This article revisits the history and ongoing realities of abortion access in New Brunswick, Canada, through the dual lenses of Reproductive Justice and Luhmann’s Systems Theory. Despite Canada’s liberal abortion laws, New Brunswick has continued to experience entrenched barriers to equitable abortion care long after decriminalization. We interrogate the dominant legal narrative that has celebrated the 1988 Morgentaler decision as the key decriminalization milestone, arguing that constitutional litigation did not meaningfully improve access for abortion seekers in the province. Drawing on archival research, legal theory, and a case study of the Moncton Hospital in the l980s, we show how physician-centered governance and the self-referential closedness of the legal system continues to marginalize abortion seekers. Data from the now closed Clinic 554 illustrate that clinic-based abortion services offer more timely care than hospital-based services, even in hostile policy environments. We conclude that persistent barriers to access can only be removed by recognizing abortion care as part of a broader set of policy reforms with overlapping justice concerns, rather than relying on legal reform alone.