This article originally appeared on VICE Canada.
Kandace Hagen's strong, clear speech patterns break ever so briefly as her eyes well up with tears. She's just told me about being forced to travel from her home province of Prince Edward Island (PEI) to have an abortion, and about helping many others who come to her desperately trying to do the same.
Hagen is not a doctor. She's not a politician. She has not paid for the work that goes into helping uterus-bearing people obtain abortions. Hagen is an activist, and it's through her and a network of others like her that rural Islanders are able to access abortion services.
PEI is the only Canadian province in which abortion is technically not available—hospitals and clinics there do not provide surgical abortions. But in practice, if you know the right people, you can be put in touch with physicians who offer what Island women sometimes call a "chemical cocktail," or a medical abortion. The cocktail is made up of misoprostol and methotrexate. Administration of the cocktail can go awry, but for rural people (who constitute 53 percent of the population) with limited income, it can also be the only choice.
VICE Canada Reports: Abortion Access in the Maritimes
Some doctors and activists are campaigning for surgical abortions to be brought to the island, and they've been doing so for years. But the government is standing firmly against it. As it stands, Islanders wanting surgical abortions paid for by the province can get them only if they get a referral to Moncton, New Brunswick, or Halifax, Nova Scotia. They can also go to Fredericton's Clinic 554, but abortions there are not provincially funded. Patients there have to pay between $700 and $850 dollars, depending on how far along they are.
Ordinary people, like Chelsey Buchanan—a Halifax woman who's been offering lodgings and transportation for those traveling to her city for an abortion—feel compelled to ensure the service is accessible, since the government won't do it.
Hagen is one of those people. She acts as a go-between amongst those needing abortions and the physicians who will help them. Earlier this spring, she perched on the edge of a wharf in downtown Charlottetown to tell me her story. The Hillsborough River flows in from the Northumberland Strait and sparkles in the background. The Strait is uncharacteristically warm for the Maritimes, but right now, the water just looks mean.
Hagen became an activist after she had an abortion in 2009. She went to the doctor, announced she was pregnant and needed not to be, and was met with icy disapproval. She left the doctor's office with a Post-it in hand, the number to Fredericton's Morgentaler Clinic scrawled on one side.
She says she's lucky she was able to overcome the challenges that Islanders face in going out of province for the procedure: She had an understanding boss who gave her time off work, a friend who could drive her to Fredericton, and the extra money to pay for transportation, overnight accommodations, and the procedure itself. It cost her $1,200 total. For too many, however, that's not going to happen. The cost for a surgical abortion is so out of reach for some, according to Hagen, that pro-choice people and organizations are crowdsourcing the cost of abortions.
Now, people come to her when they need help accessing reproductive health care. One day, a stranger recognized her in a coffee shop, came up to her, plunked down at her table, and said flat out, "I need an abortion."
Another time, a friend came to her and told her that her physician told her to try to overdose on vitamin C in order to induce a miscarriage.
"She recommended that she keep taking them and taking them and taking them until she just started to bleed," Hagen says.
In true Maritime fashion, as Hagen says, "It's become [about] who you know in order to access basic health care."
Right before her eyes well up, Hagen tells me about another woman who came to her for help. Hagen told her she could go to either Halifax or Fredericton, but that there was also a doctor on the Island offering medical abortions. The woman eventually got in to see that physician, but the process didn't go well. The physician was abrupt, and when she got home, she didn't start to bleed within the given timeframe.
At this point, Hagen says she felt "medically responsible for her, because I had set her on this course." The patient called the doctor's office for help, but they wouldn't return her calls. Hagen was left to research online, trying to let the woman know if what was happening was normal.
Eventually, the woman started to bleed, but the drugs didn't work. She went back for a sonogram, hoping they would give her a dilation and curettage, which is offered on the Island for people who miscarry. They didn't. She waited two weeks, and when she heard back from the doctor's office, she found out she was still pregnant. The fetus's development had stopped, but the majority of it was still there. She had to take the medication again. She bled for days, and again, the doctor wouldn't answer her calls. She went to the office and was sent home after being told the doctor didn't have time to see her.
"She [went] through this for two months in total. By the end, the pain was excruciating. And then she felt this shift and this very intense cramp happening. She got up to go to the bathroom, but she didn't make it. She violently expelled everything that was in her uterus all over her kitchen floor."
After cleaning the bloody contents of her own uterus off of her floor, the woman messaged Kandace. Kandace cried—she felt like she had failed the woman she'd promised to help.
"And then I realized that the bigger problem wasn't that I had failed. It was that society keeps on letting women down, over and over."
Self-harm, Suicide Among Consequences of Lack of Access
Hagen is right. That story does not describe an isolated occurrence. Lower income people living in rural areas are routinely forced to orchestrate their abortions without much help from the medical community. A similar story to the one Kandace told me made headlines last month, when Courtney Cudmore was prescribed a medical abortion at a Charlottetown walk-in clinic. If she bled too much or not at all, she was instructed, she should seek medical help. When, a few days later, she went to the Queen Elizabeth Hospital in Charlottetown with her concerns, the doctor refused to examine her because he was "uncomfortable" with the situation. He said if she wanted, she could go to Halifax (a four-hour drive away) for more information.
Initially, the government said that was a perfectly fine response. But, after considerable media pressure, PEI premier Wade MacLauchlan now says the government has decided to do away with "cumbersome" processes that stand in the way of access. He says it's time to "eliminate the main barriers women have identified." Their idea of improved access, however, means sending women to Moncton for abortions instead of Fredericton or Halifax. They make it sound like this is good enough, but it's actually a deeply problematic "solution." People leaving the Island for the care they need are left to cover all associated costs, and leaving the Island isn't always possible in the winter, when the bridge can be snowed in and the roads treacherous.
The government's steadfast refusal to bring adequate reproductive health services to the Island persists despite a leaked report from Health PEI, which found that, if abortions were performed in the province as opposed to sending people off-Island, it would save the province $37,000 per year.
As it stands, many physicians and healthcare providers are openly anti-choice, and those who provide medical abortions must do so under the table. It's no surprise, really, given that you see more churches than human beings on PEI's roads, and 93 percent of the province's population identifies as Christian. As a result, Christian values are very much a part of PEI's cultural climate, and aborting unwanted fetuses is decidedly against those values.
As Donald Savoie, a professor of Canadian public policy and administration at the Université de Moncton, explained in a National Post article exploring the persistence of social conservatism in the Maritimes, there are a few reasons for this aspect of Maritime culture. It's a rural society in many ways, and "fundamental religion resonates more in rural areas than it does in urban areas traditionally."
"Church still matters a great deal in the Maritime provinces," he said. Because the population is aging at a faster rate than in other parts of the country and young people are fleeing for larger cities or out West, the population remains, in many ways, a 'closed society.'"
In order to access the care they needed, then, 153 people left the province to abort unwanted fetuses in 2013. There are no statistics on how many people had medical abortions, or otherwise induced abortions.
Surgical and medical abortions are not the only methods people use to abort unwanted fetuses, though. (I say "people" because it's not only women who have uteruses. Some trans and non-binary people do, too. Going forward, I'll say "women" when I mean women, and "people" when I mean uterus-bearers in general). Dr. Colleen MacQuarrie is an associate professor in the University of PEI's psychology department. She began a community-oriented research project in 2010 that set out to explore the impacts on Islanders facing a lack of access. The research spanned two decades, and the results showed the degree to which people would resort to self harm to try to induce an abortion when they felt desperate. The findings also showed who is most desperate: young, rural, low-income people.
MacQuarrie found people are routinely self-poisoning in order to expel unwanted fetuses, and inflicting harm on their entire bodies through such acts as throwing themselves down stairs. Her research also indicates that some people with unwanted pregnancies consider suicide because they don't know how else to deal with the situation.
"One 14-year-old girl punished her body every day for two weeks," MacQuarrie told me, her eyes welling up behind her purple cateye glasses. "She was not going to carry that pregnancy through. She knew that if her periods didn't come back, she would have to kill herself."
The bodily harm people engage in is twofold, she found: many use excessive substances to be able to get themselves to that point.
"The thing with falling down is you have to really fall good, and excessive alcohol and drug use is important to be able to relax the body enough to fall."
She says that, for Island women, the same obstacles that were in place 20 years ago still exist today. Those obstacles include no services on the Island, no support for women in crisis, and very little accessible information about traveling off-Island. In a Western, industrialized country in which abortion has been fully legal since 1988, MacQuarrie says that there is absolutely no need for this. But, again, the militant anti-choice camp has played a major role in the state of access today. Abortion, she explains, used to be available on the Island, if people accessed it from a facility with a therapeutic abortion committee. But due to overwhelming anti-choice influence, the last one was dissolved in 1986, and the procedure ceased to be available. Between 1986 and 1995, people from the Island had no publicly supported abortion option. That changed in 1995, when the government started paying for abortions at a hospital in Halifax. The government, though, didn't make that change clear to the public.
"It's the cruelest place that you would ever want to live to access basic healthcare. Basic," she says. "It's 2015, and it might as well be the 1700s in terms of how women get supported here. It's horrific."
But PEI is not the only province where tensions run high and access is scarce, and it's not the only province where people are driven to such drastic measures, either.
It's Not Just PEI
On a bright, windy Thursday in May, about 30 teenagers march out from behind a downtown coach house in Fredericton, New Brunswick. They've been summoned by a spy holding court on the front lawn of the legislature nearby. Wielding signs, a siren, and a bullhorn, the group begins to chant as they round the corner.
"What about our lives!" they yell.
As they make their way onto the lawn, the anti-abortion protesters run over, shaking fists and signs in their faces. A woman grabs one young feminist's face, screaming, "Your mother has given birth to you!" It's May 14, the day of the National March for Life. Fredericton Youth Feminists are crashing the protest to draw attention to the prohibitive lack of access faced by New Brunswickers needing abortions. They're the only ones there to speak up against hundreds of religious people and a stalwart pack of Tory MPs calling for all abortion access in the province to end.
They stage a die-in on the lawn in counter-protest. As one of the young feminists, Keighley Nunes, explains, the purpose of the die-in is to represent "uterus-bearing people who die from DIY abortions." Her colleague Sorcha Beirne tells me about some of the methods people are using to induce their abortions.
"A classic is coat hangers," she says. "People unravel coat hangers and insert them into their uterus." She's also heard of people beating their stomachs and throwing themselves down stairs. She adds knitting needles and chopsticks to the list, too.
"More commonly, now," she explains, "people buy pills off the internet that induce miscarriages. People don't stop having abortions. They just start having unsafe abortions."
Clearly, access to abortion services is out of reach for uterus-bearing people living in New Brunswick, too. In that province, one can go to Fredericton's Clinic 554 (the former Morgentaler Clinic, which was forced to close last summer due to lack of funding) and pay out of pocket for the procedure. But it will cost anywhere from $700 to $850, because New Brunswick is the only province that doesn't fund abortions in its clinics. In fact, activist group Reproductive Justice N.B. had to crowdsource the money required for the clinic to re-open in the first place.
Aside from the Fredericton clinic, two hospitals in Moncton and one in Bathurst also perform the service. At those locations, the procedure is provincially funded.
It may seem that four locations in a province the size of New Brunswick constitutes adequate provision. But in reality, New Brunswickers needing abortions face many of the same barriers as people in PEI. People living outside of those areas sometimes cannot afford to travel to their nearest provider.
Poverty is a real challenge in the province. As of 2008, women living in New Brunswick were second only to those from Newfoundland when it came to the country's lowest incomes for women: Their average total income was $24,600, which is just above the poverty line. Those who have to travel for the procedure still need to worry about accommodations, childcare if necessary, transportation, and travel costs. Obviously, the less money you have, the less likely you are to have your own vehicle, and about 48 percent of the province's population lives in a rural area poorly served by buses.
Religion is another challenge: 84 percent of residents identified as Christian in 2011. Religion has such a stronghold on the province, in fact, that it's partially responsible for the current lack of abortion access in Saint John. The CEO of New Brunswick's English-language hospital network admitted this, albeit tentatively, in an email to his colleagues in January. As he phrased it:
"SJ [Saint John] is a very significant Irish Catholic community and it was quite a surprise to me that the hospital physicians would even entertain the matter."
Another clear example of the religious climate exists within a so-called "Women's Care Center" nestled right beside Fredericton's Clinic 554. The two organizations are so close together they look like they're housed in the very same building. The former claims to offer counseling for all options available to women with unwanted pregnancies, but in reality, it's run by N.B. Right to Life, and the people who work there try to talk people out of having abortions.
I know this firsthand. In a new VICE documentary, I posed as an unintentionally pregnant 22-year-old student named Julie needing more information on abortion access. I struggled with this decision, because from an ethics standpoint, a journalist should only go undercover if it's seriously warranted—if there's no other way to get that information or perspective, and if it doesn't harm anyone in any way. In this case, I needed to see how pregnant people in crisis are treated at this "crisis center," and I decided that there was no other way to get that information.
When I arrived for my counseling session, I was paired with an older woman with long gray hair who floated every option but abortion. I told her I was a few weeks pregnant, that my partner and I had split up and that he had moved away, and that I was estranged from my parents. She said no matter how horrible my relationship with my parents was, they would change their minds and morph into loving grandparents once the baby was born. It would all be fine! She also said she didn't experience any pain when she gave birth (and that she hadn't had an epidural).
A choice quote from the counselor:
"Keeping your baby—most girls, deep down, that's what they want to do if they listen to their heart."
I left with a stack of very scientific pamphlets explaining that abortion causes death and breast cancer, and that my fetus was "dancing."
Because the Christian population is so large, and because older people are so vocal about this issue (and it's largely older people who vote), some politicians feel they have no choice but to pander to that crowd. Other politicians are explicitly anti-choice, speaking at pro-life rallies and clearly aligning themselves with the religious right. As a result, anti-abortion sentiment has been built right into the laws, despite abortion being fully legalized in this country for the past 27 years under the Morgentaler decision. In 1989, one year after the Morgentaler decision passed in the Supreme Court, Frank McKenna's Liberal government put regulation 84-20 of the Medical Services Payment Act into effect. That regulation stipulated that, for an abortion to be covered by Medicare, it had to be deemed "medically necessary" by two doctors, in writing, and then performed by a gynecologist at one of two hospitals authorized to conduct the procedure.
New Brunswick Premier Brian Gallant's Liberal government recently scrapped regulation 84-20. The government claimed that this would allow for more widespread access, but the service was extended to exactly one hospital in Moncton—a city in which the procedure was already available.
We reached out to physicians in the province, but none would speak with us out of concern for their safety—even under condition of anonymity. The concern is real: several Canadian abortion providers have been victims of shootings, arson, and other crimes in the past. And in the US, it happens even more frequently.
While some doctors are, understandably, afraid to speak out, others are committed to drawing attention to this issue. Dr. Robyn MacQuarrie, an OB/GYN with a practice based in Amherst, Nova Scotia, is one of them, and she puts it perfectly when she says politicians are "making women's bodies political fodder."
Despite Dangers, Government Response Remains Inadequate
Though circumstances preventing adequate access differ between the two provinces, the equation that makes for such difficulty is the same: Religion → government + Rural environment and low income = DIY abortions. Attitudes of religious conservatism, in other words, are the reality in the Maritimes, and they dominate much of the cultural climate. As a result, if you're a low-income person living in an isolated area and you have an unwanted pregnancy, the challenges you face may be insurmountable.
In both provinces, the onus lies on the government to do what's right by women and others needing abortions, but government officials won't even talk about the great need that demonstrably still exists. I called and emailed the premiers' offices in both provinces for a week straight, and was finally and flatly refused with barely a "no comment" from their respective press people. Given that both premiers are Liberal and the leader of their federal party says his MPs are required to vote pro-choice, it's interesting, if not exactly surprising, that they had absolutely nothing to say to me.
As Colleen MacQuarrie said, "our politicians are incredibly gutless, frankly." She said after Justin Trudeau made his pledge, she thought the situation might change for the better, but was ultimately let down.
"I had hope, but I was very disappointed during the last campaign when Trudeau was here with [Wade] MacLauchlan," she said. "With a straight face, they said the status quo is a good compromise."
"They have zero respect for the evidence that's been created that shows that barriers to access are harmful to women's health, and exactly how they're harmful," MacQuarrie said.
Provincial government officials offer up this nonresponse as federal politicians repeatedly push back a discussion about legalizing RU-486, or mifepristone, which is a pill that induces abortion in a safer way. (Health Canada has had the application to approve the drug since 2012, and it's already being used in 57 countries. It's maybe being delivered to Poland by drone as we speak).
While politicians are doing next to nothing, doctors do have some, albeit limited, power. Colleen MacQuarrie, for example, does her best to connect patients with medical abortions when she can. Some Island physicians are offering those medical abortions, and doctors in New Brunswick continue to perform surgical abortions despite what many of them feel is a dangerous climate.
Then you have Robyn MacQuarrie, whose practice is located at the foot of the Confederation Bridge. She's trying to bring surgical abortions to the Island. She says she'll perform them herself in clinics, and only at certain times if need be so that other services can continue uninterrupted. Despite her campaigning and the health department's own report stating that on-Island abortions will save the province money, she was effectively blocked by the government from carrying through with her plans. She's not backing down, though: The restrictions surrounding abortion already violate the Canada Health Act, and right now, she says, physicians are looking to see if there's room for a Charter complaint.
"It's the wrong service and there's no need for it," Robyn MacQuarrie (who is not related to Colleen) says in reference to the medical abortions happening on the Island.
In the meantime, the people making decisions about reproductive health are mostly men—both provinces' premiers and health ministers are men. These men will not provide access because it's not politically convenient, and could prevent them from getting voted back in come election time.
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