On International Safe Abortion Day (September 28, 2026), Martha Paynter discusses her new book Lawless: Abortion under Complete Decriminalization.
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Martha Paynter is an associate professor in the Faculty of Nursing and Health Sciences at the University of New Brunswick where her research lab addresses sexual and reproductive health and the criminal-legal system. She is also a frequent contributor to Impact Ethics. In her new book Lawless: Abortion under Complete Decriminalization, Paynter details the historical context and contemporary status of the law on abortion in Canada.
Today is International Safe Abortion Day, which is dedicated to advocacy for the decriminalization of abortion and universal access to safe, legal, and accessible abortion care. To mark the day, Impact Ethics editor Chris Kaposy interviews Paynter about her book.
Q: As the title of your book suggests, abortion in Canada is completely decriminalized. Can you describe what that means?
The title is cheeky, an appreciative ode to Canada’s radical position as the only country globally with complete decriminalization of abortion. Decriminalization means abortion exists outside of any limitation in the Criminal Code, whereas legalization would mean something is legal only within a set of boundaries. For example, in 2018, Canada legalized cannabis, such that it is legal to purchase, grow, and consume within set of constraints. Abortion meanwhile is a health service, like a hip replacement or a pap smear. Health professionals are regulated and required to only perform clinical procedures for which they have demonstrated competence, which are clinically indicated and to which a patient has consented. Other countries with liberal decriminalization still have restrictions, usually related to gestational limits, for example, abortion only being legal “up to 16 weeks.”
The objective of the book is to clarify that even though Canada does not have a dedicated law governing abortion, it does have layers of laws and regulations at the federal, provincial, and territorial levels that impact abortion. The Charter of Rights and Freedoms in our constitution guarantees the right to self-govern our bodies, to “security of the person”. The Canada Health Act ensures essential health services provided by physicians or in hospitals are publicly funded. Health Canada is legislated to determine which medications are safe for use, and it only approved medication abortion in 2015. We have Charter protections for freedom of expression and freedom of assembly that can protect anti-abortion protestors but can be intercepted when that freedom harms others, such as if it involves blocking patient and health professional entrance to clinic doors. We have freedom of religious affiliation, but we also have professional ethical obligations not to abandon patients when they ask for care that causes conflicts of conscience. We aren’t really “lawless” at all.
Q: Some states in the US have gone in the opposite direction, toward criminalization. Why should we advocate for continued decriminalization in Canada?
The Dobbs v. Jackson decision of June 2022 removed the federal protection for abortion in the US, allowing individual states to make up their own laws. While a few expanded protections, like Massachusetts, which recently expanded protection for abortion at all weeks of pregnancy, most increased restrictions, even to the point of outright bans. The consequences for the health of women, gender diverse people and infants are catastrophic. It is estimated that maternal mortality has increased to staggering levels since 2023: in Texas, one of the first states to institute restrictions, maternal mortality is 155% higher than in California, a protective state. The most obvious reason to continue to support decriminalization is that it saves pregnant people’s lives. When miscarriage and infant loss happen, services like dilatation and aspiration (procedural abortion) or mifepristone and misoprostol (medication abortion) are needed to treat potentially lethal complications including sepsis and hemorrhage. It is people with wanted pregnancies that are killed by laws preventing abortion techniques.
And a law for abortion is not optimal, either. With laws come limits. There was a great deal of attention to France when it added the right to abortion into its constitution after the fall of Roe v. Wade in the US. But France only permits abortion to 14 weeks, so the law is just guaranteeing the right to abortion to that point. That point could be changed; it could be extended or retracted. It is better not to put health services into individual laws because lawmakers are not the ones who should be making decisions about how health services happen. A governor should not decide the limits on access to abortion any more than they should be defining who gets to have hip arthroplasty. Consider in Ireland, where in 2018 abortion was importantly and finally legalized to 12 weeks. Clinicians there are now burdened with explaining to every patient who arrives in their offices a day or more later than that, even though absolutely not one single thing has changed about the method of abortion or the safety or effectiveness or anything, they are no longer eligible for care because the law says so. Lawmakers are ill equipped to make clinical decisions, and clinicians are ill equipped to make legal explanations.
Q: In spite of the decriminalization of abortion in Canada, the situation with access to abortion is not perfect. What are some of the current challenges with access?
Canada is a huge country, the second biggest in the world in terms of land mass, and we have a relatively small population. Even with the monumental recent advances of medication abortion, primary care prescribing, and telemedicine, people are having to travel for care, often a very long way. Travel is costly, either directly through plane tickets and hotel rooms, or indirectly, due to lost wages and childcare expenses. Although there are no laws against it, after about 18 weeks gestation, demand for abortion is much lower, and the set of willing, competent clinicians and supportive clinical environments becomes much smaller. Arranging services becomes logistically complex and takes skilled and generous navigators, plus even more travel.
The health system in Canada is persistently heteropatriarchal, cisnormative, racist, ableist and colonial. Keep in mind this is a country that had laws on the books supporting forced sterilization until the 1970’s, and reports of it persist to present day. So, while abortion care could be free and close by, it may feel alienating and exclusionary, or even violent. Most of my research and activism is not about keeping abortion out of the Criminal Code, because the risk of recriminalization is very low. Rather, it is about improving the quantity and quality of care possible in our current progressive legal regime. It’s about educating health professionals about their roles in providing or facilitating service so they see a place for themselves in the abortion landscape, and then ensuring those services are welcoming, culturally safe, and convenient. It’s about educating the public to know what they have the right to, what abortion even is, and how to quickly and easily book services.
Q: What is your vision of the future of reproductive health care in Canada?
My vision is for people to feel proud and protective of the uniquely progressive Canadian approach to abortion, and to apply that across the board to reproductive health and justice issues. We need to do better at preventing gender-based violence, ending colonial infiltration of health services, supporting queer liberation, and ensuring the criminal-legal system generates just outcomes that do not violate reproductive health and rights. We are the gold standard for abortion in the world, and we should aim to be the gold standard for reproductive justice.
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Martha Paynter is an associate professor in the Faculty of Nursing and Health Sciences at the University of New Brunswick.
