Barriers to abortion persist

Access to abortion services limited by a lack of information and inadequate medical training

The entrance of the Women’s Clinic at the Kingston General Hospital.
The entrance of the Women’s Clinic at the Kingston General Hospital.
Photo: 
Statistics on Ontario abortion services from the Women’s International Study Forum and Canadians for Choice.
Statistics on Ontario abortion services from the Women’s International Study Forum and Canadians for Choice.
Credit: 
Graphic by Michaella Fortune
A map of Ontario hospitals offering abortion services.
A map of Ontario hospitals offering abortion services.
Credit: 
Supplied by Canadians For Choice

After finding out she was pregnant, a Queen’s student decided to terminate her pregnancy — but waited over a month for an abortion appointment.

The former student, who requested to remain anonymous, found out she was pregnant through a pregnancy test while attending Queen’s. After an appointment with a doctor and nurse at Health, Counselling and Disability Services (HCDS), she was referred to Kingston General Hospital (KGH) for an abortion.

Between her HCDS appointment and the date of the procedure at the KGH Women’s Clinic, five and a half weeks passed. In the weeks before her abortion, the student said she had to deal with symptoms of pregnancy and the knowledge that she was no longer in control of her body.

“Being pregnant is the absolute worst thing that has ever happened to me in my life. It turns out as soon as you’re pregnant that your body is no longer your own,” she said. “And that is not something that I could emotionally and physically handle.”

In 1988, the Supreme Court of Canada struck down legal restrictions surrounding abortion, deeming the restrictions unconstitutional under the Canadian Charter of Rights and Freedoms.

Including KGH, 17 per cent of Ontario hospitals provide abortion services, compared to 15.9 per cent of hospitals nationwide. Eight freestanding clinics operate within Ontario, all of which are situated in Toronto and Ottawa.

KGH told the Journal in an email statement that the Women’s Clinic provides services that include miscarriage management and abortion, and that it also serves as a resource to inform women about pregnancy and termination.

Located on the east side of KGH’s ground floor, the Women’s Clinic provides abortions up to a 12-week gestation period. Nurses, family physicians and social workers comprise the staff at the clinic.

A woman whose pregnancy is further along than 12 weeks must seek services from another clinic or hospital. KGH can’t provide abortions past that period, the hospital said, because of the increased risk of bleeding, KGH told the Journal they couldn’t disclose how many abortions they’ve performed this year or the amount of staff that work in the Women’s Clinic due to privacy concerns.

A social worker and physicians discuss the abortion procedure and associated risks with women beforehand, the hospital said, and counselors are made available before, after and on the day of the procedure.

The former student said because she chose abortion over carrying her pregnancy to term, she didn’t receive enough information about self-care during pregnancy.

“If you have been wanting to have a baby … you’re getting pre-natal vitamins and [doctors] talk about how to deal with nausea and what to do, how to take care of you and what’s okay,” she said.

“Because you’re getting an abortion, there is none of that.” The former student said she asked a doctor at HCDS for further information about what to expect on the day of her procedure, adding that she was then handed a booklet, which didn’t provide the information.

At the time, she only told her partner that she was pregnant. Due to the stigma surrounding abortion procedures, she hid her pregnancy from other people, she said.

The lack of discussion and knowledge surrounding abortion — including personal stories from others — is problematic, she added.

“How do you make an informed decision about what you want in your life without this information?” she said.

In 2012, 27,386 abortions were performed in Ontario, about 31 per cent of which were performed on women between the ages of 20-24.

While Kingston has the Women’s Clinic and Ottawa has three abortion providers, only one hospital provides abortion services north of the Trans-Canada highway.

The Canada Health Act (CHA) — which sets out regulations that provinces and territories must follow to receive funding for health insurance — doesn’t contain requirements for the locations or number of abortion clinics.

The Ontario government doesn’t mandate that there be a minimum number of clinics within the province — nor is there a provincial regulation concerning the gestational limit that some hospitals impose. The CHA states that provinces must fund healthcare deemed “medically necessary”, which isn’t defined within the act.

Doulton Wiltshire, director of Queen’s Sexual Health Resource Centre (SHRC), said she’s personally accompanied 38 Queen’s students to their abortion appointments at KGH.

Wiltshire said that although KGH usually gets students in on time for their abortion, the 12-week limit is a concern.

“The issue becomes when people don’t know they’re pregnant right away, or aren’t starting that timeline soon enough,” Wiltshire said. “If you are 11 weeks pregnant and then decide that termination is the best course of action, it’s a crunch time.”

If a student has to leave Kingston to seek abortion services, she added, that can be a huge barrier to access.

“You’re talking about having to travel several hours, and having to compete in large cities for resources. If you’re adding another couple of weeks to that, that can be hugely problematic,” she said.

She said a trip to Toronto or Ottawa can also be costly and difficult to hide from families at home if it involves a bus, train or a night in a hotel.

“We’re actually very lucky in Kingston to have a clinic. We’re the only clinic between Ottawa and Toronto,” she said.

A study published last year in the Women’s International Study Forum — a bi-monthly journal on feminist research — found the cost and time it took to travel to an abortion clinic or hospital poses a barrier to access to abortion services in Canada.

Christabelle Sethna, an associate professor at the University of Ottawa, co-authored the study. Seventeen out of 26 freestanding abortion clinics in the country participated.

“What we’re seeing here in Canada is that abortion doesn’t have to be illegal in order for abortion services to be inaccessible to many women,” Sethna said.

Sethna said major urban centres, such as Toronto, Montreal and Vancouver, are well equipped to deal with abortion care.

Travelling to those centres from other locations, though, takes time and involves extra costs, she added. The study showed 18.1 per cent of women who participated nationally had to travel more than 100 km to reach their appointment.

This process can also involve more than one appointment, Sethna said, usually for an ultrasound or consultation before the abortion procedure. She added that even when a nearby hospital performs abortions, women don’t always feel comfortable seeking services there.

“We found in the study that a lot of women bypassed the hospital closest to them, because they didn’t feel they were being respected over the telephone or they got misinformation,” she said.

“Or they may not want to go to the nearest hospital or clinic because they would be known. There would be an issue around confidentiality and anonymity.”

According to Sethna, women who leave their home province to attend school can face additional challenges, such as having to pay for an abortion up front.

“Let’s say the hospital says, ‘we’re not going to do [an abortion] at five months, but she can go to another hospital.’ Well, that hospital might be in another province,” Sethna said.

Through the Reciprocal Billing Agreement — which applies to every province and territory except for Quebec — Ontario residents usually don’t have to pay out of pocket for health care in other provinces, as health care portability is guaranteed under the CHA.

Abortion, however, is de-listed under this agreement, meaning residents who receive abortion services outside their home province are billed directly.

Abortions that aren’t automatically covered by a provincial health care plan can cost hundreds of dollars, according to Sethna’s study. The study also found that 60.5 per cent of participants who had abortions made $30,000 or less a year.

Dawn Fowler, Canadian director of the National Abortion Federation (NAF), said these costs are a significant barrier.

NAF, a professional association of abortion providers in North America, works to improve care in Canada through advocacy and supporting medical education.

“If you became pregnant and decided…you wanted an abortion, and went to one of the facilities in Vancouver and presented your Ontario health card, they’ll say, ‘I’m sorry, we don’t have interprovincial billing,’” Fowler said.

This can pose a problem for students who have left their home province for school, Fowler added.

“You can fly back home to Ontario and get your abortion there. But you have to come back to British Columbia to continue your studies,” she said.

Fowler said NAF is working to put abortion on the Reciprocal Billing Agreement through advocacy. Abortion has never been included in the agreement, which was signed in 1988.

“It’s not justified by having it excluded from the billing agreement,” she said. “[Abortion] is the only time-sensitive, women-specific item that’s on the [exceptions] list.”

Julie Lalonde, a board member of the Abortion Rights Coalition of Canada (ARCC), said women in Canada face barriers to access beyond financial constraints.

The ARCC focuses on providing better access through advocacy and working to de-stigmatize abortion. Misleading information purported by crisis pregnancy centres can be an issue, Lalonde said, as information about abortion isn’t commonly known to begin with.

“Just finding out where to go and not being duped by crisis pregnancy centres, which are anti-choice organizations, in which there are significantly more than there are actual providers of abortion services,” Lalonde said.

Whether doctors and nurses are willing to perform abortions and a lack of knowledge about reproductive health among medical professionals can also block access, she added.

The Kingston Pregnancy Crisis Centre (KPCC) aims to provide information to women who are seeking support during an unwanted pregnancy, according to Donna Bell, director of the KPCC.

Although the organization is Christian faith-based, they have no desire to sway a woman’s choice concerning unwanted pregnancy, Bell said, adding that the KPCC aims to ensure information is given on three choices: adoption, abortion and having a child.

“[The KPCC] is all about informed decisions. There’s no judgment, no pressure, no sense of this is what you should do, because a woman has the legal right to choose,” she said.

Suzanne Billing, the medical director at HCDS, said doctors at Queen’s offer information and options concerning abortion to students based on their wants and needs.

“We try to offer the options open to them in an unbiased manner so that the choice someone makes is not based on a coercive approach,” Billing told the Journal via email.

“Some come in saying they are interested in ‘x’ option,” she added, “[and] others present in tears with a positive pregnancy test, saying little.” Physicians that are well informed about women’s reproductive health continues to be an issue, according to a 2005 study published in the McGill Journal of Medicine.

The study found that almost 40 per cent of Canadian medical schools don’t teach abortion procedures to students before they’re placed in hospitals and clinics for clerkships.

Medical Students for Choice (MSFC), an organization that has chapters across Canada and the United States, aims to increase the education of physicians and nurses concerning abortion and reproductive health.

Ten of 17 Canadian medical schools have a MSFC chapter. The Queen’s chapter currently isn’t fully active yet. Alida Pokoradi, MD ’16, became “co-leader” of Queen’s MSFC chapter this year. She said the chapter is gaining members at the moment, and hopes to be fully functional by November. They currently have a few members, she said.

In her experience so far as a third-year Queen’s medical student, the curriculum requires only a surface understanding of abortion, Pokoradi said.

“In the classroom there isn’t any emphasis put on abortion because there are so many other things to cover in reference to obstetrics and gynecology,” she said.

During medical students’ clerkship years — which they complete in their third and fourth years by working at KGH or within the Kingston community — students have the option to spend one day at the KGH Women’s Clinic, Pokoradi said, but students can opt out for personal or religious reasons.

“So they could essentially finish their undergraduate medical education without having had any exposure to abortion.”

According to Jolanta Scott-Parker, executive director of the Canadian Federation for Sexual Health (CFSH), the fundamental issue is a lack of accurate information .

She said several improvements must be made in Canada so access to abortion services can be more transparent and available.

“Increasing the openness, accessing information and challenging issues around abortion stigma,” she said, “and just normalizing the reality that this is a choice that many women make.”

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