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Terminating a pregnancy still too difficult in Nova Scotia

KJIPUKTUK (Halifax) – On the surface it could appear that abortion access in Nova Scotia has improved in the last few years. People trying to access pregnancy termination, along with the advocates and health care workers who support them, tell a different story.

Abortion was not fully decriminalized in Canada until 1988. From then until 2015 change happened slowly, incrementally, and not always in the right direction. Since 2015, when Mifegymiso, often referred to as the abortion pill, was approved, the speed of change has dramatically increased.  Nonetheless, somehow it remains challenging to terminate a pregnancy in Nova Scotia. 

Mifegymiso is a combination of the two drugs Mifepristone and Misopristol. Together they make for a safe, effective way to end a pregnancy and have been used around the world for about 30 years

Despite its safety, Health Canada placed numerous arbitrary restrictions on medical abortions. Special training and registration with Celopharma – the company that manufactures Mifegymiso – took time that doctors in Nova Scotia simply do not have. It’s no secret that there is a shortage of primary and specialty care physicians in this province. The ER closures, long wait lists, cancelled surgeries, it goes on and on and everyone knows someone who has been affected. 

Moreover, this hassle of training and registration was only the beginning. Doctors were restricted to prescribing Mifegymiso for pregnancies up to 7 weeks. Many people don’t yet realize they are pregnant at that point, rendering the drug nearly useless. Doctors were not going to waste their time training for something they could barely ever prescribe, especially with a health care crisis well under way. Astonishingly, after all that extra work , there wasn’t even a billing code for an abortion consultation and prescription appointment so they could be paid for their time. 

Yet another problematic barrier was the requirement that physicians keep the drug stored in their own offices. This was impractical and unnecessary since pharmacies obviously have much better storage and facilities for dispensing drugs. Additionally, there was a puzzling requirement for written patient consent which, while not as time consuming and inconvenient as the other restrictions, still creates an air of stigma and fear around a simple and safe and proven drug. 

Now, should someone be pregnant beyond the now recommended 63 days or 9 weeks, they must be referred for a surgical abortion. The situation here has changed little over the years and at the moment there are only four places to get a surgical abortion in Nova Scotia –  Halifax, Truro, Kentville and Bridgewater. Cape Breton and Southwestern Nova Scotia are over two hours drive from the nearest clinic. 

And although the procedure is technically available at three hospitals other than the Victoria General in Halifax, Shannon Hardy of Abortion Support Services Atlantic knows firsthand that the greatest barrier to timely abortion care is “Access, both geographically and physician-based. Surgical abortions are essentially only available in Halifax and doctors are not prescribing Mifegymiso, or people can’t get in to even see a doctor.”  

When people have to factor in travel, overnight stays, meals, child care, time off work and other costs we can hardly claim to have equal access in this province. It was thought that the introduction of Mifegymiso would alleviate some of this strain – and surely it has for some – but access remains spotty because many doctors are still hesitant to prescribe the abortion pill. 

This reluctance could be for a variety of reasons, including personal beliefs. In November 2018, Martha Paynter, local nurse and health care advocate explained to Global News that “The biggest issue continues to be that this is considered a specialized service instead of the primary care that it is. We as clinicians need to step up.”

There are a mere four doctors on the whole of Cape Breton Island who are part of the NS Women’s Choice Clinic Network. That doesn’t necessarily mean other doctors aren’t prescribing or won’t prescribe Mifegymiso but they’ll be harder to track down and get in to see during that narrow window between discovering one is pregnant, deciding to terminate, and reaching out for abortion care. 

Now that so many of the restrictions on prescribing have been lifted, one might presume that more prescriptions are being written. However, Hardy says “…doctors aren’t prescribing Mifegymiso for a couple of reasons. Potentially they don’t know that the training requirement that was originally in place has been taken away, so now all doctors can prescribe it. They may not feel they have the capacity to offer follow-up care, although it is only one appointment. And, in Canada, we allow doctors to claim “conscientious objector” status, so a doctor could decide to not offer appropriate medical care based on their personal beliefs.”

It should be obvious that If one does not wish to provide abortion care then a different career path should be taken. It is a doctor’s duty to provide health care and when they refuse to do so based on their own so-called conscientious objections they are failing as health care providers. 

I asked Hardy  what surprises people the most when they learn of the true state of abortion care in Nova Scotia.“There is no reason for abortion to only be available in Halifax. The healthcare system and the people within it are knowingly limiting access to a safe, legal and common medical procedure,” Hardy says.

It’s important to understand that termination of pregnancy is not a complicated procedure requiring ultra-specialized instruments or dangerous medications. All hospitals could be providing the surgical option and all doctors could be prescribing Mifegymiso and providing follow up care. 

It is stigma and the remnants of unnecessary restrictions that are making access so challenging, not the procedures themselves. Mifegymiso has the potential to ease the burden of access to abortion but as it stands now, Nova Scotia still has a long way to go before abortion is equally available to all Nova Scotians.

Anyone who requires abortion care can contact the self-referral line for the Nova Scotia Women’s Clinic at 1-833-352-0719.

See also: Laura Slade: When ‘Unplanned’ came to town

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