Cape Breton women still face barriers and stigma when seeking an abortion

There may be less red tape surrounding the so-called abortion pill, but many women in Cape Breton will still make the lengthy drive to Halifax if they want to terminate a pregnancy.

The issue, according to advocates, is the reluctance of many family doctors on the island to prescribe Mifegymiso — the brand name for the combination of two pills used to end a pregnancy of up to nine weeks.

"We all thought ... it would be the answer to the access barrier, but it hasn't gone that way," said Shannon Hardy, founder of Abortion Support Services Atlantic.

When Mifegymiso hit the Canadian market two years ago, the hope of many advocates was that women in rural areas would not have to travel hours for a medical abortion, as they could be prescribed the pills by their family doctor.

The cost of the pills is now covered by the Nova Scotia government. Health Canada lifted several restrictions around prescribing more than a year ago, and in April eliminated the need for an ultrasound, unless the patient is unaware of how long they've been pregnant.

But Hardy, whose organization provides travel services and a place to stay for women who must go to Halifax for an abortion, said she hasn't seen a big decline in the number needing drives in from rural areas.

Some are seeking a surgical abortion. But many are going to the city so they can get Mifegymiso, according to Hardy.

Hardy believes a big barrier is women don't know who prescribes the medication. She spends a lot of time calling family practices around the province to find doctors who do.

The response has not been warm in Cape Breton.

"I get sort of an angry answer like, 'We don't do that,' I get hung up on," she said. "The people answering the phone are not necessarily medical professionals, they don't necessarily know if the doctor does that, it's really their decision whether to put me through."

If a woman is over nine weeks pregnant and wants an abortion, she requires a surgical abortion. The province is currently only referring patients to the Valley Regional Hospital in Kentville or QEII Health Sciences Centre in Halifax for the procedure. 

Hardy said Cape Bretoners make up the second highest population of women her network accommodates in Halifax, while women from the Yarmouth area take the top place.

She believes it would help if nurse practitioners could prescribe the medication. She also wants to see Doctors Nova Scotia take the lead in educating physicians about Mifegymiso.

However, things are starting to get better, according to the Nova Scotia Health Authority. Kim Munroe, the health authority's director of ambulatory care, said there is a self-referral line to call and arrangements can be made to get prescriptions for Mifegymiso in patients' own communities.

Munroe said there are four Cape Breton doctors now in the Nova Scotia Women's Choice Clinic network. There could be others prescribing, said Munroe, but joining the network is up to the individual physician.

"We'd like to see more providers self-identify themselves to be a part of our network, it makes it easier for us," she said.

The province is also encouraging more doctors to prescribe the pills, according to Heather Fairbairn, a spokesperson for the Department of Health and Wellness. Around 30 per cent of abortions in Nova Scotia in 2018/19 were through Mifegymiso, she said.

"This represents support for the therapy by the medical community. We encourage physicians to include Mifegymiso as an option in their discussions with patients," said Fairbairn.

According to Dr. Margaret Fraser, president of the Cape Breton Medical Staff Association, access to a family physician plays a major role in whether women can get an abortion in Cape Breton.

Fraser said she knows of five physicians in the Cape Breton Regional Municipality who prescribe Mifegymiso, and believes getting doctors to prescribe can be a tough sell.

"Not everybody feels comfortable providing it and not everybody has the time to provide it," she said. "It requires a minimum of two visits and up to three visits."

Abortion part of family practice

Fraser said it's a "significant investment of time" and there are risks that come along with it. For example, a patient could hemorrhage or require extra care.

However, she believes abortion is a part of a standard family practice and access comes down to a lack of physicians in the area.

"I believe very strongly that women should have access to abortion in whatever form is necessary," she said. "But unfortunately it's not always possible for every practice to provide each of those services."

Finding the services can be particularly problematic for students at Cape Breton University, many of whom are from another province or country. 

However, Fraser said she plans to provide a list of the five doctors who prescribe Mifegymiso to emergency rooms in the CBRM. She said those five doctors are doing their best to fill the gaps and to take on non-patients in need of the pill.

Munroe, with NSHA, believes many women choose to leave rural settings due to privacy concerns. In small towns, it's likely patients know people working at hospitals or clinics and may not feel comfortable. 

"There's always an option for them to have the service offered to them closer to home but through conversations and through counselling it may be determined that may not be what they want," said Munroe.

"Although we know health care services in this province is confidential and private women still have the right to protect their own information, they don't want someone to seeing them in the hospital and they have the right to go somewhere else."

Federal health minister

The issue of doctors not prescribing was recently raised by federal Health Minister Ginette Petitpas Taylor, who wrote a letter to the provincial health ministers calling out inequality of access to abortion and asking the provinces to do more.

Petitpas Taylor's two-page letter focused primarily on provinces that have not been properly reimbursing women who had to travel to receive abortions out of province. However, the health minister also highlighted the issue of doctors not performing medical abortions. 

"I am further disturbed by recent reports that Canadians are facing difficulties in finding medical practitioners willing to prescribe Mifegymiso either in person, or for those living in remote and rural areas, through telemedicine," she wrote.

Vanessa Walker, the executive director and sole employee of the Cape Breton Centre for Sexual Health, said she does her best to support women seeking to terminate their pregnancies.

The centre provides support and guidance to anyone with concerns about sexual health, free or low-cost supplies such as condoms and pregnancy tests, and help navigating the health-care system. It's also closed in the summer due to insufficient funding.

That doesn't stop people from calling the centre for help during those months, which Walker tries her best to manage. In July, she had three calls looking for pregnancy tests and several seeking information on where to get an abortion.

"When I'm open I average about four calls or messages a month for abortion access and most of them are trying to get Mifegymiso," said Walker, who is also an abortion doula who can provide emotional support and attend appointments with women.

She directs people to call the province's self-referral line to get an appointment or instructs them to call local pharmacies in hopes of finding a doctor who prescribes Mifegymiso.

Walker said another barrier is attitudes around abortion. There are multiple anti-abortion

billboards on the island, several of which are located on highways that lead off Cape Breton.

"Somebody who is going and making this choice doesn't need to see that thing," she said, adding the billboards were put up by fraternal organizations.

She and several other women took it upon themselves to fundraise to put up a pro-choice billboard in Sydney for about a month. In just a few days they raised over $1,500.

The billboard will be set up in September. If the sign is a success they may raise more money to get more permanent signage.