Three decades have passed since abortion was decriminalized in Canada but barriers remain. This is concerning because abortion is a very common procedure and an integral part of a comprehensive package of sexual and reproductive health services.
Action Canada for Sexual Health and Rights runs a national toll-free 24-hour access line that provides information on sexual and reproductive health matters as well as referrals for abortion services when needed. This work offers us privileged insight and information on the specific barriers individuals experience when seeking safe abortion services.
Many of the calls are about people’s difficulties in accessing safe abortion care. Barriers we’ve heard of on the Access Line include:
- Not being able to locate nearby services
- Needing to travel (sometimes hundreds of kilometers away because of gestational limits or having no access to a provider at all)
- Having to cover the costs incurred by travel (which can include childcare, eldercare, missed work, plane tickets, gas money, accommodations and food, expediting a passport or Identification papers)
- Having to cover the costs of the procedure itself (due to not having a health card or identification documents, issues with reciprocal billing between certain provinces, being an international student, or being in a precarious immigration situation with delayed cost coverage, providers being unsure about how to bill for their services, or people being unaware of where to safely access services when in irregular immigration situations)
- Being delayed by anti-choice health care providers or staff acting as gate keepers or receiving false or misleading information about abortion and where to access it.
- Being delayed by wait times that can come from mandatory ultrasounds and mandatory doctor’s referrals and tests, etc.
- And the list goes on…
Barriers to abortion disproportionately affect young people and marginalized people, especially those who are low-income, people of color, migrants or refugees, people with precarious immigration status and those who do not speak English or French. These barriers are compounded for those living in rural or remote areas.
Making medical abortion more easily available is an important way to expand choice when it comes to terminating a pregnancy and could have an important impact on the accessibility of abortion in Canada. It can be offered earlier than surgical abortion, has the potential to reduce wait times for surgical abortion procedures and wait times overall, can be offered to people who want to avoid an internal procedure for a number of reasons, and can be administered by different health care providers, including family doctors and professionals like Nurse Practitioners and midwives, which has the potential to increase access in more remote and rural areas. Currently, most abortion providers are in major urban centers located less than 150 km from the US border, only 1 hospital in 6 offers abortion, and services can very hard to access in some places because of unnecessary strict rules and regulations. Incorporating medical abortion care in primary care settings could change the game for people who need access to this service.
Many health care providers and their professional colleges are stepping up to the plate! In July 2017, the Canadian Nurses Association publicly stated their opinion on Nurse Practitioners (NP) prescribing of Mifegymiso. Four months later, Health Canada revised their guidelines on prescribing Mifegymiso, substituting "physician" with "health professional." This change enabled the prescribing scope of practice of other health care professionals, including nurse practitioners.
Since that time, the Colleges and or Associations of Nurses in Alberta, British Columbia, New Brunswick, Nova Scotia, and Ontario have announced their support of NP provision of Mifegymiso. Similarly, the Nurses Association of the Yukon and of the Northwest Territories/Nunavut support independent prescribing by Nurse Pratitioners.
On October 18th, 2018, the Registered Nurses Association of Saskatchewan became the 8th province/territory to announce their support of NP provision of mifepristone medical abortion!
Same goes for midwives who, since Health Canada modified the Mifegymiso product monograph language to “health professional” rather than “physician, have been exploring how to expand midwifery scope of practice to include both contraception counseling and medical abortion care.
Continued advocacy for better access to Mifegymiso matters. It presents us with an opportunity to address historical gaps in abortion access in Canada. Join us in taking action to make sure Canada takes full advantage of Mifegymiso’s potential to address historical gaps in abortion access from coast to coast to coast.
If you have questions about pregnancy options and/or are looking for abortion providers in your area, contact our national 24-hour toll-free Access Line at 1-888-642-2725 or email [email protected]