By Sandeep Prasad and Colleen MacQuarrie*
Abortion is legal in Canada and has been for over 30 years. There are no criminal laws restricting access to abortion or post-abortion care in Canada and it is a recognized essential medical procedure, required to be fully accessible and financially covered by provincial and territorial health insurance plans under the Canada Health Act.
One would naturally assume that all people in Canada have access to a recognized essential medical procedure; however, this is far from the case. Only 16 per cent of Canadian hospitals offer abortions, with the majority of facilities located in urban areas and within 150 kilometres of the U.S. border. Most provinces only offer surgical abortion and in PEI, zero providers offer surgical abortion while those who offer medical abortion are far and few between and veiled in secrecy for fear of backlash.
A woman in PEI recently waited five hours in an emergency waiting room after being incorrectly instructed on how to administer a prescription for a medical abortion. She was eventually told by the attending physician that he was uncomfortable treating her and ultimately received no care at the hospital.
While physicians in Canada have the right to conscientiously object to providing a medical service on religious or moral grounds, they also have an obligation to guarantee a patient's human right to personal integrity, life, health and autonomy. In such a case, the physician is required to refer the patient to another provider who is willing to provide the service. Where a referral is not possible due to a lack of skilled providers in the area, or a patient's life or health is in danger, the physician has a duty to provide treatment.
In the recent P.E.I. case, the woman, who had been advised to seek ER medical attention by the province's emergency information telephone service and who had begun to experience cramps and bleeding while waiting, was told by the ER physician to go out-of-province, to Halifax, if she wanted to receive the necessary post-abortion care -- Halifax is over 300 km away, with a round-trip bus ticket costing over $100.00.
Disregarding the fact that individuals seeking abortion services in P.E.I. must for the most part travel out of province to access them, the situation is particularly disturbing because the physician refused to meet his professional obligation to use his skills, training and judgment to treat a patient in an emergency situation and in turn, unacceptably risked the patient's well-being. What is even more disturbing is that hospital officials and the Health Minister consider proper protocols to have been followed.
Physicians have an obligation to provide care. In cases where a physician refuses to provide care on moral or religious grounds or cannot provide care because of a lack of skill or training, the physician has a duty to refer the patient to a physician who will provide timely and effective care. Sending a patient out-of-province for emergency care is neither timely nor effective.
The case speaks to an urgent need to regulate a largely provincial-wide refusal to provide an essential medical procedure. And highlights the need for immediate action on local access to abortion care, including enhanced communications and navigation of systems for abortion care, a policy framework for medication-based abortions, and most importantly, local dedicated clinic days for those seeking abortion care. The PEI Abortion Rights Network has outlined these demands in detail in an open-letter to Premier Wade MacLauchland and Minister Currie.
Not only does the provincial-wide refusal to provide abortion services represent a violation of human rights, it creates a very dangerous and potentially life-threatening situation for those seeking abortion services in P.E.I. In communities without access to essential sexual health services, like abortion, patients (often young women) have to travel across or outside of their province to obtain what is a recognized essential medical procedure in Canada. This can be especially difficult for someone with limited access to resources and transportation or with responsibilities that limit their mobility like a family or inflexible working conditions.
Restricted access to abortion, compounded with physicians who do not fulfill their professional duty to provide patients with timely and effective referrals or necessary service in emergency cases, creates life-threatening situations that could otherwise be avoided. And while P.E.I. is the only province in Canada in which there are zero surgical abortion providers, access to abortion remains limited outside of urban settings and several cases across Canada have brought light to a number of physicians who are unwilling to provide care or referrals related to abortion as well as contraceptive methods.
In response, two provincial Colleges of Physicians and Surgeons have recently undergone policy reviews on conscientious objection. The new policy in Ontario and Saskatchewan's draft policy both require that physicians provide effective and timely referral and care that is urgent or otherwise necessary. Both policies address a physician's primary obligation to their patient's health and emphasize the issue of time, which is particularly relevant for patients seeking to terminate a pregnancy, given the time sensitive nature of the procedure. Most abortions are performed within the first 12 weeks of pregnancy. In Canada, medical abortion is only available until 7 weeks and few physicians are trained to provide abortion services after 12 weeks. Being forced to carry an unwanted pregnancy while waiting for a procedure can also have significant negative emotional and psychological health impacts on a person.
Despite the importance of timely referrals, many provinces and territories outside of Ontario and Saskatchewan follow an outdated Canadian Medical Association Code of Ethics, which does require a physician to inform patients when personal values would influence a recommendation or service but does not require a physician to provide timely referrals. The P.E.I. Medical Society refuses to offer guidance to its physicians.
Whatever the decision a person makes about their sexual health, it is that person's own choice. In making that decision, healthcare professionals and educators have an important supporting role to play in providing timely, effective, accurate, and science-based information as well as legally permissible and publically funded services that support the choice a person makes.
*Colleen MacQuarrie is an associate professor of psychology at the University of Prince Edward Island and spokesperson for the PEI Abortion Rights Network, a group of individuals and organizations working together to ensure that all women living in Prince Edward Island have access to publicly-funded, accessible, safe abortion services in their own province.MORE ON HUFFPOST:
REALITY: Over 99.75 percent of abortions do not cause major medical problems. Less than one-quarter of 1 percent of abortions performed in the United States lead to major health complications, according to a 2014 study from the University of California, San Francisco, that tracked 55,000 women for six weeks after their abortions. The researchers note that this makes an abortion statistically about as risky as a colonoscopy. If that fact seems surprising, consider how American pop culture misrepresents the risks of abortion: Nine percent of film and television characters who have abortions die as a direct result of the procedure, according to another 2014 study from UCSF.
REALITY: About one in five abortions are medical abortions. The Centers for Disease Control and Prevention found that 19 percent of abortions in 2011 were medical abortions and that 28.5 percent of those took place in the first nine weeks of pregnancy. The Guttmacher Institute also found that medical abortions increased substantially from 2008 to 2011, meaning more women have ended their pregnancies with this alternative to surgery.
REALITY: Most women will not regret their decision, and are no more likely to experience mental health problems than women who carry an unplanned pregnancy to term. While many women experience mixed emotions after an abortion, 95 percent of women who have abortions ultimately feel they have made the right decision, according to an August 2013 study from UCSF. "Experiencing negative emotions postabortion is different from believing that abortion was not the right decision," the researchers explained. Furthermore, while unplanned pregnancies often cause emotional stress, there is no evidence to suggest that women who choose to terminate their pregnancies will be more likely to suffer from mental health issues, according to a 2008 report from the American Psychological Association that investigated all relevant medical studies published since 1989. The APA found that past studies claiming abortion causes depression and other mental health problems consistently failed to account for other risk factors, particularly a woman's medical history. The APA accounted for these factors and found that, among women who have an unplanned pregnancy, those who have abortions are no more likely to experience mental health problems than those who carry the pregnancy to term.
REALITY: Fetuses cannot feel pain until at least the 24th week of pregnancy. Experts ranging from Britain’s Royal College of Obstetricians and Gynaecologists to the American Congress of Obstetricians and Gynecologists agree with that timeline. In fact, research from UCSF found that fetuses can't perceive pain before 29 or 30 weeks of development. Then why have so many states banned abortions after 20 weeks of pregnancy? Perhaps misrepresentation of research is partly to blame: Many of the researchers most frequently cited by pro-life politicians told The New York Times that their research does not prove anything about fetal pain.
REALITY: Most Americans support a woman's right to choose. According to a Gallup poll from 2014, 78 percent of Americans think abortion should be legal in some or all circumstances. (Fifty percent said "some circumstances," while 28 percent said all.) What's more, in 2012, Gallup found that 61 percent of Americans think abortions that take place during the first trimester of pregnancy should be legal. (Nine out of 10 abortions in the U.S. do take place during that time period, according to Guttmacher.)
REALITY: The abortion rate in the United States is the lowest it's been since 1973. The abortion rate has been on the decline for years, and hit its lowest level in 2011, according to the latest data available from the Guttmacher Institute. The study's author partially credited the decline to better contraceptive use and more long-term contraceptive options, such as the IUD.
REALITY: Women face a growing number of barriers to accessing abortions. More than 57 percent of American women live in states that are hostile or extremely hostile to abortion rights, according to the Guttmacher Institute. That represents a marked increase from 2000, when 31 percent of American women lived in such states. In 2011, 89 percent of counties in America had no abortion clinics. This is no accident: Across the U.S., lawmakers have enacted 231 new abortion restrictions over the past four years, according to a Guttmacher analysis from January 2015. As a result, many women have to travel great distances to reach an abortion clinic, where they may face 24-hour wait periods. These barriers particularly affect women living in rural areas and low-income women, who often can't afford to take time off work and pay for gas and a hotel room. Other laws force women to go through potentially distressing procedures, such as viewing their own ultrasound photos, in order to move forward with an abortion.
REALITY: Women rarely cite pressure from family or partners as leading to their decision to abort. A 2005 study from the Guttmacher Institute found that less than 1 percent of women surveyed cited such pressure among their main reasons for having an abortion. A 2013 study from UCSF reached a similar conclusion, and found that while women rarely cited partner coercion as a reason they sought an abortion, many did cite the desire to escape a bad relationship or domestic violence.
REALITY: Most women who have abortions are already mothers. Sixty-one percent of women who had abortions in 2008 were mothers, and 34 percent had two or more children, according to the Guttmacher Institute. That number only increased after the 2009 financial downturn. The National Abortion Federation told Slate that between 2008 and 2011, 72 percent of women seeking abortions were already mothers. A study from Guttmacher found that mothers typically have abortions to protect the children they already have; they simply cannot afford to raise another child.
REALITY: Requiring abortion clinics to meet these standards does little to improve patient safety and forces many to shut down. Currently, 22 states require abortion clinics to meet a set of restrictive and often arbitrary standards, dictating that they be close to hospitals and that their hallways and closets meet certain measurements. Clinics often need to undergo expensive renovations in order to comply, and leading doctors' groups say the laws do little to improve patient safety. What's more, 11 states now require that doctors at abortion clinics obtain admitting privileges at a nearby hospital, but many hospitals flat-out refuse to grant these privileges. As a result, hospitals essentially have the power to shut down nearby clinics.
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