The Badgley report on the abortion law In 1967 the General Council of the Canadian Medical Association approved an extension of the basis for the legal termination of pregnancy by changing the clause "Where the continuance of the pregnancy may endanger the life or physical health or mental health of the mother" to "If continuation of the pregnancy will endanger the life or health of the pregnant female or there is substantial risk that the child may be born with a grave mental or physical disability or where there are reasonable grounds to believe that a sexual offence has been committed from which pregnancy has resulted." It was also recommended that such abortions should be performed in active public-treatment hospitals accredited by the Canadian Council on Hospital Accreditation. Acting largely on these recommendations, the Canadian government in 1969 altered the Criminal Code to make provision for an abortion to be lawfully performed by a qualified medical practitioner in an accredited hospital if the therapeutic abortion committee of the hospital had issued a certificate stating that in its opinion the continuation of the pregnancy would, or would be likely to, endanger the woman's life or health. Within months physicians across Canada were beset by requests for therapeutic abortion in numbers they had never faced before. Some hospitals established abortion committees; others "did not. Some committees were liberal in their interpretation of the new law; others were restrictive. Soon facilities at many hospitals became overloaded owing to the increased demand for therapeutic abortion, and the waiting period for elective surgery grew longer. Hospital personnel were suddenly confronted with the prospect of caring for patients undergoing voluntary termination of pregnancy, and for some persons this was a difficult task, but they either accepted it or moved to other areas. By 1971 the era of liberal therapeutic abortion had arrived, and more than 30000 legal abortions were performed in Canada that year.1 Thereafter it became increasingly apparent to all involved with therapeutic abortion - be they physician, hospital administrator, nurse or patient - that gross inequities existed in the availability of therapeutic abortion to the women of Canada. A consequence of this was the appointment in September 1975 by the federal government of a three-member committee headed by Professor Robin Badgley. The committee's task was to determine whether the procedure provided in the Criminal Code for obtain-

ing therapeutic abortions was operating equitably across Canada. The findings of this committee are now available.1 In accordance with the terms of reference of the committee no recommendations are forthcoming, but the findings of the committee clearly indicate that changes must be made. The committee concluded that the procedures set out for the operation of the abortion law are not working equitably across Canada. One of the major causes of inequity in the working of the law is the requirement that applications for therapeutic abortion be approved by a hospital abortion committee. Some committees approve all applications, while others turn down applications on virtually the same stated grounds. In most cases the decision rests on the interpretation or definition of the word "health". Some committees require face-to-face interviews with patients; others require no more than a brief outline of the conditions on which the application is based. The acceptance or rejection of an application for therapeutic abortion in Canada is thus determined more by "the luck of the draw" than anything else - and what could be more unfair? Furthermore, the delay encountered while the abortion committee reaches a decision can be critical to the ease and safety with which the abortion may be completed. The Badgley report reveals the shocking fact that in Canadian hospitals there is an average delay of 8 weeks between the initial consultation and the performance of the abortion. For every five women who obtained an abortion in Canada at least one left the country for this purpose:3 between 1970 and 1975, 50 000 Canadian women were estimated to have undergone induction of abortion in the United States.4 Most of these women did not choose this expensive and sometimes hazardous alternative. They simply did not have access to, or could not satisfy the requirements of, a therapeutic abortion committee in Canada. Something must be done to curtail this exodus of Canadian women to US abortion clinics. It is disturbing that the committee found that some women in Canada face a financial deterrent to obtaining an abortion. Of patients surveyed 20% were subject to extra billing, among them many who were socially vulnerable - young women, newcomers to Canada and the least well educated. Instead, fees for therapeutic abortion should be set at an equitable level by

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paying agencies, and physicians should adhere strictly to the prescribed fee. Extra billing, particularly in this sensitive area, is to be deplored and can only lead to public criticism and charges of profiteering. The cost of providing therapeutic abortion for Canadian women is considerable. In 1974 the hospital and medical cost for the treatment of each woman having a therapeutic abortion averaged $27O.76;. the same year it was estimated that 58. was spent by each Canadian to pay for the cost of therapeutic abortion, while only 24. was spent on federal and provincial family planning.6 Obviously funding for prevention must be increased if the cost of therapeutic abortion is to be reduced appreciably. These comments, touch on only a few of the findings of the committee concerning operation of the abortion law, but the evidence that the Canadian abortion law is not working equitably across Canada is clearly before us. It will not be easy to abolish or ameliorate existing inequities, but every effort must be made to regionalize modern facilities so that therapeutic abortion can be carried out at the earliest possible gestational age. This can only be achieved by eliminating the therapeutic abortion committee. The decision to carry out therapeutic abortion must be made by the patient and her personal physician. If the lawmakers insist on leaving the word "health" undefined, then the medical profession is forced to make the decision as to what constitutes a serious threat to the health of a woman. Who is more qualified to make that judgement than the woman's personal physician? W.D.S. THOMAS, MD, FRCs[C] Ste. 214, 3195 Granville St. Vancouver, BC

References 1. BADOLEY RF (chmn): Report of the Committee on the Operation of the Abortion Law, Ottawa, Supply and Services, 1977, p 440 2. Idem: Report of the Committee on the Operation of the Abortion Law, Ottawa, Supply and Services, 1977 3. Ibid, p 81 4. Ibid, p 80 5. Ibid, p 408 6. ibid, p 419