Re-Evaluating rights

When Texas Senator Wendy Davis filibustered for over ten hours to halt the vote on a law that would limit abortion access in her state last month, Canadians watched with as much interest as our southern neighbours. Canada hasn’t had a law concerning abortion since the famous Supreme Court Case spurred by Dr. Henry Morgentaler stuck down the abortion provisions in the Criminal Code in 1988. Since then no Canadian ruling party, despite the individual efforts of some backbenchers, has touched the debate.

The result is that women are free to make the best choice for themselves personally in Canada. But how free are they? While the law can make no limitations on Canadian women, they do face issues accessing abortion services stemming from a lack of available doctors and the stigma that surrounds the procedure.

In Waterloo Region, many women who find themselves in need of reproductive health assistance go to Planned Parenthood. The centre, which offers full counseling and a number of other reproductive health services, prepares women to deal with some of the issues that arise with seeking an abortion including wait times, travel and language barriers.

“They only [perform therapeutic abortions] up to 12 weeks here and so many days,” explained Angie Murie, the executive director of Planned Parenthood Waterloo Region. “And they will not do it if you have medical conditions of one sort, like epilepsy or a heart condition.”

The here Murie refers to is the Freeport Clinic, a site that is part of the Grand River Hospital system. It’s a large medical facility that offers many procedures, but one or two days a week it also provides therapeutic abortions. It is the only abortion clinic, public or otherwise, for all of Waterloo-Wellington. That means residents of Guelph or other further out towns have to travel all the way into Waterloo to access abortion services. “That’s a problem as far as I’m concerned,” said Murie.

As a result, wait times can stretch anywhere from one to three weeks. And should a woman with an underlying medical condition or who is more than 12 weeks pregnant need help, they’ll have to make an appointment in either Toronto, Hamilton or London.

“[Travel] is a barrier as well for some women,” said Murie, recalling the story of one patient who had to travel to London. “She didn’t have a car and the bus that was available wouldn’t get her there…her appointment wasn’t until seven in the morning so she had to go the night before, which means a hotel stay.”

For a woman who has access to support, a car and funds, these barriers might simply be inconvenient. But for some women they are much more than that. “We get a lot of university students who come here,” said Mary Hall, the interim clinical services supervisor at the Region of Waterloo sexual health clinic, another resource for people looking for information about abortions. Students, teenagers and people who work full time face more barriers paying the costs of travel.

Patients may also have trouble finding information about abortion services from their own medical providers. Under Canadian Medical Association policy, doctors cannot be compelled to provide abortions.

These barriers are not unique to Waterloo Region. In fact compared to some areas of Canada, it is still relatively easy to access abortion services. “Where you live makes a big difference in terms of what abortion services you’re going to be able to access and how easily you will be able to access them,” said Dr. Christabelle Sethna, an associate professor at the Institute of Women’s Studies at the University of Ottawa. She’s studied how far woman have to travel to access abortion services across the country.

“If you live in a rural area in a smaller centre it becomes a lot harder to access abortion,” said Sethna. Some provinces, like PEI, have no abortion service providers at all. Women are forced to travel to other Maritime provinces. Sethna cites the example of New Brunswick where women must get the approval of two doctors before they can go forward with the abortion.

Despite the fact that technically speaking, abortions are a relatively simple out-patient procedure that most doctors could do as long as they have access to a hospital in case complications arise, few do it. For some, it’s because of moral or spiritual reasons.

Murie said  the problem may lie at the medical school level. “I know that on a regular basis we’ve heard that when they’re teaching about stuff in hospitals that abortion is really down played.”

McMaster Medical School, which has a Waterloo campus, did not respond to CCE requests to provide details of its curriculum regarding abortion services. At University of Toronto, therapeutic abortions are listed as part of the course curriculum for students in third and fourth year.

One recent graduate of McMaster’s medical program was willing to speak to the CCE anonymously about her experience learning about therapeutic abortions in medical school. While she attended McMaster, the only abortion training she received was during an ethics class, when they discussed what to do if a patient approached them requesting information about them. “There were evening sessions that were organized by  student groups and presented by local abortion providers,” she said. “They were very well attended.” Residencies that offered experience providing abortion services were also atypical, according to her.

The reason for this is not a grand conspiracy on the part of medical schools or the government to stop women from accessing abortion services. It’s due in large part to the stigma and fear that surround the procedure. “It can be kind of  hard to get in touch with doctors who are abortion providers, ” said the McMaster grad we spoke to. Students need that contact to get practical experience. And as she pointed out, the fact that she didn’t want to be identified in the article speaks volumes.

This sentiment is echoed by Murie, who notes she always ensures her own staff are careful even when arriving and departing the Planned Parenthood offices — even though they don’t even perform abortions there.  “That level of internalized shame kind of permeates a lot of what we do,” she said. “There’s always this sense of how much do we advertise stuff versus how much do we keep it quiet because we don’t want to invite to much tension.” It’s an unusual position for a non-profit to be in since most normally want increased awareness of their services.

Attacks against doctors are still unusual in Canada but not unheard of. But the stigma is what keeps many people quiet and makes it more difficult to find the services they need.

Hall did however note that patients have had an easier time finding her clinic since the internet made things easier to find information on anything. “Most of the people are getting our info from the website and they are not having trouble accessing it,” said Hall.

Though abortion services in Canada – and Waterloo Region –  is more accessible than in some places, Sethna does not believe we should become complacent. “This is what I’m trying to hammer home in my work,” she said. “Abortion does not have to be illegal in order to be inaccessible.”

You can find more information about reproductive health services on Planned Parenthood’s website, ppwr.on.ca/

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