Each year on September 28, advocates around the world mobilize for access to safe and legal abortion. This year's theme is about busting abortion myths to fight stigma and discrimination.
Abortion stigma is fueled by myths. Myths that place safe, legal and accessible care and services out of reach for people worldwide and deny those who are weighing their options the evidence-based and judgment free information they need to make the choice that is right for them.
Abortion myths vary in size and scale but the biggest one in Canada? That abortion is easily accessible.
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. And so naturally, many of my friends and colleagues -- in Canada and abroad -- are often surprised to hear how many barriers actually exist.
The lack of access to safe abortion services is an ongoing obstacle and barrier for those who choose to terminate their pregnancies, particularly for individuals living in rural or remote areas. Only one in six hospitals provide abortion services in Canada, the majority of which, like free standing sexual health clinics, are disproportionately dispersed across Canada, and primarily located in urban centres. There are zero abortion services available in the province of P.E.I. and only four facilities that cover the one million km2 across Nunavut, the Yukon and the Northwest Territories.
The lack of services offered through clinics and hospitals in many regions of the country is compounded by other barriers related to the need to travel great distances or across provincial borders, wait times, age, financial resources, migration status and physician's invoking clauses of conscientious objection. Only Ontario and just recently Saskatchewan have adopted policies ensuring that doctors who refuse services to patients due to religious or personal beliefs have an obligation to refer to another capable doctor -- especially significant for abortion care, given the time-sensitive nature of the procedure and limited availability of service providers.
When abortion providers aren't available nearby, there are unforeseen expenses like transportation, accommodation, lost wages, childcare, eldercare and possible procedural costs (clinics are excluded from reciprocal billing agreements between provinces even though they assume a significant number of abortions in Canada). So, while abortion is technically available in Canada like any medically necessary procedure, there are a number of barriers that make access to abortion services uneven and inequitable, disproportionately affecting low income Canadians.
Some people who are seeking to terminate a pregnancy are also bombarded with anti-choice myths from services they trust. A recent University of Ottawa study found that Crisis Pregnancy Centers (with a record number in Ontario) provide medically inaccurate information, judgmental counselling and shaming that contribute to abortion stigma -- a significant barrier that is heightened for those from racialized or other marginalized communities.
So where does the government come in?
The right to health requires governments to ensure the availability, accessibility, acceptability and quality of comprehensive and integrated sexual and reproductive health information and services, including abortion, and to remove any barriers that impede access to such services. With the 2015 Federal elections in our midst, this moment represents an opportunity for our leaders to lay out their plans and commit to their promises. Some have already begun to point out the discrepancy in access across provinces and their willingness to enforce the Canada Health Act by withholding transfer payments to provinces violating the Act, but we need real action.
We need to see our federal leaders engage provincial and territorial governments in discussions to ensure that access to abortion services across Canada complies with international human rights law, especially Canada's obligations under the right to health.
We need our federal government to play a leadership role in ensuring access to medical abortion in rural and remote areas, training family physicians to provide the service and exploring appropriate task-shifting for the provision of medical abortion which would allow other health professionals to provide this service.
We need our federal government to establish a national protocol for individuals seeking later-term abortion services and coverage for travel fees incurred by those seeking to access the procedure at any stage.
We need our federal government to ensure that all people in Canada have access to this medically necessary procedure, regardless of immigration status.
And we need provinces to regulate the provision of reproductive health information and counselling to ensure that such publicly-available services do not stigmatize abortion and that they only provide accurate and evidence-based information.
In short, we need real, barrier-free access to abortion services for all people across Canada from coast-to-coast-to-coast.
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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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