Abortion in Canada has been legal in Canada since 1969, and since 1988 has been treated like any other medical procedure: governed by provincial and medical regulations. However, access is still not equal across the country, and even finding accurate information can be difficult and hazardous to your health.
If you’re pregnant and panicking, there’s a good chance your research will lead you to the website of a crisis pregnancy centre. There are about 200 of them across Canada and 4,000 in the United States, and they’re supposed to offer no-judgment counselling services for women who want to know what their options are. Most of the time, they won’t tell you they’re religious organizations hell-bent on convincing you to keep your baby.
Recently, Joyce Arthur won a lawsuit brought against her by the Christian Advocacy Society of Greater Vancouver (CAS), that had been filed in response to her 2009 report Exposing Crisis Pregnancy Centres in British Columbia, that uncovered the lies and misinformation spread by these centres. This lawsuit has unfortunately done nothing to close down these centres, or limit their falsehoods.
Women from PEI know that surgical abortions cannot be obtained in this province and must travel, often at their own expense, to another province for the service. It’s not only here that abortions can be difficult to obtain. A recent study from UBC discusses the challenges faced by rural women across Canada, by examining the BC Abortion Providers Survey. The results of the study are particular to rural BC, but it is reasonable to assume that the same barriers stretch across the country.
Twenty interviews were completed and transcribed, representing 13/27 (48.1%) rural abortion providers, and 7/19 (36.8%) of urban providers in BC. Emerging themes differed between urban and rural providers. Most urban providers worked within clinics and reported a supportive environment. Rural physicians, all providing surgical abortions within hospitals, reported challenging barriers to provision including operating room scheduling, anesthetist and nursing logistical issues, high demand for services, professional isolation, and scarcity of replacement abortion providers. Many rural providers identified a need to “fly under the radar” in their small community.
This first study of experiences among rural and urban abortion providers in Canada identifies addressable challenges faced by rural physicians. Rural providers expressed a need for increased support from hospital administration and policy. Further challenges identified include a desire for continuing professional education opportunities, and for available replacement providers.
According to the researchers, there were fewer or no barriers to providing services in urban settings. In the smaller rural settings, physicians were limited by necessity to sharing resources with other physicians.
The barriers associated with this setting included lack of operating room time for abortions, a tendency to defer an abortion case for an “urgent” non-abortion case, and difficulties in logistically scheduling operating room staff (e.g., nurses and anesthesiologists) to accommodate staff who did not wish to participate in abortion care. Several rural physicians faced logistical challenges when scheduling patients for counseling (occurring at their private practice offices), timely ultrasounds and for procedures.
Rural physicians often felt overwhelmed by the lack of support and the demands placed upon them in serving a broad geographic area. There was also a sense of isolation as many kept their practices low-key out of concern for their family members should the community become aware of their work. Many also were the only physician to perform abortions, thus professionally isolating them as well. In contrast, urban providers were able to function in relative anonymity. In some instances, the low volume of demand left the physicians feeling unprepared to deal with possible complications.
Researchers were somewhat concerned about sampling bias as their research was limited primarily to physicians performing surgical abortions. Experiences of those who provided only medical abortions were not included in the study. The study only covered physicians in BC, but there is no reason to think that the experiences of rural doctors would vary considerable across the country.
While women in PEI may need to travel to Halifax or Fredericton for care, the distances within larger provinces are often much greater. Wherever they are from, there is no question that women with fewer financial resources are the ones who are most disadvantaged by these geographic restrictions. The study doesn’t suggest answers to these issues, but it does go a long way to identifying the problems that must be overcome.