In Canada, abortion care is health care — but there's more we can do

Martha Paynter is a registered nurse and a PhD candidate at Dalhousie University's nursing school. Her clinical work and her research centres around abortion and reproductive care, with a particular focus on marginalized communities.

Within days of Alabama criminalizing the provision of abortion care, Ontario's Court of Appeal ruled that physicians who object to abortion must provide an immediate referral to a practitioner who does not — to ensure that patients receive timely and appropriate treatment.

But although my social media feed was full of shocked fury about Alabama, there was only a trickle of relief expressed about the Ontario decision and the limits it sets on conscientious objection.

We continue to have a poor understanding surrounding the access to and governance of abortion in Canada. While that lack of communication reinforces stigma and leads to inequity, abortion is a component of health care here; there is nothing criminal about it.

Denying abortion care violates constitutional rights — security of the person and the right to gender equality. In the past four years, there have been significant regulatory changes that have improved access to abortion, especially for those living in rural areas who would have previously had to travel for a surgical procedure.

Improving access

In 2015, Health Canada approved medical abortion — medication known as Mifegymiso, a compound that includes two drugs which, together, terminate early pregnancies.

Nova Scotia and most other provinces and territories supported that decision by agreeing to publicly fund the medication, a rarity in a public health-care system that does not usually pay for medicine taken at home. In Nova Scotia, family doctors and nurse practitioners can now prescribe a medical abortion and patients can self-refer to the Nova Scotia Women's Choice Clinic to be connected to service providers in Halifax and across the province.

But there continue to be practical impediments to abortion access in Canada.

Barriers to care

Sometimes, patients learn of their pregnancies too late and cannot access medical abortion, available for only up to nine weeks, or even surgical abortion, which is available in Nova Scotia until about 15 weeks and six days.    

Because few practitioners provide surgical abortion in Canada, some patients must travel long distances to reach the care they need. In Nova Scotia, that can mean a 500-kilometre trek for a surgical abortion; in the northern territories, that can mean flying out of your community.

This geographic barrier translates into an economic blockade: if you do not have the money for gas, a motel room, and time off work, you may not be able to seek care. The costs can climb higher for those who seek abortion care later on in their pregnancy: they may have to travel further, to Ontario or even Colorado, where there are providers with the skills to perform procedures beyond 16 weeks.

As a nurse and a scientist, I feel we are not talking enough about our responsibility as clinicians to provide — or at least support — abortion care as basic, normal, primary health care. Medical, midwifery and nursing schools are not teaching this obligation and the practical steps to actualize this care.

And this is indeed an obligation.

Our professions are based on the principle that, first, we must do no harm. Impeding patient autonomy is harmful, and failure to learn how to serve our patients' needs is neglect. At a minimum, providers must know how to swiftly send patients to someone who can provide care if they cannot do so themselves.

Failure to secure abortion forces a patient to experience pregnancy.

From a clinical standpoint, pregnancy and birth are more dangerous than abortion and have immeasurable and lifelong social and economic repercussions on patients' lives.

Many clinicians who provide and support abortion care are frustrated. Why can't our systems simply support women and people with uteruses? Why can't people have access to free contraception? Why can't society be free from sexual assault and reproductive coercion? Why can't kids get great sex education that teaches them consent, autonomy and respect? Why can't our health professional schools teach not only how to prescribe abortion and contraception — but how to speak with patients to communicate our trust in them and our admiration for their self-care?

How we care for patients

We have a choice to stay frustrated or to be motivated to act.

These are not unachievable or unrealistic dreams. In fact, they are evidence-based, economically wise, and ethical options for our future.

As a clinician supportive of abortion, it is my responsibility to communicate widely and openly about the practice: what it is, how it works, where to get one and how to get one.

Communication reduces fear, stigma, and ignorance. It is my responsibility to communicate to my professional regulatory body, my union, the university where I trained and where I teach, and to my peers about how we must contribute to removing the remaining impediments to access.

What is happening in Alabama and elsewhere amounts to political interference in a patient's health and their right to decide what happens to their body.

It is criminalization of care and it is unimaginable for me. But before 1988, this was the reality in Canada, too.

Health-care providers and patients worked together to secure freedom of access to abortion in Canada — and we must continue to work together to uphold these rights.  

Despite stability of abortion provision currently, the anti-choice movement in Canada remains eternally hopeful about restricting our rights, even as 77 per cent of Canadians identify as pro-choice.

We cannot allow a vocal minority to interfere with our commitment to reproductive health — or to our commitment to our patients.

Abortion is health care and we are health-care providers. Let's get to work.