Varied paths towards feminist policy change: the case of abortion rights in four Canadian provinces

ABSTRACTThe story of institutional law reform in Canada has been described by one veteran as ‘somewhat troubling.’ It is a story not without significant successes: In Québec civil law, the codifications were remarkable achievements which realised sweeping and highly-esteemed reforms. Among Canadian common law provinces, Ontario founded the Commonwealth’s first law reform commission in 1964, and as early as 1967 Alberta innovated the now internationally-influential joint venture design of its commission. Further, Canada’s original national commission was notable for its ambitious pursuit of social issues, and the second national commission challenged conventional legal paradigms at unparalleled depth. Across the country, many law commissions were established. Yet, what is ‘troubling’ is how many, including long-established and prominent commissions, were since closed or constrained, impeded from accomplishing what they might have. Meanwhile, in Québec civil law, the codifiers’ repeated calls for a permanent commission have gone unheeded. What does the future hold for institutional law reform in Canada? In Québec civil law, there are some signs of movement towards reform continuity. An important question will be whether processes of continuous incremental reform can be developed and managed to alleviate reliance on overwhelming legal overhauls. Elsewhere in Canada, a few Canadian provinces that shuttered commissions have since re-established them in altered forms. The common themes of austerity, ideology, and alleged redundancy in the downfall of past Canadian commissions remain an ever present concern to the survivors, as they simultaneously confront newly emerging challenges. Time will tell whether, because of their experience in reforming themselves in response to their troubling story to date, Canada’s law commissions may be best-positioned to meet institutional law reform’s challenges of the future.

Abortion and Human Rights for Women in Argentina Barbara Sutton (bio) and Elizabeth Borland (bio) introduction Legal abortion is one among several dimensions of a reproductive justice agenda, and yet it continues to be at the center of controversy in many places around the world. While in countries such as the United States abortion is legal but contested,1 in places such as Argentina, abortion is largely illegal, with few exceptions.2 Despite its criminalization, it is estimated that up to 522,000 abortions take place annually in Argentina.3 Abortion is also a leading cause of maternal mortality, and the clandestinity of the practice especially hurts the most destitute women.4 In this context, women's movement and feminist activists in Argentina have long advocated for the legalization of abortion. Their cause gained momentum in the last decade. Unlike the more narrow emphasis on "choice" that has been prevalent in the United States and other contexts,5 and critiqued by scholars and activists advocating for "reproductive justice,"6 abortion rights activists in Argentina have included expansive frames in their discursive repertoire, even as they concentrate on legalizing abortion. One of these expansive frames pertains to the notion of human rights. The proliferation of human rights discourse as a recognized and shared language across national borders and cultures—for example, as evidenced by international human rights treaties—suggests the need to examine how this frame works in practice and whether it has local resonance in different national contexts. According to Elizabeth Jay Friedman, from a feminist perspective, part of the power of the human rights frame derives from its ability to "provide legitimacy to political demands, given both its political acceptance and its 'machinery,' or instruments for its realization."7 Furthermore, the notion that "women's rights are human rights" was increasingly deployed in the global arena during the 1990s and is still being invoked in prominent activist spaces in different locales, including the 2017 Women's March on Washington.8 Still, [End Page 27] as we shall see, this frame is not without critics, including among feminists who have taken issue with its usefulness both philosophically and in terms of its concrete application in specific national contexts.9 Thus the question emerges: Is the human rights frame useful or viable when it comes to articulating long-standing feminist demands such as abortion rights? If so, in which circumstances? In the case of Argentina, why have abortion rights activists chosen to incorporate the language of human rights as an important component of their discursive repertoire? Within Argentina, the movement for abortion rights needs to be situated in the context of broader struggles for social justice, democracy, and gender and sexuality rights. In the last two decades several progressive laws were passed in Argentina, including legislation on sexual and reproductive health (2002), comprehensive sex education (2006), ending violence against women (2009), marriage equality (2010), and self-determination of gender identity (2012). These changes followed a historic turning point marked by a severe economic and political crisis in 2001, when a variety of social movements were agitating for new and old demands.10 However, despite legislative progress on matters of sexual and reproductive rights, legalizing abortion has proven more difficult to achieve. This article examines activist efforts to decriminalize and legalize abortion, paying special attention to the strategic use of a human rights frame. The prominent coalition to demand the legalization and decriminalization of abortion in Argentina is the National Campaign for the Right to Legal, Safe, and Free Abortion, launched in 2005.11 By its tenth anniversary the Campaign had the support of more than three hundred organizations as well as countless individuals from all walks of life. Groups in the coalition include political parties, labor organizations, academic institutions, human rights groups, and many more. Activists characterize the Campaign as plural (comprising a diversity of individuals, social sectors, and political ideologies), federal (reaching the various regions of the country), self-organized (not directed by any external entity), and democratic (with the main direction of the Campaign determined through plenary meetings and collective discussion). The Campaign's key slogan, which has unified it when tensions and disagreement have arisen, is: "Sex education...

Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized. The aim of this study is to identify the factors that have facilitated or hindered implementation of reforms in Canadian provinces between 2000 and 2010.A literature and policy scan identified evaluation studies across Canadian jurisdictions. Experts from British Columbia, Manitoba, Nova Scotia, Ontario and Quebec were asked to review the scope of published evaluations and draft provincial case descriptions. A one-day deliberative forum was held, bringing together researchers (n = 40) and decision-makers (n = 20) from all the participating provinces.Despite a relative lack of published evaluations, our results suggest that PC reform has varied with regard to the scope and the policy levers used to implement change. Some provinces implemented specific PC models, while other provinces designed overarching policies aiming at changing professional behaviour and practice. The main perceived barriers to reform were the lack of financial investment, resistance from professional associations, too overtly prescriptive approaches lacking adaptability and an overly centralized governance model. The main perceived facilitators were a strong financial commitment using various allocation and payment approaches, the cooperation of professional associations and an incremental emergent change philosophy based on a strong decentralization of decisions allowing adaptation to local circumstances. So far the most beneficial results of the reforms seem to be an increase in patients' affiliation with a usual source of care, improved experience of care by patients and a higher workforce satisfaction.PC reforms currently under consideration in other jurisdictions could learn from the factors identified as promoting or hindering change in the provinces that have been most proactive.

This essay explores the efforts to change Canada’s traditional plurality voting system to either majority or proportional voting systems at the municipal, provincial, and federal levels between 1874 and 1960. Specifically, it will provide evidence showing that appeals to populist culture, regional disaffection, and the efforts of individual and party reformers are not sufficient in explaining why, when, and where reforms have occurred. Instead, this essay will demonstrate that serious interest in, and the successful adoption of, majority and proportional voting system reforms in Canada was primarily driven by class factors, specifically the class interests of Canadian farmers and the perceived threat that various labour and socialist parties posed to Canada’s major political parties (and by extension their economic supporters) at different points in Canadian history. By surveying three broad periods of reform efforts, the essay demonstrates that while many different factors—reformer sentiment, party needs, ethnic tensions—may have fueled interest in voting system reforms in Canada, only organized political threats based on class issues motivated any serious or long-standing reform.

This chapter focuses on what I have termed the “new social-isms,” and the ways in which these popular conceptual frames embed neoliberal political rationalities in social policy reform and citizenship practices in Canada. This term flags the many and different appeals to the “social” that have been interwoven into political rhetoric, social policy thinking, and policy performances in the past decade, among them social cohesion, social exclusion/inclusion, social capital, social care, social economy, and social investment. These concepts, and the social policy prescriptions that they evoke, contrast markedly with deployments of the social in the postwar model of social governance, such as social security, social justice, social citizenship, social solidarity, social rights, and social welfare. Although applications of the new social-isms vary widely both across national settings and in academic debates, the prominence afforded to these terms in contemporary social policy reform is often taken as evidence of a “social turn” in neoliberal governing practices, if not as a beacon of a new and still unfolding “late” or “post” neoliberal era. This social turn is represented as a qualitative departure from the familiar modalities of the postwar welfare state and neoliberal fundamentalism, as well as an exercise in pragmatism and reflexivity that responds to the “new social risks” of the contemporary era. It purportedly is shaping a “third way” or hybrid liberal state form that maneuvers through the uncharted waters of postindustrialism and globalization, while, at the same time, avoiding the perils of either “too much state” or “too much market” (Giddens 1998).

STEP Canada held its inaugural Symposium on 5 and 6 November 2007 in Toronto on the subject of trust law reform in Canada, co-chaired by Margaret O'Sullivan and Kathleen Cunningham, both senior STEP Canada executive members. The Symposium was extremely well attended by representatives across the country, including participants from every major trust company at the senior executive level, senior trust and estate practitioners, academia, government, law reform commissions and the judiciary. A primary theme of the Symposium was that trust law reform in Canada is long overdue and modern legislation is needed in Canada to enable sophisticated planning reflecting modern societal needs and an increasingly complex investment market. The existing patchwork of trust law in Canada's common-law provinces primarily dates back to the late 19th Century. It is foreseen that new legislation should enable trusts to better reflect contemporary social needs and the increasing use of the trust given the demographics of an aging population. There have been only modest amendments to trust legislation in certain of the Canadian provinces, such as the ‘prudent investor’ rule with regard to trustee investment.

BackgroundIn the early 2000s, Ontario and Quebec, two provinces of Canada, began to introduce hospital payment reforms to improve quality and access to care. This paper (1) critically reviews patient-based funding (PBF) implementation approaches used by Quebec and Ontario over 15 years, and (2) identifies factors that support or limit PBF implementation to inform future decisions regarding the use of PBF models in both provinces.MethodsWe adopted a narrative review approach to document and critically analyse Quebec and Ontario experiences with the implementation of patient-based funding. We searched for documents in the scientific and grey literature and contacted key stakeholders to identify relevant policy documents.ResultsBoth provinces targeted similar hospital services—aligned with nationwide policy goals—fulfilling in part patient-based funding programmes’ objectives. We identified four factors that played a role in ensuring the successful—or not—implementation of these strategies: (1) adoption supports, (2) alignment with programme objectives, (3) funding incentives and (4) stakeholder engagement.ConclusionsThis review provides lessons in the complexity of implementing hospital payment reforms. Implementation is enabled by adoption supports and funding incentives that align with policy objectives and by engaging stakeholders in the design of incentives.

Social movement boundaries are fundamentally about deciding who “we” are by defining who we are not. However, newly salient issues in a movement community can shift these boundaries by changing the membership criteria for both insiders and outsiders. Through a comparative case study of two relatively conservative feminist organizations, Women's Equity Action League (WEAL) and Feminists for Life (FFL), I examine how shifting boundaries around abortion rights in the feminist movement led to movement splintering, as organizations struggled and sometimes failed to maintain their relationships in a movement that increasingly defined them as outsiders. This analysis reveals how abortion rights' growing importance to both the feminist movement and the New Right resulted in the realignment ofFFLwith the feminist countermovement. This process had important consequences for both the organization and the countermovement with which it was realigned. This article contributes to our understanding of how shifting boundaries affect individual organizations, the movements in which they participate, and the relationships between countermovements.

In 2022, the US Supreme Court decision in Dobbs v. Jackson Women's Health Organization to overturn federal law safeguarding abortion rights led to considerable national debate on abortion and reproductive rights. We report the findings of a survey of academic scientists' perspectives regarding abortion rights, state policies, and the impact of the 2022 Supreme Court decision in Dobbs v. Jackson. Furthermore, we look at how academic scientists' institutions acted to address the Dobbs decision. Using a 2023 cross-sectional survey, we address the following research questions: (i) What are scientists' views of abortion rights? (ii) How have scientists responded to the 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization? and (iii) How are their views different from that of the general public with regard to Dobbs v. Jackson and abortion rights in general? Findings show that abortion was a key factor influencing scientists' voting decisions. We also highlight substantial differences between scientists' perspectives and those of the general population and reveal gender differences of opinions within the scientific community. We conclude by presenting the actions implemented by universities and scholars in response to the Dobbs decision and discuss the implications our results have for both policy and practice.

Background: Team-based care involves family physicians working with other health professionals to provide primary care to patients. It has been implemented across Canada; however, its adoption varies, as health care delivery is the responsibility of provincial governments and not the federal government. Objective: To examine variations in the composition of team-based primary care amongst Canadian provinces in 2008 and identify patient characteristics that may have predicted access. Methods: Data are from the 2008 Canadian Survey of Experiences with Primary Health Care, a national survey of patients’ experiences with primary care in Canada. The sample size available for analysis was 11,521 and the response rate was 70.8%. Team-based care was defined as a family physician working with either a nurse or another type of health provider. Logistic regression was used to examine determinants of access to team-based care, adjusting for demographic, health status, and socioeconomic variables. Results: In 2008, 37.1% of Canadians reported having access to team-based care. The composition of team-based care varied amongst provinces and the most common model in all provinces were family physician plus nurse-only teams except in Quebec and Manitoba. Statistically significant predictors of access to team-based care were province of residence and total number of chronic conditions. Conclusion: With continuity of primary care reform in Canada, a new national survey is needed. Future assessments should aim to increase accuracy in the definition of team-based care through improvements in survey question design and patient education.

This study examines population-based trends in home care service utilization, alone and in conjunction with hospitalizations, during a period of health reform in Canada. It focuses on the extent to which observed trends suggest enhanced community-based care relative to three competing hypotheses: cost-cutting, medicalization, and profitization. Analyses drew on administrative health data from the province of British Columbia for the period from 1990 through 2000. Annual trends in age- and gender-adjusted utilization rates are examined by use of joinpoint regression; multivariate analyses draw on generalized linear modeling. Home support claims decreased significantly during the study period. There was less evidence of decline with regard to home nursing care claims and the extent of both home support and home nursing care. Intensity of care increased for home support services but decreased somewhat for home nursing care. Multivariate analyses revealed a decline in joint use of home support and hospital care and little change in joint use of home nursing and hospital care. Similarities as well as differences in trends are evident across age groups. The findings suggest a reduction and reallocation of health services in general rather than a shift of focus toward community-based care. In this way, they appear more consistent with a cost-reduction hypothesis than with expectations of enhanced community-based care that are generated by recent health reform initiatives.

BackgroundAmid growing concerns about primary care accessibility and the need to support longitudinal, community-based models of care, Canadian provinces have implemented major reforms to how family physicians are paid. These models share objectives of making longitudinal, community-based family practice more attractive and, to some degree, addressing long-standing disparities in pay between family medicine and other specialties. These new remuneration models require robust evaluation to guide improvements, future investments and planning.Methods and analysisWe will conduct a multimethod study to explore physician perceptions and outcomes of these new models. First, we will complete semi-structured interviews with family physicians in British Columbia, Manitoba and Nova Scotia (provinces where a new blended compensation model has been introduced). Interviews will explore family physicians’ motivations for moving onto the blended compensation model; how the model has impacted their practice, administrative burden, visit length, capacity, changes to care coordination; and other areas of interest. Second, using provincial and national administrative datasets, we will assess the impact of these payment reforms on service volume, attachment/enrolment, continuity of care, and costs.Ethics and disseminationWe have obtained cross-jurisdictional ethics approvals from Research Ethics British Columbia for the qualitative components and Nova Scotia Health for the quantitative components of this research. Harmonised ethics approvals have been obtained from additional institutions across all study regions. We will create summaries of findings of provincial and cross-provincial analyses and share them with relevant policymakers, physician associations and study participants. Our dissemination will also include traditional publications such as peer-reviewed articles, commentaries/editorials, and academic conferences.

While most people believe that the movement to secure voluntary reproductive control for women centered solely on abortion rights, for many women abortion was not the only, or even primary, focus. Jennifer Nelson tells the story of the feminist struggle for legal abortion and reproductive rights in the 1960s, 1970s, and early 1980s through the particular contributions of women of color. She explores the relationship between second-wave feminists, who were concerned with a woman's right to choose, Black and Puerto Rican Nationalists, who were concerned that Black and Puerto Rican women have as many children as possible “for the revolution,” and women of color themselves, who negotiated between them. Contrary to popular belief, Nelson shows that women of color were able to successfully remake the mainstream women's liberation and abortion rights movements by appropriating select aspects of Black Nationalist politics—including addressing sterilization abuse, access to affordable childcare and healthcare, and ways to raise children out of poverty—for feminist discourse.

All universal health care systems are unique, but Canadian health care is a genuine enigma. Although it is usually described as a single-payer system, the public share of total spending is, at 70% (see table; to compare this country with others, see the interactive graphic), low by northern European standards. Complexities arise from the fact that it's a federal system that divides responsibilities between the national government (responsible for services to some Native Canadians [First Nations and Inuit peoples], the armed forces, the Royal Canadian Mounted Police, and inmates of federal prisons, as well as some aspects of health protection) and the provinces (constitutionally responsible for everything else). Both universal . . .

Although recent public management reforms in Canada. Mexico and the USA are characterized by similar themes and vocabularies - privatization, customer service, devolution - the nature and extent of actual change reflects the national politics and administrative histories of the three countries. In brief, Canadian public management has been heavily influenced by the need for fiscal retrenchment at both, national and provincial levels, Mexican public management has been influenced by the transition from oligarchic to democratic governance at federal, state and local levels, and USA public management has been preocuppied at the federal level with implementation of the Government Performance and Results Act and with the miscellaneous initiatives organized under the ‘Reinventing Government’ theme as it has been popularized by the Clinton administration.