“Does this mean I will go to jail?”
This is a real question a young OB/GYN asked after learning of a legislative measure quickly making its way through Parliament that has the potential to create real barriers to reproductive care in Canada.
And this question goes to the very heart of the concerns that the Society of Obstetricians and Gynaecologists of Canada (SOGC) have about Bill S-228 – An Act to amend the Criminal Code (sterilization procedures). The bill proposes to amend the Criminal Code to explicitly state that coerced sterilizations are a federal offence under aggravated assault provisions, carrying a maximum sentence of up to 14 years in prison.
We want it to be very clear that the SOGC strongly condemns coerced or forced sterilization. No woman should ever receive permanent contraception without her free and informed consent. We recognize that instances of coerced sterilizations have taken place in Canada and that sadly and unacceptably remain a present-day issue. We have spoken with survivors, and we acknowledge the deep generational trauma that forced sterilizations have had on far too many women.
We fully support the intent of this bill to ensure that this practice – which is already against the law – is finally stopped and that those who perpetuate these assaults against women are held to account.
However, we do have significant concerns about unintended consequences for women’s access to reproductive care.
Medical emergencies can unfold in minutes. In cases like massive postpartum hemorrhage or ruptured ectopic pregnancy, life-saving surgery may be required. If there is even a perception these interventions could later be treated as potential criminal offences, hesitation becomes a real risk.
We are also deeply concerned about a chilling effect this legislation could create when it comes to women’s access to reproductive care. If physicians fear criminal prosecution when providing consensual elective sterilizations or prescribing medications that could – at some future point – result in sterilization, some may choose to stop offering this care altogether.
We are deeply concerned about a chilling effect this legislation could create when it comes to women’s access to reproductive care.
For example, what will this law mean for that young OB/GYN when she is asked by a woman to perform an elective tubal ligation? If procedures involving women’s reproductive organs are now treated as legally exceptional or higher risk, will that OB/GYN grant this woman’s request? She has real concerns it could land her in jail, so why would she take the risk? This means women would face additional barriers in accessing both emergency and elective reproductive care – at a time when women are waiting unacceptably long periods for sexual and reproductive health care in Canada.
In effect, a law intended to protect women could inadvertently contribute to a more restrictive and risk-averse environment in the delivery of reproductive care.
We have already seen examples of this playing out in the United States. Legal uncertainties around reproductive health laws have led some physicians to delay or withhold urgent care out of fear of prosecution. This has led to preventable deaths and has caused a deadly erosion of access to reproductive care for women in the U.S. We cannot let this happen in Canada.
We reiterate – we share the same goal: to ensure all women in Canada have access to safe reproductive care that respects their fundamental rights. Our organization has taken steps to address this within the profession, including issuing an opinion in 2021 on non-coercive contraceptive care. This opinion provides practitioners with clear guidance to ensure that contraceptive care – including voluntary sterilization – is delivered in a culturally sensitive way that ensures patients are fully informed and free of coercion. We also are presently working on the development of standardized best-practice tools on informed consent for sexual and reproductive health practitioners across the country.
But we firmly believe decisions about reproductive health care do not belong in legislatures or courtrooms. They must remain a medical decision made between a woman and her clinician. Using a blunt legislative instrument to address an acknowledged history of systemic racism and discrimination within the health system against Indigenous, racialized and marginalized populations is not the answer.
Our concern is that this bill could paradoxically undermine the goal of safe reproductive care by eroding access to reproductive health services, putting women at real risk of harm.
We call on Members of Parliament not to pass this bill in its current form and focus instead on improving policies and funding that could enhance enforcement of existing laws that prohibit coerced sterilizations.
