What is really going on here? We'd like to think that only a minority of Canadians truly support Harper's ideological slash-and-burn mentality, as illustrated by his government's obstinacy on climate change despite 59 per cent of the public wanting the Conservatives to make the issue a top priority. But that does leave 41 per cent for whom it's not a top priority. In fact, the same poll revealed that half of respondents gave the government poor marks for its performance on climate change, implying that the other half were satisfied. But the United Nations had just slammed Canada for its abysmal record on climate change, so on what exactly are those respondents basing their positive opinion?

Could it be that Harper has been successfully duping his supporters over the past eight years? In addition to silencing his critics, which means that the public doesn't get to hear their voices much, the Conservative government has consistently engaged in a pattern of lies, broken promises and obfuscations since day one. Unfortunately, the mainstream media seems to have only just discovered Harper's complex "web of deceit," in relation to the Senate scandal.

Of course, all governments end up guilty of obfuscation and broken promises to some extent, but the Harper government seems to have successfully divorced its rhetoric from any semblance of good intentions or truth. Despite their message being little more than smoke and mirrors, Conservative Party leaders claim that it "resonates" with voters. Perhaps many people really are fooled by it, at least at election time. Or maybe his supporters just don't give a damn what Harper does or doesn't do.

However, going back to the climate change issue, perhaps that 50 per cent public support for the government's poor record on climate change reflects the fact that conservatives are less likely to value environmental protection in the first place, with many of them likely denying outright that climate change is human-caused, especially in Harper's home province of Alberta.

Some of Harper's most grievous misdeeds have actually been widely publicized in the mainstream press, most notably his proroguing of Parliament four times simply to shut down debate and criticism. But such transgressions still had negligible effects on his popularity. This might lend weight to the "don't give a damn" theory, but I think it's more likely that Conservative voters tend to harbour an authoritarian mindset that leads them to heartily approve of heavy-handed tactics by their government, especially when used to silence the Opposition and piss off progressives.

The Senate scandal may yet bring down Harper before the 2015 election, especially in light of an October poll that found 68 per cent of respondents think Harper should step down immediately, if it's proven that he lied. So perhaps even some diehard Conservatives are finally becoming disenamoured with Harper. Still, it's hard to know what to make of the 30 per cent of respondents who gave a thumbs up to keeping a potential liar in the Prime Minister's office until the next election.

A bittersweet victory for sex workers

Cross-posted from Rabble, originally published December 23, 2013

Sex workers’ delighted cries of excitement resounded across the country last week when they heard the thrilling news that the Supreme Court of Canada had tossed out the worst of our country’s criminal laws against prostitution. The decision means that basic human rights and legal protections have finally been extended to one of society’s most marginalized groups.

The ruling is indeed a positive and crucial step forward in the fight to gain rights and recognition for sex workers. But the victory was also painfully bittersweet. Sex workers’ tears of joy were mixed with sorrow over the memories of terrible tragedies -- all of them heartbreakingly unnecessary. Far too many sex workers paid the ultimate price for this outcome. Each one of them was a real human being whose life, dignity, and hope were ripped away from them and their families.

Laurel Irons, a Vancouver advocate for sex workers, put it this way (personal communication):

"I am of course elated and hopeful with yesterday's news … but it also hurts, in that way it can hurt when someone admits to a wrongdoing they denied for years...  When the highest law in the land says, 'yeah you were right, these laws are harmful', I'm left struggling with the knowledge and memory of all the lives lost, the violence, shame and hurt inflicted, the children apprehended, all the choices people had to make based on fear and sometimes a desperate need for survival. I’m finding it really hard not to think once again how senseless it all was, how fucking avoidable. How things could have -- should have -- been different... For all of this I find myself mourning all over again."

Raven Bowen, an activist and researcher in Vancouver, said:

"I'm celebrating but I'm also very sad. I've been involved in sex worker rights organizing since 1995… Only a handful of people [back then] gave a crap about sex workers. City hall and law enforcement were all deaf to our cries for justice, social inclusion, basic human and labour rights and protections for sex workers... [Recently] I spoke to an officer… who was positioning himself as a champion of the oppressed and taking credit for how far we've come. This individual dismissed my acknowledgement of the difficult road that was traveled to get where we are today and all of the unnecessary loss of life caused by, among other things, police inaction."

Sex workers believe that the criminal laws just struck down were a major contributing factor in the known murders of at least 200 of their colleagues and friends since the 1970’s, and for the disappearance of hundreds more.

Homicides of sex workers were rare before Canada enacted its first anti-solicitation law in 1972, but they began within a few years and continued to escalate,  especially after the introduction of the “communicating” law in 1985 (prohibiting public communication for purposes of prostitution). Over 300 sex workers were murdered or went missing in Canada in the intervening 28 years. Vancouver was ground zero for much of the violence, with a serial killer likely responsible for dozens of murders and disappearances of sex workers in the Downtown Eastside.

Those women didn’t die because prostitution is inherently violent or exploitative. They died because the laws stigmatized them and made it easier for predators to target them. Sex workers couldn’t take measures to protect their safety because the laws criminalized key aspects of their work. It was illegal to talk to clients in public, so street workers couldn’t take the time to screen clients or negotiate services -- they had to jump quickly into cars to avoid police attention. But they couldn’t move indoors because it was illegal to work at any permanent venue, such as a massage parlour or even their own homes. It was also illegal to band together with other workers for greater safety or pay people to help them. And if something bad happened, they were afraid to call the police for fear of arrest. The police wouldn’t take violence against sex workers seriously anyway, and some even harassed or assaulted them.

The prostitution laws also made it easier for third parties to exploit sex workers with impunity, because workers had little recourse to legal protection or other supports. Decriminalization will make the industry more transparent so that bad actors can be held accountable. For example, sex workers and their clients are in the best position to detect and report exploitive activity, but they will do so only if they know they won’t be arrested themselves. Even though abuse and exploitation happens in the sex industry, it is not nearly as widespread as commonly assumed. Most third parties are decent and honourable people who simply help facilitate work for the workers and keep them safe. Under the prostitution laws, however, people such as call screeners, drivers, and security guards were criminalized under the “living off the avails” law.

With decriminalization, workers will have equal protection under the law, including enjoying the benefits of labour law protections, the right to organize, occupational health and safety measures, human rights and equality, freedom from discrimination, and protection under criminal laws if a crime is committed against them. The prostitution laws deprived them of these basic freedoms and protections that the rest of us take for granted.

It’s taken the sex worker rights movement decades of struggle just to get governments and police to take sex workers seriously as human beings and citizens with rights. Finally, they’ve achieved that recognition, but at a very high cost. As we move forward into an uncertain future -- amidst the grandstanding and scare-mongering propaganda by politicians and prohibitionist groups -- we must never lose sight of what’s really at stake here: peoples’ lives.

On the day of the Supreme Court decision, Raven Bowen wrote these words to a group of sex workers and allies:

"Sex workers suffered and many died for every bit of progress we experience today. Over the coming weeks and months please do not allow anyone to lose sight of this fact. There are many revisionist historians out there who will disrespect those who we've lost by silencing us when we speak about our memories and our pain. I say this because like many of you I was there, fighting, in the dark."

Laurel Irons expressed the strong need for healing in the sex work community as it tries to meet the many challenges of the work ahead, which she said must include "mass education" of the media, policy makers, and general public:

"I also hope to see space made for us to come together to process all the things this actually means to us, to support one another, to begin to heal now that we can do so out of the darkness... We know there are so many out there still hustling in dark corners, who may be feeling all the complexities of this in isolation, or who may not actually experience the positives of this for some time coming. I just want to turn my attention to all of these folks and hope we can be strong for one another in these early, tenuous first steps of healing, as we learn to walk together in the light, for a change."

Prostituted words: Time for a new style guide

Cross-posted from Rabble, originally published December 6, 2013 

Globe and Mail columnist Margaret Wente wrote in June:

Prostitution is the most exploitative, degrading work on Earth. Despite those stories about high-class call girls, its practitioners are overwhelmingly the most wretched girls and women in society. Prostitution turns women into lumps of meat that are bought and sold for the sexual gratification of men.

Wente's dehumanizing language is a testament to how deeply ingrained the stigma against sex workers still is in our society. In reality, what's degrading is not sex work itself, but the language Wente uses to describe it, which reveals her personal disgust for those who engage in it -- both sellers and buyers. Despite wishful thinking to the contrary, sex work has been part of every society for millennia and always will be. Denigrating it, or trying to eradicate it or criminalize it, only serves to harm those involved in it (most of whom are doing it by choice, even if many don't like the work). The reason sex workers launched a constitutional challenge to decriminalize Canada's prostitution laws is because the laws forced them to work in dangerous conditions and no one seemed to care.

Ironically, this column is being published on December 6, the annual commemoration of the 1989 Montreal Massacre in which 14 female students were singled out for death because the killer saw them as feminists -- they were studying engineering. Despite violence against women being taken much more seriously by our society in the aftermath of that tragedy, sex workers (who are mainly women) remain highly vulnerable to violence. It's not hard to see why. Their ability to work safely is criminalized, and those laws are also society's way of sending a strong message of moral disapproval for sex work. Such official condemnation is hugely stigmatizing against sex workers. It gives cover for predators to kill, assault and rape sex workers; it encourages prudes to hate or pity them; and it allows prohibitionists to disrespect them and deny their autonomy.

Words matter. We know they can lead to discrimination, violence and death. The recent tragic suicides of bullied teens attests to that, as well as the existence of hate propaganda laws and media bans on offensive language. Australian researcher Lizzie Smith explains some of the harmful effects of using the word "prostitute":

The term 'prostitute' … brings with it layers of 'knowledge' about her worth, drug status, childhood, integrity, personal hygiene and sexual health. ... This stigma is far-reaching and arguably does more damage to women who work in sex work than the actual work. This stigma feeds into understandings of women that are violence-supporting, and referring to victims of violence as 'prostitutes' continues to 'other' these women and locates them as somehow deserving: she knew the danger. More than that, it feeds into violence-supporting attitudes about all women.

Recently, journalist Sarah Ratchford recounted how the media eagerly conflated Rob Ford's alleged crimes with allegations of prostitution, "a word they shouldn't even be using in the first place." Ratchford pointed out that having sex for money is not illegal in Canada, and that the word prostitute is "outdated":

Following many years of misogyny and anti-sex attitudes, it has collected an unfortunate sheen of dishonour. It connotes an immoral, shameful way of life. … By colouring sex work in this manner, journalists are only serving to further stigmatize a group which needs it least.

Writer Lezlie Lowe shows how the word "hooker" in a headline about a woman's murder will set up the audience to not care about her, reinforcing stigma and continuing the cycle of violence against sex workers. She interviewed Leslie Jeffrey, a political science professor at the University of New Brunswick, who said that media use of the word "hooker" sends the following message:

[T]hese women or men don't matter. So if they are killed, we aren't going to investigate. I am not going to go to the police and say this is horrible and call up my radio station and demand that people do something. Because what I just heard was: 'This person who was looking to die, because they were a bad person, died.'

Ratchford and Lowe are rare examples of journalists trying to hold their media colleagues to account for the use of stigmatizing language against sex workers. Sex workers themselves have been complaining about it for years, and have put together fact sheets and glossaries to help researchers and journalists see the light and adopt new language.

All media outlets use terminology style guides that their reporters are required to follow. These are living documents that evolve with the times, yet I'm not aware of a single media outlet that has prohibited offensive terms for sex workers. Esther Shannon is a Vancouver women's rights activist and founder of FIRST, a feminist advocacy group for the rights of sex workers and for the decriminalization of sex work. When she first saw Margaret Wente's "lumps of meat" column in the Globe and Mail, she embarked on a campaign to persuade the newspaper to amend its style guide to forbid the use of stigmatizing language to describe sex workers. She wrote to Sylvia Stead, the Globe's Public Editor (as well as John Stackhouse, the Editor-in-Chief):

I have highlighted Ms. Wente's 'lumps of meat' sentence because it acts to strip all people doing sex work of any claim to be considered human. In so doing, it adds to the horrendous level of marginalization and stigma sex workers face every single day of their lives. Sex workers and their supporters believe this stigma strongly contributes to the violence many sex workers experience on the job.

The lesson of history is that certain words have been used with deliberate or reckless disregard to those who are the most affected by their usage. … Once black people were 'niggers' and once gay men were 'faggots'. It's now widely accepted that these hugely offensive words were -- and still are -- used to de-humanize individuals and to foster discrimination and hatred. Eventually, the Globe and Mail began to name this kind of racist and homophobic language as deeply offensive.

[But] now sex workers are 'lumps of meat.' I am asking the Globe to catch up to the understanding that there is a shift occurring in Canadian society as regards to the position, experience, and rights of sex workers. The Globe needs to tell all of its writers that it abhors the use of de-humanizing language in reference to sex workers.

From the get-go, the Public Editor consistently failed to grasp Shannon's core concerns around the import of stigmatizing words, and it's a failure that continues to this day. The most recent dialogue between them was sparked by Wente writing another column in November that used the demeaning word "hooker." Stead responded that while she would prefer that word to not be used in a news article, "opinion columnists should be allowed greater licence in their selection of language." Shannon told me: "I confess I did come to wonder how much [the Public Editor's] resistance had to do with the fact that people cannot even conceive of sex workers as having any form of agency -- they don't want to hear it, but what's worse is that they can't hear it."

Although the media is increasingly using the accepted term "sex worker," including a few hundred times by the Globe and Mail in recent years, that paper has also used both the words "hooker" and "prostitute" in the same stories 44 times since 2010 (and individually in countless more). The situation is similar across virtually all other media outlets, including even the liberal Toronto Star. So we still have a long ways to go. To that end, I've made a start on a new suggested "Sex Work Style Guide" for media. Improvements and additions are welcome in the Comments.



* The incidence of sex trafficking and sexual slavery is hugely inflated. Most "victims" are adults who have consented to do sex work and don't want to be "rescued."

** Some third parties can be exploitive, but usually they aren't. Generally, their role is to facilitate work for sex workers and help keep them safe. However, the current criminal laws increase the risk that sex workers will be exploited because they have no legal recourse.

*** Prostitution is an acceptable term when referring to the criminal laws surrounding sex work. It is also sometimes used to distinguish the direct exchange of money for sexual intercourse from other forms of sex work, such as exotic dancing, web camming, phone sex, pornography, etc.

Note: For definitions of criminalization, legalization and decriminalization in relation to sex work, see here and here.

Defunding abortion: A non-starter

Cross-posted from Rabble - originally published November 1, 2013

 

The anti-choice movement has launched a national campaign to try to convince provinces to defund abortion. This campaign is the latest of numerous attempts over the years to defund abortion in several provinces (including B.C., Alberta, Saskatchewan, and Ontario), beginning immediately after the Supreme Court struck down Canada's abortion law in 1988.

Every single effort to defund abortion has failed and so will the current one. The anti-choice movement appears oblivious to history and evidence indicating that provinces will not and cannot defund abortion. Provincial governments know that it would violate women's Charter rights and the Canada Health Act, as well as clash with previous legal precedents. Defunding abortion would also invite an expensive (taxpayer-funded) court challenge that provinces would not likely win.

The current anti-choice campaign is mainly appealing to the public and their wallets, but this is also a lost cause. The public has little say in what medical services are covered by provincial health plans, because health-care coverage cannot be decided by majority vote for obvious reasons (to prevent inequity and discrimination). Taxpayer funding of health care works similarly to how citizens pay taxes. Citizens cannot choose which government services they are willing to pay taxes for, based on whether or not they use them or like them. Public funding for things like infrastructure, education, and health care benefit all Canadians. It's how we improve the lives of everyone and establish a degree of equity.

Nevertheless, since anti-choicers can't win on criminalizing abortion, they're trying to capitalize on the public's alleged dislike for funding it. A 2013 Angus Reid poll found that 43 per cent of Canadians support funding of abortions whenever they are requested, 42 per cent believe it should only be funded for medical emergencies, and 7 per cent think it should not be funded at all. Remarkably, this breakdown closely mirrored the percentages of Canadians who support the legal right to abortion in all cases (47 per cent) versus those who want at least some restrictions (41 per cent), and those who want it completely banned (7 per cent).

This implies that public support for defunding abortion may be just as meaningless as public support for restrictions -- for which there are no realistic prospects at all in Canada. Despite abortion being frequently in the news, most Canadians are probably not familiar with legal jurisprudence on the abortion issue and why women's legal right to abortion has been deemed integral to the exercise of their Charter rights. Further, most people don't know much about abortion practice in Canada, so mistaken beliefs are commonly reflected in polls. A 2010 poll found that 41 per cent of Canadians think abortions are only available during the first three months of gestation, when in fact it's available on request until 20 weeks, and after that only under compelling circumstances at a doctor's discretion (this is policy, not law). Many Canadians may also be unaware that abortion restrictions do not reduce the abortion rate. Their main effect is to increase hardship for women and put their health and lives at risk.

The main anti-choice arguments opposing the funding of abortion are numbered below, and come from the website of Campaign Life Coalition (primarily from here and here. I've shortened or combined a few of them for brevity.) My rebuttals are explained in more depth here, including citations. 

1. "Canadian taxpayers fund at least $80 million every year for the killing of children in the womb. That figure does not include the cost of common abortion complications, which could easily escalate the total cost to hundreds of millions of dollars annually!"

The overall cost of abortion care to the taxpayer is a pittance relative to health-care costs as a whole. Paying for abortion care is very cost-effective compared to unwanted birth. The social costs of raising unwanted children are prohibitive, since they are at higher risk for life dysfunction, including abuse and poverty. Complications from safe and legal abortion are extremely low, especially in Canada -- in the range of 1-2 per cent and mostly minor. If abortion was defunded in Canada, complications would increase because many low-income women would end up having a delayed abortion (medical risk increases with gestational age), or resort to unsafe clandestine abortion.

2. "There is a severe shortage of family doctors, nurses, and funding for elder care and for treatment of autistic children across Canada. Real medical needs are being ignored, patient wait times are outrageously long, and funding for cancer research has been cut."

This is a red herring argument. Other problems in the health-care system have nothing do with whether certain procedures like abortion should be funded. The cited issues will not be solved by defunding abortion.

3. "Abortion is an elective procedure that is not medically necessary. Our tax dollars should not subsidize life-style choices."

All abortions have already been deemed medically necessary by every province and territory, which means the procedure must be funded under the Canada Health Act, both in hospitals and private clinics.
The term "medically necessary" has been broadly defined to mean a "medical service that is essential to the health and medical treatment of an individual." This must include all abortions because every pregnancy poses some medical risks, even when the woman and her fetus are healthy. Further, the World Health Organization's definition of health also covers mental health. Women who can't obtain an abortion are at high risk of suffering negative psycho-social consequences. Lack of funding increases the chance that women won't be able to get a legal abortion and as a result, suffer ill health due to unwanted pregnancy or unsafe abortion.

Anti-choicers say that provincial governments have the exclusive right to decide whether to defund a particular service, and while that is technically true, it doesn't really apply to abortion. Provinces cannot simply defund all abortions, since even some anti-choicers will concede that a few are medically necessary to save the woman's life or in cases of rape and incest. Provinces must rely on the medical profession to help them define which abortions are necessary and which are supposedly not, but medical groups have refused to go along with this because they say all abortions are medically necessary (such as in Alberta in 1995). In any case, it's not up to doctors to decide on the medical necessity of abortion -- women have a right to abortion on request without having to state a reason.

Even if a naïve anti-choice provincial Health Minister tried to defund all abortions without the input of medical groups, it's extremely unlikely he or she would be successful. The media and the women's movement would have a heyday attacking such a dangerous and discriminatory policy, and the Health Minister probably wouldn't last long in his or her position. More importantly, defunding abortion would be unlikely to withstand constitutional scrutiny. When Saskatchewan citizens voted to defund abortion in a 1991 referendum, the government shelved it after its lawyers advised that defunding abortion would probably not survive a Charter challenge, as it would discriminate on the basis of sex. That's because only women get pregnant and only women need abortions. In addition, several court decisions have required provinces to fund abortions at clinics as well as hospitals, and legal expert Joanna Erdman has argued that abortion funding is protected under the Charter's gender equality guarantee.

Describing abortion as a "lifestyle choice" is derogatory to women. However, it could be said that a woman's decision to have a baby is not medically required -- she gets pregnant and has a baby because she wants to. But it's not a woman's reason for her decision that's at issue, it's the outcome. Childbirth and abortion must both be fully funded because women's reproductive capacity is integral to society, and the government cannot make childbearing decisions for women because they are rights-bearers.

Reproductive health care is health care. When anti-choicers say abortion should be defunded based on the idiotic claim that "pregnancy is not a disease," they should be consistent and also oppose funding for pre-natal care and childbirth.

4. "Over 96 per cent of abortions are performed for convenience as a back-up birth control method."

In contrast to this sexist and insulting falsehood, a woman's decision to have an abortion is a very serious one that is not taken lightly. Women are responsible moral agents who can be trusted to make the best decision for themselves and their families, according to their own unique circumstances that no one else can judge. Further, most Canadian women use contraception, although much could be done to improve access to the most effective methods. Unintended pregnancy can happen to anyone despite best efforts, because no birth control is 100 per cent effective and people are human and make mistakes. Abortion must be there as a safety net.

5. "The 100,000+ children aborted annually would pay at least $500 million dollars in income taxes alone after their first year of employment. This lost tax revenue would help keep dying government programs afloat like Medicare, Old Age Security, and Canada Pension Plan."

Women are not brood mares for the state. They cannot be conscripted to produce babies for economic or other reasons. Unfortunately for anti-choicers, Canadian women were declared persons in 1929, and gained equality rights and other constitutional rights under the Charter in the 1980s. The age of reproductive slavery that anti-choicers yearn for is never coming back.

The lament for the "100,000+ children aborted annually" makes plain the real goal behind their duplicitous "Defund Abortion" campaign -- to stop all abortions. But that's nothing more than cruel ignorance. If abortion was ever banned in Canada, women would still be having 100,000 abortions a year, only they'd be doing it clandestinely and unsafely. Those abortions wouldn't be reported or tracked, just swept silently under the rug along with women's misery, fear, suffering and deaths. Sadly, punishing women for having sex does seem to be what the anti-choice movement is really about.