Nova Scotia 'out of step' with current abortion access, says health minister

Nova Scotia's health minister says abortion access in the province is "out of step" with current practices, and has asked health officials to find ways to improve.

Randy Delorey said Wednesday that women and advocates have raised important issues about access.

"This is the first time I'm aware this issue has been brought to this government's attention," he said in a statement. "We
understand practices have evolved over time and Nova Scotia is out of step with other provinces."

Delorey said he has asked staff at the Nova Scotia Health Authority and the Health Department to look into concerns and report back on how to improve access.

The health minister's statement came after The Canadian Press reported this week on barriers to abortion access in Nova Scotia, which is the only province that requires a referral for an abortion.

There are also long wait times for the time-sensitive procedure and no provincial coverage for medical abortions using pills.

Women are also being forced to wait to obtain abortions because the hospital-based clinic that performs most procedures in the province doesn't have an ultrasound machine.

Several women interviewed described waiting four to eight weeks to obtain an abortion.

NDP MLA Lenore Zann, the party's status of women spokesperson, said current wait times are horrendous, and called the need to obtain a referral "very backwards."

"Nova Scotia is really behind when it comes to women's reproductive rights," she said. "We are slowly turning a corner
but this is 2017 and it's time to get on the bandwagon and change."

Zann also said the abortion pill Mifegymiso has been proven safe and effective and should be added to the provincial formulary for universal coverage.

Dr. Joyce Curtis, medical director of the Halifax Sexual Health Centre, said the clinic plans to prescribe Mifegymiso but that there are significant hurdles to overcome first.

One of the biggest issues is a lack of provincial funding for the abortion pill, a two-step process using the drugs mifepristone and misoprostol.

"It will cost $300 to $400 depending on the pharmacy mark-up. That cost will certainly leave a lot of people out," Curtis said. "It depends on their socio-economic situation but it's a lot of money for most people."

There is also no fee schedule from the province's medical services insurance (MSI) for billing follow-up visits that may be required after prescribing Mifegymiso, also known as RU-486.

Ultrasound delays

The abortion pills can be used to terminate a pregnancy of up to 49 days.

Curtis said an ultrasound exam must be completed before taking the pills to date the gestation and to make sure the
pregnancy isn't tubal.

Wait times for ultrasounds could emerge as an issue, however, as even a short delay would block access, she said.

While some provinces have radiology clinics outside of hospitals where women can obtain an ultrasound within a day or two, in Nova Scotia all ultrasounds are done in hospital.

Dr. Lianne Yoshida, medical co-director of the QEII hospital's Termination of Pregnancy Unit (TPU) in Halifax, said wait times for a hospital ultrasound can take longer.

She said wait times for abortions in Nova Scotia could be reduced if the TPU, which performs nearly 90 per cent of abortions in Nova Scotia, had an ultrasound machine.

Removing referral rule

"We've done the paperwork to get an ultrasound machine but we still don't have one," she said. "We've even looked at getting a private donation or fundraising for it."

A so-called bedside ultrasound machine would help doctors confirm when an early abortion is complete, Yoshida said, noting that the machine would cost about $50,000.

Without ultrasound equipment, the clinic will generally not book appointments for women until they are at least eight weeks pregnant. 

"I've been working on getting an ultrasound machine. It would certainly assist in early abortions but it would be helpful across the board at every gestational age," Yoshida said.

She's also been working to remove the referral rule, which requires women to obtain approval from their family doctor before booking an abortion.