Social Policy

‘Good on paper’: Abortion access limited in Canada’s North

Women in Canada’s three Northern territories face unique barriers in exercising their right to make autonomous reproductive choices.

The 1988 Canadian Supreme Court decision of R v. Morgentaler ensured that abortion is a constitutional right for Canadian women. While legal protection of the right to choose exists across all Canadian provinces and territories, a lack of government funding and availability of trained physicians has created issues of access in provinces such as P.E.I. and New Brunswick.

In the North, funding is present to provide the services. However, geographic population displacement creates obstacles that disproportionately affect rural women compared to those residing in urban areas.

In the Northern territories, surgical abortion is funded and offered at each hospital in the respective territorial capitals. Surgical abortion is one of two options for women who wish to terminate a pregnancy with a gestation period of less than 12 weeks (14 weeks for the Northwest Territories). For a surgical abortion on a pregnancy over 12-14 weeks, the woman then must travel to Ottawa, Winnipeg, Vancouver, Edmonton, or Calgary for the procedure.

The other option for women who choose to terminate a pregnancy is medical abortion. Medical abortion involves ingesting two drugs that work together to force a miscarriage. The entire procedure takes place over the course of multiple days, and requires a follow up doctor’s visit two to three weeks later. This is an option for women with a pregnancy of less than seven weeks. There are many reasons why women choose this option, the most prominent being the privacy and comfort of being able to make reproductive decisions at home. Unfortunately, because the medical abortion option is technically prescription medication, it is not covered by territorial health insurance. The approximate $250 cost is the responsibility of the individual.

What the demand of travel fails to address is loss of income from extended time away from work, emotional removal from one’s community and culture, and the challenges of maintaining the right to privacy when making reproductive choices.

For women who live in Whitehorse, Yellowknife, or Iqaluit, the physical proximity to regional hospitals meets access standards for the most part, on par with southern urban communities. However, these cities are still not without issues. In Whitehorse, surgical abortion is not always immediately available. The procedures can only be performed a couple of days each month, and due to the lack of resources, can be bumped for incoming emergencies.

For women who reside in Northern rural communities, barriers to accessing reproductive choices are significant and unique. Whether a woman chooses a medical or surgical abortion service, the procedure demands travel to the capital cities. This is where access to abortion in the North is often labeled as “good on paper.” Under the three distinct territorial health insurance policies, abortion services and medical travel are funded and arranged by the government departments. What the demand of travel fails to address is loss of income from extended time away from work, emotional removal from one’s community and culture, and the challenges of maintaining the right to privacy when making reproductive choices.

In the Northwest Territories, Northern Options for Women is a program that assists women in accessing education on reproductive options and abortion services. Some of the work the organization does includes arranging transportation for women to Yellowknife rather than having travel be arranged through a local health centre. This helps ensure the privacy of the individual as she navigates the number of existing obstacles that challenge her access to services.

Between the lack of pharmacies present in all communities, and high turnover rates of doctors, maintaining a community presence of trained professionals with the authority to write prescriptions is difficult.

For minors, privacy is a significant factor when making reproductive decisions. Canadian girls who understand what their reproductive choices are and what they mean do not legally have to inform their parents or guardians in order to receive abortion services. However, where travel is a necessity to receive abortion services, privacy becomes difficult to maintain. A lack of privacy in reproductive decision making challenges the autonomy behind the decision. For girls and teenagers, the fear of informing a parent of the need for an abortion can lead to dangerous situations where girls attempt to self-terminate.

In the summer of 2015, Health Canada announced the approval of the drug Mifepristone, with a projected availability date of spring 2016. Colloquially known as the “abortion pill,” Mifepristone works similar to the currently approved Methotrexate. With Health Canada’s announcement came a flurry of praise, celebrating the potential impact the availability of the drug could have on rural Canadian women. However, as Grace Lisa Scott pointed out in a VICE magazine article in January 2016, the drug can only be prescribed by doctors and pharmacists who have undergone hours of mandatory training. In remote Northern communities, nurses and nurse practitioners are often the only medical point of contact in the absence of traveling doctors. Between the lack of pharmacies present in all communities, and high turnover rates of doctors, maintaining a community presence of trained professionals with the authority to write prescriptions is difficult. In the current landscape of how Mifepristone is planned to be prescribed, rural women will still have to travel to urban areas to receive the services. While Health Canada is catching up to the world standards for access options, the exclusion of community nurses from being able to prescribe the drug fails to broaden access to rural women.

Abortion is still highly emotional and stigmatized, and the removal of women from their communities is an unnecessary barrier and hardship for a medical decision that is a constitutional right.

Although reproductive choices in Canada remain a constitutional right, guaranteeing the rights of access to Northern women remains a challenge. Having access to abortion services in communities would mean fewer obstacles for women exercising their reproductive rights, and improve their ability to make better, informed decisions about their bodies and family planning. Empowering rural community medical services means women would not have to make the financial sacrifices to get an abortion, and would greatly improve the privacy and decision making for pregnant minors.

The current landscape of access to abortion services in the North forces women from their communities and cultural support networks into urban medical centres with practitioners that are often from southern Canada. Abortion is still highly emotional and stigmatized, and the removal of women from their communities is an unnecessary barrier and hardship for a medical decision that is a constitutional right.◉


Photo credit: istockphoto/Weedezign

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