New Brunswick’s only freestanding abortion clinic, which also provides health care to much of the province’s transgender population, is set to close.
Clinic 554 has previously relied on crowdsourced donations to stay open, and the staff sometimes forgoes payment from patients in order to provide services.
“We feel a tremendous amount of fear for our patients and the underserved communities we care for,” Clinic 554’s medical director, Dr. Adrian Edgar, said in an emotional statement posted to Facebook. “I thought I would be the family doctor for my patients until I or they died.”
But, because of New Brunswick’s refusal to cover abortions performed outside of a hospital, which advocates have said violates the Canada Health Act, Edgar said “it is financially unsustainable for us to keep our doors open, and the clinic has been placed for sale.”
He’s hoping the next federal government might intervene.
“I am sad, that during this federal election, our leaders have focused on whether or not they’ll ‘reopen the debate’ on abortion, rather than the real crisis at hand: access,” he said.
Clinic 554 is a family practice, but it also provides abortion services and other kinds of reproductive health care, including compassionate and affirming care to transgender people — something that isn’t always easy to find in New Brunswick, which has a shortage of doctors to begin with. In 2018, more than 75,000 people across N.B. and Nova Scotia were on wait-lists.
The provincial government covers the cost of the other services the clinic offers, but the demand for abortion and the high cost of the procedure for the clinic has made the situation untenable, Edgar explained in his statement.
“It has never been financially sustainable to provide barrier-free abortions at Clinic 554 without Medicare reimbursement from the province,” he said. “We remained open all these years through sheer perseverance and due to the charity of individuals from all across Canada.”
New Brunswick’s Health Minister Ted Flemming has not responded to HuffPost Canada’s request for comment. The Department of Health’s spokesperson, Bruce Macfarlane, said in an email that the province’s position on abortion “remains unchanged from that of the previous government.”
Abortions often cost between $700 and $850, according to Darrah Teitel, a campaigns officer at Action Canada for Sexual Health and Rights. (Action Canada was speaking on behalf of Edgar, who was seeing patients.) Procedures are covered by the province if they’re performed at a hospital.
Only three New Brunswick hospitals perform abortions, two in Moncton and one in Bathurst.
But as with other medical procedures in the province, there’s limited capacity. And given the time-sensitive nature of abortion, Teitel says, “ironically and hilariously,” those hospitals’ staff sometimes refer patients to Clinic 554.
Clinic 554 served the larger Atlantic Canada region, said Jessi Taylor of Reproductive Justice New Brunswick.
“Because it hosts a lot of specialized care and care for highly marginalized populations, people often travel to access the clinic,” she told HuffPost Canada. It’s “the only clinic between Newfoundland and Montreal, so if you need something like abortion services and for some reason hospital care is not accessible to you, we’re the only clinic that exists.”
There are many reasons people might opt for an abortion at a private clinic instead, Teitel said.
“Hospitals are often staffed, especially in smaller provinces, by people that are known” to the patient, she said. ″There’s the fear of being outed. There’s the fear of being judged. And then there’s the threat that you’ll encounter anti-choice gatekeepers who may refuse to refer you, or delay you from getting an abortion, or push you towards a crisis pregnancy centre.”
Crisis pregnancy centres present themselves as medical clinics, and sometimes offer ultrasounds or pregnancy tests, but rely on misleading or outdated information to dissuade women from getting abortions. There are many in New Brunswick, including one next door to Clinic 554.
In cases where patients desperately need abortions, can’t go to hospitals, and can’t cover the costs themselves, Teitel said Edgar won’t turn them away.
“The clinic doesn’t deny service to people if they don’t have the money,” she explained. “And that’s why they’re going under.”
Within 90 days of the clinic’s sale, Edgar explained, “our team will have nowhere to provide our services.”
Provincial responsibility?
New Brunswick’s Medical Services Payment Act says the government will not cover “entitled services furnished in a private hospital facility in the Province.”
Teitel says that regulation has been illegal since the Supreme Court of Canada struck down the existing abortion law in 1988, but that ”New Brunswick flagrantly refuses to get rid of it.”
The Abortion Rights Coalition of Canada and the National Abortion Federation have also said New Brunswick (along with Ontario) is violating federal law by not covering abortion services in private clinics. And last year, Health Canada also addressed concern over New Brunswick’s limits on abortion coverage.
“The lack of coverage for private clinic abortions under the New Brunswick provincial health care insurance plan remains a concern under the accessibility and comprehensiveness criteria of the Canada Health Act,” Health Canada wrote in its 2016-2017 annual report.
In his statement, Edgar said he and a team of volunteers have repeatedly tried to raise the issue with Flemming, to no avail. He would like to see the federal government step in to hold New Brunswick to the Canada Health Act.
Teitel echoed those concerns. “Why has this professedly pro-choice government never stepped in to intervene on behalf of the human rights of patients in New Brunswick?” she asked.
NDP leader Jagmeet Singh released a statement Thursday asking similar questions, and claiming that Justin Trudeau’s “refusal to enforce the Canada Health Act has led directly to the closure of New Brunswick’s only freestanding abortion clinic.”
Watch: Elizabeth May defends abortion rights during the English-language leaders’ debate. Story continues after video.
The long fight for survival
Clinic 554 has long been in a precarious financial situation. What was previously the Morgentaler Clinic announced its closure in 2014, again citing the lack of provincial funding as a major reason.
Over the next few months, Reproductive Justice New Brunswick, with the help of Fredericton Youth Feminists, crowdfunded more than $130,000 to reopen the Morgentaler Clinic as Clinic 554. The move got widespread attention from international press.
“You can see in the history of the clinic how much love and how much community support it has,” Taylor said. “However, it is absolutely egregious that anybody in Canada, with our universal health-care system, would have to crowdsource for their ability to have health care.”
Other services the clinic provides
In addition to providing abortions, Clinic 554 is one of the few areas in New Brunswick where transgender communities can access care.
“The fact that people come to the clinic is largely because it provides a stigma-free, barrier-free access to sexual and reproductive health services,” Teitel said. “For youth and for LGBT folks, especially inside of a more conservative province, it’s extremely hard for people to find the kind of care that doesn’t make them feel judged.”
That was the case for Sascha Gionet, a trans man who travels nearly two hours from Dieppe, NB, to the clinic in Fredericton. Finding an understanding doctor who could treat his Crohn’s disease and also understand how that treatment might interact with his hormone-replacement therapy was a difficult process, he said.
His previous endocrinologist brushed off his concerns about medical interactions, he said. But Edgar “is the total opposite of that,” Gionet explained. “He was already knowledgeable about my illness and the medications I was on, and did his own research to figure out the best course of action considering my situation.”
Some medical services can be exceedingly uncomfortable for trans people, Gionet said, such as being a trans man who needs to get a pap smear. But the clinic was one of few places he didn’t feel othered or condescended to.
“Little things, like the language used towards us and the way said procedures unfold, make a world of difference,” he said.
Monika Valentin, a trans woman who recently left New Brunswick for Montreal, feels similarly. Clinic 554 was known for being one of the few places trans people could be accepted and cared for, and she has trouble picturing what the landscape will look like for young trans people in the province.
“I’m not worried for myself, because I know I’m going to be OK,” she said. “I just worry for the younger people who are going to feel like they don’t have anywhere to go.”
Some people who have the time and the funds will be able to travel for their care, Taylor explained — when the clinic closed down in 2014, many women crossed the border into Maine for abortion services, she said. But many can’t do that.
“The current system that we have right now, our health policies are based around luck and privilege,” she said. “Luck and privilege are not a health-care policy.
“Luck and privilege is not justice.”
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