Sandwiched between a hearing clinic and dentist, a steady stream of women buzzed into the second-floor office of Everywoman's Health Centre, one of several abortion providers in Vancouver, B.C.
For 24-year-old Gabriela Briones, this day was two weeks in the making. A journalist from northern Mexico, Briones was on a tourist visa visiting her boyfriend when she found out she was pregnant.
"I don't want to be in this situation. I don't want to be pregnant," she told Glacier Media. "I looked at my options, and in Mexico… and in my state, it's completely illegal."
"It was: return to that situation in Mexico, or stay here where it's totally legal, safe."
While south of the border in Washington, D.C., riot police marched through the street hours after the U.S. Supreme Court overturned Roe v. Wade, eliminating nearly 50 years of a constitutionally protected right to abortion in the country.
In Canada, access to abortion went uninterrupted for people like Briones.
"It's very important that people seeking abortion care in Canada know that this does not affect their access to care at all," said Martha Paynter, a nurse and researcher working with the University of British Columbia's contraception and abortion team. "Abortion in Canada remains completely outside of the criminal justice system."
Paynter, who also works at Nova Scotia's only abortion clinic, described it as "a health-care procedure, just like a knee replacement, or a suture."
In Canada — where abortion is decriminalized but not enshrined into law and access varies — some experts have predicted an American surge could lead to increased wait times and shortages of abortion pills.
"For clinics across Canada, it may very well mean that we have increased demand," said Paynter.
Out-of-country patients pay hundreds of dollars for abortion
When Roe v. Wade established constitutional rights for women in the U.S. 50 years ago, Canada was "emboldened," says Mulder.
Today, all Canadian women have legal access to abortion. But for patients visiting the country and not covered by one of the province's health-care plans, an abortion can cost hundreds of dollars.
"Those patients are welcome in our clinics, but they will not have their care publicly funded the way it's funded for people with provincial and territorial health [insurance]," said Paynter.
Briones's experience could be a sign of patients to come. She paid $500 to get access to an abortion. Then she had to wait weeks to get an appointment due to what she said was high demand. Part of the delay was due to the language barrier.
"To be honest, it's been complicated," she said.
Arriving at the Vancouver clinic the same day the U.S. Supreme Court released its ruling, Briones struggled to communicate over an intercom system at the clinic door. But once inside, a translator was waiting, and Briones said the level of treatment she received was as much as she could have hoped for.
"They made me feel comfortable, dignified," she said.
Briones says she knows of women back home in Mexico who independently help women access abortion pills. But it can be a scary and hard process to navigate, and one Briones ultimately decided to avoid.
Experts say those kinds of decisions could drive women from the United States to seek abortion services in Canada.
In some U.S. states like Texas, where recent laws have restricted access to abortion even before the supreme court's ruling Friday, some Mexican women's rights groups have even moved to support access to abortion for women in the United States.
That's all made possible by a wider move away from surgical-based abortion to abortions that rely on pills like mifepristone.
Approved by Health Canada in 2015, medication abortion with mifepristone has been available in Canada since about 2017, said Paynter.
"We haven't had a lot of time to become really adept at it," she said.
The COVID-19 pandemic has led to a boom in telemedicine across the country, priming doctors and nurses on the technological quirks and benefits it provides.
"A lot of providers became very comfortable with doing what we call 'no-touch abortion,'" said Paynter. "And that means you have a conversation with the patient. They don't require blood work. They don't require an ultrasound. We prescribe the medication. And that's it."
The use of mifepristone by primary care providers has drastically increased access to abortion in many rural areas in Canada, said Dr. Regina-Maria Renner, an obstetrician and gynecologist who works at a practice providing abortions on Vancouver Island.
A Canadian abortion provider survey looking at 2019 data found roughly a third of abortions in Canada are now carried out through medication, making the process less invasive and more easily deployed in combination with telemedicine, according to Renner, who helped carry out the study in her role as a clinical associate professor at UBC.
"I think what we will see is a lot more primary care providers perhaps being motivated by this to add medication abortion to their practice," said Paynter. "And we really can expand it infinitely through primary care networks."
Unequal access to abortion in Canadian
Since a U.S. Supreme Court draft decision on the case was leaked last month, many people have taken to social media to offer help to women seeking an abortion.
But for Tara Mulder, an assistant professor at UBC and an expert on the history of abortion, the impulse to be "individual heroes," whether putting up women in a safe room or giving them a ride, is misguided.
The best thing people supporting access to abortion can do is donate to the number of support networks already in place, she said. Mulder said that could mean travelling to clinics in Canada.
"We've seen this at different points in history — women from Canada, going down to the states to have abortions, people in the United States going up to Canada to get cheaper prescription medication," she said.
"We do see this kind of cross-border interaction."
Even within Canada, access to abortion can vary depending on who you are or where you live.
Paynter says in a country like Canada, where many need to travel long distances to access medical care, Indigenous women and those living in remote areas face the biggest barriers to accessing abortion services. And some provinces have more clinics or restrictions on term limits than others.
Mulder says, if neglected, those gaps in abortion access could get bigger.
She says today's U.S. Supreme Court decision was the culmination of a slow eroding of access to abortion across many American states and should sound a warning for women's health advocates in Canada.
"The erosion can happen with limiting those resources. And that's what we should keep our eyes out for," she said.
Too early to predict a surge
Due to the cost of accessing abortion without Canadian medical coverage, Paynter says she doesn't expect a surge of U.S. patients to impact Canadian access. Renner is not so sure.
The doctor said it's too early to know what impact the U.S. Supreme Court ruling will have on abortion demand in Canada.
"That might certainly be the case," Renner said. "It might put some pressure onto how much care we can provide, and there might need to be very conscious planning into this."
"It is all very hypothetical. I can't speak to how this will be triaged."
For Briones, she's just grateful her unplanned pregnancy came at a time and place she could get help.
"I'm alone. I'm away from friends and family. But at the same time, I feel good," she said. "I feel so fortunate."
Whether telemedicine will help act as a bridge for U.S. patients remains an open question.
For now, health-care workers like Paynter and Renner are grieving the restriction of millions of women's reproductive rights south of the border.
Paynter's first reaction to the news was "deep sorrow for colleagues across the U.S." who won't be able to provide care.
"It's a very sad day," said Renner. "I'm really upset. I worry for the patients."
