It took a Supreme Court lawsuit in 2016 for Prince Edward Island to finally offer abortion services. Nova Scotia would do well to learn from PEI and finally remove unnecessary restrictions before they too find themselves in court.
Access to abortion in Nova Scotia is systemically obstructed by the provincial government, and although it has not received the same media attention as New Brunswick or PEI, health advocates have been demanding better access for decades.
For a time, Nova Scotia was the maritime province where an in-hospital abortion was most accessible, but since the 1988 Morgentaler decision, the province has retained two regressive policies that compound risks, create delays and place barriers on reproductive rights.
Nova Scotia has fallen embarrassingly behind the rest of Canada. The province now stands alone in requiring a doctor's referral and medical tests before a person can access abortion services. Since there is no medical justification for preventing self-referrals, the policy gives undue power to a third party over another person's bodily autonomy, and also creates unsustainable delays.
A Nova Scotian seeking abortion has to find a doctor who will see them in a timely manner, hope that the doctor isn't anti-choice, and then wait to have tests done. In a place with a serious doctor shortage, this is no small task.
Why then, nearly 30 years later, does Nova Scotia still require physicians to provide a referral for an abortion?
The physician referral policy may also be unconstitutional. R. v. Morgentaler struck down the law requiring referral from a doctor for a "therapeutic abortion." Therapeutic Abortion Committees, as they were called, interfered with a person's right to health and safety by causing egregious delays (and, in some cases, denials) for a time-sensitive medical procedure. Why then, nearly 30 years later, does Nova Scotia still require physicians to provide a referral for an abortion?
They could also learn a thing or two from New Brunswick. Until very recently, New Brunswick had also been operating with impunity, contrary to the Supreme Court decision and the Canada Health Act, by requiring two doctors to sign off on an abortion referral. While New Brunswick "volunteered" to end that policy after mounting pressure from activists, Nova Scotia's health minister claims that his government has never been made aware of any problem with this rule. This claim comes as a surprise for local sexual health advocates and reproductive rights activists who are clear about how these restrictions make abortion difficult to access in Nova Scotia.
But New Brunswick isn't perfect, either. Nova Scotia and New Brunswick continue to be the only two provinces that refuse to cover the cost of surgical abortions outside of hospitals. New Brunswick, however, has recently taken steps towards addressing the historical barriers through policy change and becoming the first province in Canada to pledge universal cost coverage for Mifegymiso (a combination of medications used to provide medical abortion). In Nova Scotia, provincial cost coverage could mean drastically reduced wait times and access in remote areas. The drug has the potential to address serious barriers, but not without support from provincial leaders.
The pressure to remove outdated rules that stand in the way of health care needs to continue. Nova Scotia needs to follow the lead of provinces and territories already covering Mifegymiso's $300 to $450 price tag and truly support health-care professionals in providing medical abortion in and out of hospitals settings. Then, Nova Scotia would be en route to universal health care.
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