Canada boasts a health care system where all citizens have access to publicly-funded services. In reality, however, this access is far from universal.
“We like to think we have one health-care system, when in reality we have 13,” says Jenna Quelch. “The provinces and territories design their own systems: they decide what will be covered.”
And as Quelch has discovered, these disparities are particularly obvious when it comes to reproductive health issues — specifically those related to sex, reproduction and gender-related care.
Quelch is a PhD candidate in the Department of Political Science, with a collaborative specialization in public health policy at the Dalla Lana School of Public Health. Her research examines the vast differences among the provinces with respect to funding and access for gendered health services.
As a 2024–25 Connaught PhDs for Public Impact fellow, she’s currently crafting a unique mixed-methods dissertation: its aim is to create public-facing reports and policy recommendations designed to lead to more equitable service provision.
Quelch says people are often surprised to hear about the differences in what each province and territory considers worth funding. Gender-affirming care, for example, is covered in all of them — but the list of covered procedures that fall under that category varies from place to place.
When it comes to fertility, says Quelch, “B.C. recently announced that it’s going to be funding in-vitro fertilization (IVF). But Ontario’s been funding it for years; so has Quebec. And Alberta doesn’t fund it at all.”
Abortion, though theoretically available everywhere in Canada, has faced significant practical restrictions.
In Prince Edward Island, for example, abortion was unavailable until 2017 — almost 30 years after the procedure was decriminalized in Canada. Access to Mifegymiso — the brand name of the abortion pill in Canada — also varies across the country: while it is universally covered in most provinces, people in some areas may have to pay out of pocket or rely on private insurance.
What accounts for these variations? Quelch’s research suggests there are numerous factors.
“Procedures such as IVF, gender-affirming care and abortion are contentious,” she says. “These are things that can be prickly politically and contested medically. Depending on what province you live in, you’re going to have a pretty different level of access to health care, especially for those services that are linked to the reproductive body.”
But it isn’t just a matter of which party is in power: Quelch points out that both the NDP government in BC and the conservative Saskatchewan Party have both introduced recent policies to fund IVF, though using different mechanisms.
A nationwide doctor shortage and a rural-urban split may also explain the variation.
“A small town like Celista, B.C. is not going to open an IVF centre — and that makes sense,” she says. “It’s very expensive: You need the technology and you need specialists. And there’s a shortage of these things. So this is not something that’s going to be accessible everywhere. That said, some provinces do a good job with travel funding, so that people who live in smaller places can get to these clinics if they need to.”
Quelch’s PhD work will determine the extent of these differences, and the reasons behind them.
“I first built an index to capture what the variation looks like — scoring provinces and territories and using policy documents to piece together a map of the healthcare landscape, province to territory. Until now research has been sort of piecemeal, with one thing studied at a time. We don’t currently have a big-picture view.”
Next, she conducted a survey of health care consumers. “We got about 2,000 responses across six provinces, trying to quantify how people understand medical necessity when it’s linked to women’s health or reproductive health care,” she says.
“And coming this fall I’ll interview policy makers to see if that group understands medical necessity the same way. How did a province or territory decide to fund something? Are they getting pushed by other political parties? Are provinces and territories learning from each other?”
The end result will be a resource that can be used as a guide for policy makers.
“I’m cognizant that our health care system is under a lot of strain and Canadian provinces and territories are trying to get their dollars in the right place,” Quelch says.
“But these are procedures that can change your identity, and what your family looks like. I think the fact that we’re seeing so many gaps in reproductive health care speaks to the fact that these issues have to be looked at more thoughtfully.”