National Abortion Federation

The National Abortion Federation (NAF) is an organization of abortion providers. Though originally a U.S. group, NAF has expanded to include practitioners in Canada and Australia as well as many European countries. According to their web site, half of all abortions performed in the United States and Canada are performed by NAF members.

NAF was established in 1977 with the merger of the National Association of Abortion Facilities (NAAF) and the National Abortion Council (NAC). They participate in a variety of activities, including lobbying efforts, public outreach campaigns, and a helpline referral service to member practitioners, giving accurate medical information about abortion, non-biased options counseling and post-abortion counseling, as well as helping to fundraise for women who cannot afford the full cost of an abortion due to Medicaid restrictions. The organization annually holds a meeting to address areas of concern to abortion facilities such as political challenges, staffing, and legal issues. Since 1981 NAF has also held an annual Risk Management Seminar to address clinical aspects of abortion practice. They also publish clinical guidelines for practitioners.

NAF indicates that "In order to become a member, a clinic must complete a rigorous application process. Member clinics have agreed to comply with our standards for quality and care, updated annually in our Clinical Policy Guidelines, which set the evidence-based standards for abortion care in North America. NAF periodically conducts site visits to confirm that our clinics are in compliance with our guidelines."

NAF is particularly controversial to pro-life organizations because a small number of member doctors and facilities have been involved with legal troubles such as malpractice, illegal abortions, patient death, and loss of licensure.

Canadian Public Policy and Outreach Program
NAF launched a Canadian Public Policy and Outreach Program on May 16th, 2006 with the support of Senator Lucie Pépin, Federal MP and former Minister of State for Health Carolyn Bennett and NDP Status of Women Critic Irene Mathyssen. The program offers Canadian women abortion referral to NAF providers, options counseling and post-abortion counseling through the NAF toll-free helpline, and French language website support.

Canada is unique among nations in being without an enforceable criminal abortion law. The 1988 Supreme Court ruling R. v. Morgentaler found the 1969 criminal code provisions unconstitutional with the majority decision turning on s. 7 (life, liberty and security of the person) of the Canadian Charter of Rights and Freedoms (Judge Wilson's decision was based on s. 15). To date, the Canadian Federal Parliament has not been successful in enacting replacement abortion legislation nor has it repealed criminal code sections 287 and 288. Provinces govern how abortion service is delivered and though they don't have authority to criminalize abortion and may face penalties if they contravene the Canada Health Act they still enjoy considerable political latitude on the abortion issue. This grey area of law and health policy has led to some provinces enacting their own legislation to control access and service delivery. Further evidence of provincial autonomy in the seen in the variance that exists throughout Canada in availability of abortion service and in the how components of care are delivered (facility, counseling, timeliness of care, referral process, cost, quality of provider care). The NAF Canadian Public Policy and Outreach Program seeks to address this variance through working to promote compliance with its Clinical Policy Guidelines. . Their efforts in this regard can be seen to compete unfavourably with policy standards of the Canadian Medical Association (CMA) and provincial Colleges of Physicians and Surgeons as will be explained in the paragraphs below.

NAF has taken issue with the Canadian Medical Association's (CMA) abortion referral policy which allows physicians to refuse to refer women to abortion providers in accordance with their conscience and CMA Policy - Induced Abortion. If pressed, a physician must indicate alternative sources where a woman might obtain a referral. . NAF has lobbied to force Canadian physicians to opt out of provincial healthcare plans entirely if they do not refer for abortion. This does not respect the grey area of law and policy which leave abortion as a free decision of each individual Canadian. There is no legal obligation to provide elective abortion, nor is there any law compelling a person to participate in abortion. The CMA policy respects the unique Canadian context of abortion, whereas the NAF does not. Universality of physician participation is a core Canadian value. The NAF suggestion that physicians should opt out of provincial payment plans simply because they cannot morally participate in abortion is not very Canadian.

Some regions of Canada do not like the policy of abortion-on-request and do not approve of clinic abortion. New Brunswick is one such province. New Brunswick Regulation 84-20 under the Medical Services Payment Act only funds abortions performed by a specialist in the field of obstetrics and gynaecology in a hospital facility approved by the jurisdiction in which the hospital facility is located and two medical practitioners certify in writing that the abortion was medically required. . New Brunswick does not fund clinic abortion at all and no citizen of New Brunswick has ever challenged their government to do so. Currently NAF member Henry Morgentaler is appealing a decision in New Brunswick but the chance of his success is not assured.

Contrasting NAF standards of care against those of New Brunswick it is apparent that New Brunwsick exceeds NAF policy standards through providing an abortion by specialist OB/GYN physician (NAF standard: medical doctor or nurse practitioner), pre-abortion options counselling by two physicians (NAF recommendation: group counselling), while the delay that could be created in the course of obtaining two physician referrals and meeting a test of medical necessity falls short of both NAF standards (the CMA policy standard covers this area in Canada). Physician referral in New Brunswick is to the nearest clinic. NAF referral for Canadian women does not recognize Canadian hospitals or non-NAF member clinics in their toll-free helpline service, therefore would be to their Fredericton clinic. The odds of a woman travelling further and paying the full cost of abortion are increased if the NAF referral service is used. On balance, a woman seeking an abortion within the New Brunswick system which is criticized by the NAF, has a number of options and the NAF cannot be said to be promoting the best ones.

NAF exists by donation only and is a registered charity. Canadian Health policy makers are invested and accountable to the populations they serve.

In conclusion, the Canada Health Act guarantees Canadians access to necessary healthcare services, but provinces have autonomy in the delivery of healthcare service and can decide whether abortion is medically necessary. For this reason the NAF Public Policy Outreach Program operates in conflict with current Canadian law and policy through duplicating and/or lowering policy standards and individual standards of abortion care, or through imposing an American political and legal perspective on the Canadian abortion issue.