Inside The Battle To Improve Abortion Access In Atlantic Canada

Canada is often viewed as a pro-choice paradise. Such a view is only bolstered when you consider how fraught and politically divisive the debate over abortion access is in its southern neighbor, the United States. Indeed, it is true that Canada has no laws that criminalize abortion — previous laws were first loosened in 1969, and then thrown out entirely by the Supreme Court in 1988 . . . and yet.

For many in the country, abortion is made difficult to access because of barriers of cost, geography, and culture. “A lot of people are really unaware of the difference [in access]; a lot of people look at Canada as this abortion safety zone,” confirmed Kathleen Pye, a founding member of Reproductive Justice New Brunswick.

This phenomenon is particularly acute in Atlantic Canada, a region comprised of approximately 1.2 million women scattered across New Brunswick, Prince Edward Island, Nova Scotia, Newfoundland, and Labrador provinces, a relatively low population spread over a large geographic area. And those difficulties are exacerbated by additional limits placed by provincial regulations — ones that activists in the region are fighting against, with increasing success.

The Fight In Prince Edward Island

“I’m shocked,” said Dr. Robyn MacQuarrie, a PEI professor and member of Abortion Access Now PEI. For the first time in more than 30 years, women on the island would soon be able to get surgical abortions without leaving the Canadian province.

March 31st marked the unlikely success of a lawsuit first set into motion this January by the advocacy group Abortion Access Now PEI, which argued that the lack of abortion access in the province was a violation of the rights guaranteed to Islanders under the Canadian Charter of Rights and Freedoms. Abortion Access Now PEI filed a notice of application against the PEI government to the province’s Supreme Court, giving the province 90 days to respond.

The announcement marked the end of the province’s refusal to provide abortion services to women in the province. But it doesn’t mean that the women of Atlantic Canada no longer face access barriers — ones that might come as a surprise to women in other parts of the country, considering Canada’s reputation for ease of access to abortion.

“To say we have access is not entirely genuine,” said MacQuarrie. “Really what we have is legal permission.”

For the women of Atlantic Canada, legal permission alone doesn’t go far enough.

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That lawsuit was the final step in a long campaign to ensure that Islanders had local access to surgical abortions, which have not been performed legally in the province since 1981. In June 2015, the province’s government introduced changes allowing women to self-refer for abortion services at Moncton Hospital in New Brunswick, removing the barrier of requiring a referral from a physician or the province’s health ministry. But women still had to travel off the island to a hospital or clinic in New Brunswick or Nova Scotia — something requiring an overnight trip, a place to stay, and a companion to accompany them to the clinic.

“It was always intended that the self-referral option would migrate to a PEI Location,” MacQuarrie said of the province’s earlier decision to allow women to self-refer for abortion care in New Brunswick. “Because the province stalled on continuing the process of repatriating care, we decided that our best option would be to get an option from the court.”

And women complained that getting the referrals to out-of-province hospitals was difficult in a political climate where doctors didn’t want to provide them, either because of their own views, or because of concerns about community backlash: “The government refused to put information on its website about how you would access abortion at all,” MacQuarrie said.

Although medical abortion is available for earlier pregnancies, information and follow-up care isn’t easily found. Becka Viau, a PEI resident, started her site The Sovereign Uterus after reading about Courtney Cudmore, who received a prescription for a medical abortion from a walk-in clinic on the island, and spoke out about her inability to access aftercare when she had complications.

In response to Cudmore’s openness, Viau started her own site to share the experiences of women who struggled to access abortion on the island. “Her courage to speak out inspired me to provide an anonymous space for other women to share their stories.”

A Regional Issue

PEI isn’t the only Atlantic province where abortion services remain difficult to access. About a year ago, the fight to maintain access to abortion services in New Brunswick received international attention when a crowdfunding campaign was launched to keep a private clinic running.

New Brunswick women were faced with leaving the province — or even the country — in order to access abortion services when the Morgentaler clinic closed in 2014. They went to clinics in Montreal or Maine at great financial cost, considering that pregnant people not only had to pay for travel and accommodations, but also for the procedure itself.

“When they did close, there was a huge gap in services,” said Jessi Taylor, spokesperson for Reproductive Justice NB. “When we didn’t have a clinic, most people had to travel to Maine to get abortions. They were telling us that about half their patients then were people from New Brunswick.”

The $125,000 crowdfunded by the group was used to open a new private clinic in Fredericton — Clinic 554. New Brunswick women again had an option other than a hospital, but it didn’t remove the considerable financial barrier of having to cover the cost of abortion out of pocket.

“We have a clinic back and that’s great, but people still have to pay,” Taylor said.

And it was only in 2015 that the province eliminated a restriction that previously required women in New Brunswick to have the approval of two physicians for abortion to be considered “medically required,” and therefore covered under provincial health care.

Truly expanding access in New Brunswick means extending provincial funding to the clinic most women choose to use, Taylor said: “We know that people feel safer there,” she added. “Sixty percent of the women in the province are paying for that for a reason.”

Some of the Islanders seeking access to abortion services have traveled to Nova Scotia, another province to their north. But access to services in that province requires a doctor’s referral and can involve a wait time of two to three weeks. The province has no freestanding clinics and all abortions are performed in a hospital, usually in Halifax.

The geographical factors are perhaps most significant for some of the women in Newfoundland and Labrador, Canada’s newest province. Procedural costs in the North Atlantic province are covered under provincial health care. In St. John’s, the province’s capital, women can go to a hospital with a doctor’s referral, or to a private clinic that bills to the province. But abortion services aren’t available anywhere else in the province.

The island of Newfoundland is about the size of Cuba. A drive to St. John’s can be as much as 12 hours away, and the bus across the island only leaves once daily. And the mainland part of the province, Labrador, has small communities spread over a large geographic area. Getting to St. John’s from Labrador involves hours of travel by car and boat or a short flight that can cost upwards of $1000.

Cultural Barriers

Less understood than the simple math of hours driven and dollars spent — but still key in understanding barriers to access — is the culture of Atlantic Canada. This is a place where church is still central to daily life in ways that it no longer is many other parts of Canada. An Angus Reid poll conducted last year found that Atlantic Canadians were more likely to embrace religion, at 38%, than the national average of 30%. That increased acceptance of religion plays out in the politics and policies of the region.

“PEI has always imagined itself as an island apart,” Colleen MacQuarrie said. “The anti-choice movement has renamed us a life sanctuary. Those are parts of the fabric within which we’re trying to repatriate care. The church and state seem to be more closely aligned here than perhaps in other places.”

That leads to a lot of silence around abortion, something that makes an already difficult process even harder to navigate. “On PEI there’s no easy access to information currently around how to access, around what happens, around the difference between medical and therapeutic, approach, timelines,” Viau said. “It’s just very silent and invisible here.”

That silence most hurts those who can least afford to continue a pregnancy they don’t want, with potentially dangerous consequences: “Obviously poorer, more marginalized women are going to be the ones who are going to feel those restrictions the worst of all,” said Colleen MacQuarrie. “Our research shows that when women are denied safe access to abortion, they will sometimes feel desperate — and desperate women will sometimes do things they would never ever consider in other circumstances.”

It’s all part of a wider cultural climate that limits reproductive choices for women in ways that go beyond abortion itself. “We have doctors in Fredericton who refuse to prescribe birth control to unmarried women,” Taylor said. “If that’s the climate of New Brunswick, we need to change that too.”

PEI activists use some of the island’s culture to promote their cause. Beginning in January, posters by an anonymous artist or artists were plastered around Charlottetown, PEI’s capital. They demanded “Access Now” and featured an image of Anne Shirley of Anne of Green Gables, the province’s best-known export, wearing her signature red braids and a bandana over her face.

“I think it was clever, and a smart way to raise awareness of women’s right to have bodily autonomy,” Colleen MacQuarrie said. “I think it also speaks to the general interest, the fact that no one really knows who this artist is. We have an entire group of people thinking about the issue and how they can influence change.”

As difficult as the struggle for fair abortion access in the region has been, it has forced a conversation about a medical procedure that is incredibly common but often silent and misunderstood.

“What’s been so great about what’s happened is that it’s really created this conversation around access in general,” Pye said. “It’s so common, but it’s something that people are still uncomfortable talking about. But it’s something that we absolutely have to start talking about.”

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Lead image: Wikimedia

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