New abortion debate emerges in N.B. — on how best to improve access

There's a new debate emerging about abortion in New Brunswick — between groups who support access but have different approaches on how to pursue that goal.

Health-care professionals who provide the service in three hospitals in the province say media reporting on claims of delays in those facilities is "inaccurate."

"The network's position is that no patient has had to wait more than two weeks since the hospital-based clinics opened as they are now," says Martha Paynter, a spokesperson for the New Brunswick Abortion Care Network.

The network says it's a "self-organized, collective effort" of doctors, nurses, nurse practitioners and pharmacists, some of whom work for hospital family-planning clinics but who speak as a group independently of the government. 

"What we want to emphasize as a network is that all of the abortion-care providers in this province, in this country, are super-dedicated to patients, want them to get care as fast and as safely as possible and want them to to have information about all of the choices," Paynter said. 

At the same time, staff at Fredericton's Clinic 554 — where the province refuses to fund surgical abortions — say it's the regional health authorities' claims of timely access that are inaccurate.

"There is and has always been a wait list for abortion" in New Brunswick, Clinic 554's medical director Dr. Adrian Edgar said in an email to Horizon's CEO last week.

"The patients tell me this directly."

The diverging interpretations of the two groups, both dedicated to access, became apparent last week when a federally commissioned report on the issue was released.

The report, which focuses on Clinic 554, called on the New Brunswick government to fund procedural abortions, also called surgical abortions, in clinics outside hospitals.

The report said a higher rate of patients at the clinic get an abortion before the ninth week of pregnancy than those in Canadian hospitals — one indicator of a barrier to access at hospitals, it concluded. 

The provincial government, however, disputed that there are delays at the three hospitals in Moncton and Bathurst that provide the service. 

Clinic 554, in turn, cited two examples of women who staff said were referred there because they couldn't get hospital appointments before Dec. 10.

The Horizon and Vitalité health authorities responded that, as of last week, they were booking appointments for eight to 10 days later.

Now the abortion care network is backing that.

"Actual time between patients calling and being booked for care with hospital-based clinics is between 8-10 days," the network said in a statement. 

Paynter, an assistant professor of nursing at the University of New Brunswick, said two-thirds of patients who go to the hospital clinics choose medication abortions — the abortion pill Mifegymiso — which is prescribed up to the ninth week of pregnancy. 

"By definition, those, at minimum, constitute two-thirds of all patients being under nine weeks," she said.

"So it's likely more than that, but it's definitely at least that."

The medication option has been covered by Medicare since 2017.

'This is apples and oranges'

Paynter questioned why the research study compared the timeline for Clinic 554 procedural abortions to those in hospitals nationally, rather than the three inside the province.

"You're comparing all of Canada with just New Brunswick. This is apples and oranges." 

The study's lead author, Jula Hughes, told CBC News that her team was told gestational timeline data for the three New Brunswick hospitals was not available.

Hughes, a law professor and longtime supporter of Clinic 554, was commissioned to lead the research study in 2021, when the federal government was facing pressure to force the New Brunswick government to fund abortions at the clinic through Medicare.

Then-federal health minister Patty Hajdu announced the study at the clinic, which has been the focus of legal and political battles over abortion access for decades.

Hughes's report pointed out other barriers to procedural abortions in hospitals, such as education levels, an inability to take time off work and the travel distance from many parts of the province to hospitals in Moncton and Bathurst.

The network's members say they are working to improve access where the service is available — for example by asking the province to set up a single provincial point-of-access phone number.

On its website, the network points out patients can book appointments directly with the hospital clinics at the Moncton and Bathurst hospitals, without a referral.

The site also includes links and resources to help patients contact providers that prescribe Mifegymiso, including the Fredericton Downtown Health Clinic, which offers virtual appointments provincewide, and the Saint John Sexual Health Centre.

Paynter says that's essential because media reporting focusing on Clinic 554 often ignores the growing use and availability of Mifegymiso.

"Nobody is talking about it," she said. "We've only had it since 2017 and it just gets excluded from the reporting."

That in turn can impede even wider access, she says.

"In theory, any primary care provider could prescribe it. But they don't even know about it." 

Even so, more than two-thirds of abortions in the province in 2022 used medication, "a big change in a very short amount of time," Paynter said. "We are seeing very big changes, very fast, and it's great but it's kind of hard to keep up with." 

Clinic 554 advocates see the situation differently.

Hughes's report is skeptical of what the provincial data on Mifegymiso means, saying the number of doses prescribed and covered by Medicare is "a very imperfect proxy for the rate of medical abortions in the province."

And Clinic 554's Edgar said the high number of medication abortions is evidence not that women are choosing the less intrusive route first — but that they're forced to go that route because hospital access is limited.

Edgar has also accused Horizon and Vitalité of misleading the public on delays to access.

In an email last week he said he treated two patients referred from Vitalité hospitals because they could not get appointments before Dec. 10.

"I personally participated in the handover at the time of booking and literally have the faxed referral — on Vitalité letterhead — in this patient's chart," he said of one case.

He did not respond to a request from CBC News to provide a copy of the paperwork with the patient's information removed. 

Paynter said there are sometimes patients "on the edge" of passing the gestational point of their pregnancy when the hospitals will do the procedure — 16 weeks in Moncton and 14 weeks in Bathurst — and then "bad luck" can make scheduling it impossible in time.

But in those cases, the network will help women find options outside the province, she says. 

The differing interpretations can't be called a split in the movement for abortion access.

Both groups support the broad principle. And the network believes procedural abortions in clinics outside hospitals need to be part of the mix, calling the province's refusal to fund them "unfair."

But the Higgs government is adamant it will not fund the procedure at Clinic 554.

And Hughes's report acknowledged there is no "straightforward articulation" of a Charter right to abortion care that Ottawa could use to force the province to do so.

Paynter would not comment on whether there's been too much focus on that issue.

"I don't want to speak on that," she said. "I want to promote understanding of what people can do." 

That emphasis on improving existing options is bearing fruit, Paynter said.

The family planning clinic at the Dr. Georges-L. Dumont University Hospital in Moncton recently doubled its capacity, the network says. 

And the clinic at the Moncton Hospital will soon do procedural abortions up to the 18th week of a pregnancy — two weeks longer than the current 16.

"We're making progress all the time," she said.