Invisible Frontlines: Reproductive Justice and Nursing at the Margins

By Sarah Lapin 

At a modest clinic tucked into the fabric of Montreal, community health nurse Sophie Savoie offers care that many Canadians take for granted — prenatal checkups, STI screenings, contraception consultations, and abortion referrals. But the patients she serves are often living outside the protections of Canada’s healthcare system: migrants with precarious status, uninsured and uncertain, many of them women navigating trauma, poverty, and isolation. 

“We’re basically doing humanitarian work in Montreal,” Savoie says. “It’s very unusual work because there’s nowhere [else] where you have the same reality … of having to get them [patients] access to the healthcare system.” 

Savoie is the lead nurse for women’s sexual and reproductive health at Médecins du Monde Canada’s Montreal clinic, a community-based NGO offering free care to those excluded from public coverage. Each week, she coordinates a patchwork of services with volunteer midwives, physicians, and external partners — a fragile network held together by resourcefulness and resolve. 

“When I started at the clinic, we were not even doing ultrasounds,” she recalls. “We did not have midwives… we had to build a little network of partners and services.” She describes how they once secured IV iron for pregnant patients through an external nurse — until the partner clinic changed leadership and the pathway collapsed. “So we have to find another way… It’s always changing”.  

This ever-moving target is compounded by systemic barriers and political currents. “More and more people are seen as though they don’t have the right to be here,” Savoie says. “So it’s more and more difficult.” Even as public resources shrink, the clinic strives to meet expanding needs — often with limited tools, and no guarantees. 

At the core of Savoie’s work is a simple but powerful truth: reproductive healthcare is a human right. Its denial, she argues, is both a public health failure and a profound form of violence. “If you don’t have the choice… if you cannot get an abortion, you cannot get contraception, you have no control on your fertility — it touches really basic human rights.” She has seen patients forced to terminate pregnancies they wanted because they couldn’t afford follow-up care, and others who had no choice but to carry to term without support. Although the individual outcomes may vary, the core dilemma remains the same. 

Despite these challenges, Savoie remains deeply committed to her work. “You have to love it to stay, because it’s pretty hard” she admits. “But I believe in it. These patients are part of our community. Their health is our collective responsibility.” 

She also sees her role as inherently political. “We’re not just providing care — we’re documenting, we’re reporting, we’re trying to bring these voices into policy spaces that ignore them.” 

This intersection of care and advocacy speaks to the broader relevance of her work to global health. Though she’s never left Montreal in her role, Savoie sees herself as part of a transnational chain of movement, displacement, and solidarity. 

“People don’t migrate by choice. They’re fleeing war, poverty, violence,” she explains. Savoie argues that global health is about equity, and that includes what happens right here. If Canada wants to lead in global health, we can’t ignore what’s happening at home. 

Beyond the ethical implications, Savoie points to the practical consequences of exclusion. “It’s expensive to care for a baby that was not, that their parents didn’t want. And then [sometimes] the baby is put in the foster care system.” The logic, she explains, is backwards. “It’s very violent […] but it’s also not strategic. We don’t save any money doing that.” 

Current policy, she says, is based on fear — fear of so-called medical tourism or abuse of services. But in reality, “It’s not based at all on data or observations or studies. It’s based only on fear.” She speaks of migrants given work permits without healthcare access, even when Canada extends them for humanitarian reasons. “We’re not even able to give them those basic care when they’re here… it doesn’t make sense.” 

Her journey through healthcare has also mirrored the evolution of nursing itself. From working in high-volume obstetrics and palliative care to volunteering with Médecins du Monde’s mobile clinic for people experiencing homelessness, to her current role in the women’s health clinic, Savoie has seen nursing in nearly every setting. She reflects on how constrained nursing can be in more traditional systems, such as hospitals. “We’re not used at our full potential in a lot of environments,” she says. “There’s a lot of rules… I know the aim is to protect the public, but nurses are very competent.” However, at the Médecins du Monde clinic, the reduced availability of doctors means that nurses must work with a high level of autonomy. As Savoie describes it: “We’re able to work at the maximum potential of our profession.” Her experience at the clinic has shown her how nurses can manage multidisciplinary teams, advocate for patients, and even influence policy. “I didn’t really know about that side of nursing before working here.” 

She also praises the strength of collaboration across female-dominated professions like nursing and midwifery. “Maybe we’re not able to access everything, but when we work together at the full range of our capacity, we are able to do something that makes a lot of sense”.  

Savoie sums up her work in very simple terms: “If we want a healthy community… people need to get the basic healthcare that they need.” When women are denied the ability to make decisions about their own bodies, the consequences ripple outward; affecting not only individual wellbeing, but family stability, public health outcomes, and economic equity. Ensuring access to this care is not just a matter of individual rights — it’s foundational to building communities where everyone has the chance to thrive. Her work is equally a reminder that global health isn’t only about distant crises or large-scale interventions; it also lives in the community outside your own front door. In a system that too often excludes those most in need, Savoie’s efforts bring into focus a vision of care rooted in equity, humanity, and solidarity, not just as an ideal, but as a lived practice. 

Sarah Lapin

is a graduate student at McGill University, currently pursuing a Master of Science in Nursing with a concentration in Global Health. She holds a Bachelor of Science in Interdepartmental Honours Immunology, also from McGill. Sarah’s graduate work, conducted in partnership with Médecins du Monde, focuses on understanding healthcare professionals’ perspectives of managing chronic illness in migrants with precarious status in Montreal. Sarah is also active in the global health sphere beyond her studies. She serves as a student coordinator for the Interprofessional Global Health Course, fostering interdisciplinary collaboration and education on pressing global health issues. She is also a Health Reporter for McGill Perspectives on Global Health 2024-2025.